Journal Club

Which advanced airway strategy should come first in out-of-hospital cardiac arrest? This 2018 review compares AIRWAYS-2 and PART, examining supraglottic devices and tracheal intubation. It considers trial outcomes alongside operator experience, training and the practical realities of prehospital resuscitation.

Psychologist Esther Murray joins the St Emlyn’s podcast to explore moral injury in emergency and prehospital care. The accompanying notes discuss research into medical students’ prehospital experiences and the psychological impact of witnessing traumatic events, while recognising the limits of the small study that prompted the conversation.

The 2018 PARAMEDIC-2 trial challenged assumptions about adrenaline in cardiac arrest. Simon Carley examines the distinction between improved survival and favourable neurological outcomes, the trial’s patient selection and the competing arguments about practice, stressing why the results need more than a simple yes-or-no interpretation.

Does tamsulosin help patients with renal colic pass their stone? Simon Carley reviews a 2018 randomised trial in adults with CT-confirmed stones under 9 mm, examining patient-reported passage, follow-up imaging and subgroup uncertainty. He considers why the findings challenged routine medical expulsive therapy in this ED population.

Does the speed or composition of intravenous rehydration affect neurological outcomes in children with DKA? This review examines the 2018 PECARN trial, its four fluid regimens and the limits of its findings. Simon Carley explains why challenging established assumptions does not remove the need for careful fluid management.

Does tranexamic acid improve recovery after spontaneous intracerebral haemorrhage? This 2018 appraisal of TICH-2 examines death and dependence, haematoma expansion and the uncertainty around the results. It explores why a possible effect on bleeding does not necessarily establish a meaningful improvement in patients’ longer-term outcomes.