Prompted by NICE guidance published in 2012, this discussion asks how emergency departments can improve care for people with painful sickle cell crises. It explores stigma, trust in patients' accounts of pain, individual care plans and collaboration across the emergency and haematology teams.
Should superficial venous thrombosis be observed or treated with anticoagulation? This 2012 discussion considers what ultrasound adds, unpacks the composite outcome in CALISTO and weighs treatment benefits against bleeding and burden, emphasising the importance of explaining uncertainty when making decisions with patients.
Should patients in below-knee plaster casts receive heparin to prevent venous thromboembolism? This 2012 reflection examines a published evidence review, contrasting the frequency of detected DVT with rarer serious outcomes and asking how treatment harms and individual risk should influence practice.
How did NICE's 2012 DVT guidance balance diagnostic certainty with the services available? Simon Carley discusses Wells scoring, D-dimer testing and ultrasound, focusing on the distinction between proximal and calf thrombosis and the uncertainty surrounding repeat scanning and anticoagulation.
Why can a cheap, straightforward treatment struggle for attention alongside more dramatic interventions? Reflecting on tranexamic acid after CRASH-2 in 2012, Simon Carley questions the appeal of expensive or technically demanding therapies and asks how clinicians can close the gap between evidence and routine practice.
Practical perspectives on trauma care and team leadership.
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