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Day two of the 2019 Intensive Care Society State of the Art meeting explores fluids, blood-pressure targets and vasoactive treatment, alongside sustainability and staff wellbeing. Later sessions consider trauma systems, bleeding control, chest injury and the needs of older patients with major trauma.

What does cardiac movement on ultrasound mean when no pulse can be felt? This 2019 review explores pseudo-PEA, its distinction from cardiac standstill and reported outcomes, while highlighting the limited evidence for proposed treatment changes and the need for further research.

Day-one highlights from the 2019 Intensive Care Society State of the Art meeting in Birmingham. Topics include personalised critical care, organ donation conversations, cardiac arrest research, skin and eye emergencies, and the difficult assessment of patients with decompensated liver disease.

How do T-MACS, HEART, TIMI and EDACS compare with a troponin-only strategy for suspected cardiac chest pain? This review examines a multicentre study using one high-sensitivity troponin I assay, balancing diagnostic sensitivity and rule-out efficiency against missing data and limits to generalisability.

The October 2019 podcast roundup, accompanied by links to that month's reading. The notes point to CRASH-3 and tranexamic acid in head injury, lower-limb thromboprophylaxis, and reports from the RCEM, European Resuscitation Council and Tactical Trauma conferences.

Can clinical probability guide D-dimer thresholds and reduce imaging for suspected pulmonary embolism? Dan Horner appraises the PEGeD management study, examining follow-up outcomes, assay units, possible selection bias and the limited evidence for moderate-risk patients, with a perspective on applying the findings in different settings.