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.
JC: TICH TICH BOOM? TXA in ICH. St Emlyn’s Read More
More oxygen is not necessarily better. This 2018 journal club examines a systematic review comparing liberal and conservative oxygen strategies in acutely ill adults. Simon Carley considers mortality findings, the size of the absolute effect and why even a meta-analysis needs careful critical appraisal.
JC: Oxygen in the Acutely Unwell Patient. St Emlyn’s Read More
How should clinicians balance bleeding and thrombosis when anticoagulation causes problems? This 2018 RCEM CPD discussion covers haemorrhage, reversal strategies, adverse reactions, treatment failure and monitoring. It emphasises individual risk, practical delivery of care and making complex pathways usable, reflecting the drugs and evidence available at the time.
Complications of anticoagulation and how to manage them. St Emlyn’s Read More
SALT-ED compared balanced crystalloids with saline in adults admitted from the emergency department to non-critical-care beds. This 2018 appraisal distinguishes the neutral primary outcome from the signal in kidney outcomes, examining pragmatic trial design, follow-up and the limits of applying one centre’s findings more widely.
JC: So long Salt and Saline? St Emlyn’s Read More
Did the SMART trial settle the debate about balanced fluids and saline in intensive care? This 2018 journal club examines its cluster-randomised design, small difference in a composite kidney outcome and interpretation of mortality findings. It asks how much weight clinicians should give the results.
JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s Read More
Can inhaling an alcohol swab ease nausea in the emergency department? This 2018 appraisal examines a small trial comparing isopropyl alcohol and oral ondansetron combinations. It considers symptom relief, difficulties with blinding and sampling limitations, explaining why the findings do not establish a replacement for established antiemetic treatment.
JC: More on alcohol sniffing and nausea. St.Emlyn’s Read More
Did hydrocortisone improve outcomes in septic shock in the ADRENAL trial? This 2018 appraisal examines the absence of a demonstrated 90-day mortality benefit alongside secondary findings on shock resolution and time in intensive care. It explores trial design, patient selection and the limits of subgroup interpretation.
JC: The End of the ‘Roid? ADRENAL Read More
Is paracetamol alone enough for pain after minor musculoskeletal injury? This 2017 review examines a randomised non-inferiority trial comparing paracetamol, diclofenac and their combination. It explores pain outcomes, trial design and exclusions, including why the findings cannot simply be extended to fractures or all painful injuries.
JC : Paracetamol, NSAID’s or both in MSK trauma. St.Emlyn’s Read More
