Robert Lloyd reflects on three months working in South Africa and the effect of acute stress on his clinical performance. He describes how repeated practice, mental rehearsal, preparation, self-talk and breathing helped him cope, then considers how simulation might prepare others for pressure.
An Englishman in South Africa: Robert Lloyd at St.Emlyn’s Read More
Does hypertonic saline offer better outcomes than mannitol after traumatic brain injury? This 2016 appraisal explores the limited comparative evidence, distinguishes changes in intracranial pressure from outcomes that matter to patients and considers the uncertainty surrounding temporary treatment before definitive care.
JC: Salt or Sugar? Hypertonic saline for head injury at St.Emlyn’s. Read More
Small changes can make an emergency department visit feel less frightening for a child. Inspired by ICEM 2016, this reflection explores welcoming children, involving caregivers, using play, listening carefully and respecting dignity, with children’s rights at the centre of the encounter.
Making ED Visits Easier for Children Read More
Why did European and UK trauma guidelines published in 2016 recommend different approaches to resuscitating bleeding patients? Iain Beardsell compares their positions on crystalloids, blood products and vasopressors, reflecting on how disagreements between credible guidelines can challenge apparently settled clinical beliefs.
The European Guideline on Management of Major Bleeding – are you in or out? Read More
Could a single dose of dexamethasone be an alternative to a course of prednisolone for children with an asthma exacerbation? This 2016 appraisal examines a non-inferiority trial, including patient selection and blinding concerns, and places its findings alongside earlier studies.
JC: Why don’t we use dexamethasone for children’s asthma? Read More
How should clinicians balance missed acute coronary syndrome against the harms of unnecessary investigation? In notes accompanying his UMECS 2016 talk, Rick Body explores the limits of symptoms and clinical judgement, acceptable risk and the importance of including patients in chest-pain decisions.
Getting your chest pain evaluation right: #UMECS16 Read More
Why does a diagnosis seem to appear everywhere just after we learn about it? This exploration of the Baader–Meinhof phenomenon connects selective attention and confirmation bias with history-taking and investigation, asking clinicians to test alternative explanations and seek another perspective when needed.
The Illusion of Frequency. Baader-Meinhof storm St.Emlyn’s Read More
When might withdrawal of life-sustaining treatment be considered in the emergency department? Using hypothetical cases and the 2008 UK code of practice, this 2016 discussion explores uncertain prognosis, reversible causes, patient wishes and the need for senior colleagues and families to be involved.
