#FOAMed

Preparing a critically ill patient for transfer brings challenges that can be less obvious at the bedside. In this third Sydney HEMS reflection, Natalie May explores sedation, ventilation, physiological preparation and contingency planning through lessons from interhospital retrievals.

Would your hospital’s major incident plan work with the staff and resources actually available? This 2017 conference companion explores usable action cards, familiar roles, scalable command structures and local training, with attention to regional networks and an all-hazards approach.

Can procalcitonin reliably guide antibiotic decisions in the emergency department? This 2017 review traces the biomarker’s evidence across adults, children and intensive care, explaining why different populations, study questions and uncertain effects on outcomes complicate apparently promising results.

Could a simple cold-water stimulation technique shorten the wait for an infant’s urine sample? This 2017 appraisal of Quick-Wee examines the randomised trial, collection success, uncertain contamination findings and the practical challenge of providing uninterrupted attention in a busy ED.

When clinical findings and test results conflict, how should we rethink a diagnosis? Natalie May uses a case and thought experiments to explore heuristics, cognitive bias and probability, showing why more tests alone cannot resolve uncertainty in emergency medicine.

Could vitamin C, thiamine and steroids transform sepsis care? This 2017 appraisal interrogates a striking before-and-after study, exploring confounding, retrospective data and the risks of adopting an unproven treatment before reliable evidence of benefit and harm is available.