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
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
Preparing a critically ill patient for transfer brings challenges that can be less obvious at the bedside. In this third Sydney HEMS reflection, Natalie May explores sedation, ventilation, physiological preparation and contingency planning through lessons from interhospital retrievals.
101 Reflective Lessons from a Year with Sydney HEMS. Part Three: Clinical Read More
Can procalcitonin reliably guide antibiotic decisions in the emergency department? This 2017 review traces the biomarker’s evidence across adults, children and intensive care, explaining why different populations, study questions and uncertain effects on outcomes complicate apparently promising results.
Are you PROcalcitonin? St.Emlyn’s goes bug-hunting. Read More
Could vitamin C, thiamine and steroids transform sepsis care? This 2017 appraisal interrogates a striking before-and-after study, exploring confounding, retrospective data and the risks of adopting an unproven treatment before reliable evidence of benefit and harm is available.
JC: Vitamin SCepTiC? Read More
How well do SOFA, qSOFA and SIRS predict outcomes in patients with suspected infection? This 2017 review examines a large intensive-care database study, highlighting missing data, sensitivity and specificity, and the limits of applying ICU findings to the emergency department.
JC: Are we getting cosy on the septic SOFA? St.Emlyn’s Read More
What changed when Sepsis-3 was introduced in 2016? This overview explains the shift towards organ dysfunction, the roles proposed for SOFA and qSOFA, and revised septic-shock definitions, while noting early concerns about applicability and performance across different clinical settings.
Holy Smokes! Batman, the SOFA and the Latest Sepsis Definitions Read More
What happens to circulation when we give intravenous fluid, and how can we tell whether it has helped? This 2015 physiology review connects Frank–Starling and Guyton models with fluid responsiveness, examining the limitations of routine observations and the role of cardiac output assessment.
Maestrini, Frank, Starling, Guyton…….and Fluids at St.Emlyn’s Read More
