This January 2019 update examines the November 2018 changes to the UK Green Book’s tetanus guidance. Chris Gray discusses wound classification, vaccination and immunoglobulin recommendations, then considers the evidence and unanswered questions behind those changes. It is a historical guideline discussion.
New Year, New Tetanus Guideline. St Emlyn’s Read More
This 2018 overview explores HIV in emergency medicine, from assessing exposure and recognising infection to caring for people receiving antiretroviral therapy. It also introduces post-exposure and pre-exposure prophylaxis. The discussion reflects the guidance available at publication and should be read in that historical context.
PEP, PrEP and all things HIV Read More
Why return to whole blood in major trauma? Zaf Qasim reviews the military experience, early civilian studies and practical challenges of introducing a whole-blood programme. This 2018 overview considers compatibility, storage and transfusion risks while acknowledging the limits of the evidence for civilian patients.
Whole Blood in Major Trauma – Everything old is new again Read More
What does ‘massive’ pulmonary embolism really tell us about a patient’s risk? In this case-based 2018 review, Dan Horner examines physiology, clot burden, clinical trajectory and bleeding risk, arguing for a fuller assessment and shared decisions rather than reliance on a single blood-pressure threshold.
Pulmonary Embolism – We call it massiiiiiiivve Read More
Fluids are drugs, with potential benefits and harms. Simon Carley examines a 2018 narrative review of intravenous fluids in critically ill adults, covering fluid choice, shock phases and evolving physiology. He also asks how to read expert reviews critically and remain open to evidence that challenges established practice.
JC: Intravenous fluid therapy in critically ill adults (review). St Emlyn’s Read More
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.
JC: Does Epinephrine work in Cardiac Arrest. St Emlyn’s Read More
Simon Carley shares highlights from the 2018 BASICS North West conference, spanning prehospital care, sepsis, stroke research and support for clinicians. The report ends with his torso trauma discussion, covering changing interventions, paediatric injuries, assessment of shock and the challenges of care across the patient journey.
Torso Trauma tips and the BASICS North West conference 2018. St Emlyn’s Read More
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.
JC: Fluid resuscitation in paediatric DKA. St Emlyn’s Read More
