The 2015 SPLIT trial compared saline with Plasma-Lyte in intensive care patients. This appraisal explains its crossover design and kidney-injury outcomes, then considers statistical power, fluid given before ICU admission and the limits of applying the results to emergency department patients or other balanced solutions.
SPLIT trial published. Saline or Plasmalyte on the ICU? St.Emlyn’s Read More
What does a raised lactate actually tell us? This 2015 physiology discussion revisits lactate production and clearance, then explores hypoxia, the stress response and interpretation in sepsis and trauma. It questions the leap from a marker of illness severity to a treatment endpoint.
How did sepsis guidance respond to ProMISe, ProCESS and ARISE? This 2015 commentary examines changes to the Surviving Sepsis Campaign care bundles, particularly the shift away from mandatory central venous targets, and considers the resulting choices around assessing circulation and response to treatment.
Sepsis 2015: EGDT without the “G”? Read More
The 2015 ProMISe trial compared early goal-directed therapy with usual care for patients with septic shock in UK hospitals. This appraisal examines mortality, treatment overlap and patient selection, asking what the findings added to ARISE and ProCESS and which questions about individualised care remained unresolved.
The ProMISe Study: EGDT RIP? Read More
A 2014 journal club examines falling severe-sepsis mortality across Australian and New Zealand intensive care units between 2000 and 2012. It asks what improving outcomes might tell us about the whole package of care, while distinguishing historical comparisons from evidence for any single treatment.
JC: What has an awesome NNT of 5.8 for severe sepsis? St.Emlyn’s Read More
An initial response to the 2014 ProCESS trial of protocolised sepsis care. The post asks how changing background care, differences between patient populations and widespread adoption of resuscitation principles might affect the interpretation of a trial that challenged early goal-directed therapy.
JC: Is Early Goal Directed Therapy dead? St.Emlyn’s Read More
To explore the discomfort of arterial blood gas sampling, an emergency clinician volunteers to have the procedure filmed without local anaesthetic. This personal account accompanies a video made for NHS Change Day 2014, supporting a pledge to pay closer attention to procedural pain.
Self Experimentation in Medical Education – LA for ABGs Read More
A 2013 journal club examines a randomised trial comparing GlideScope video laryngoscopy with direct laryngoscopy in trauma patients. It considers survival, uncertainty around a small head-injury subgroup and whether results from a specialist trauma centre apply across emergency medicine.
JC: Video Layngoscopy – Did Video kill the Laryngoscope star? Read More
