Could etomidate offer an alternative for short paediatric procedures? This 2012 appraisal examines a small prospective cohort, questioning patient selection, the absence of a comparison group and the variability in sedation depth and recovery time behind apparently high procedural success.
Etomidate for Paediatric Sedation Read More
Are we diagnosing disease, or deciding when a probability is high enough to act? The opening Risky Business article uses myocardial infarction and pulmonary embolism to explore uncertainty, treatment harms and why stopping investigation is different from proving that disease is absent.
Emergency Medicine, a risky business part 1. You are not a diagnostician. Read More
What changed when UK paracetamol-overdose guidance was revised in 2012? This historical review discusses the move to a single treatment line, changes to acetylcysteine administration and the implications for admissions, treatment complications and reducing errors in a familiar emergency presentation.
Paracetamol 2012: less means more Read More
Does patient-controlled analgesia improve pain relief in the emergency department? This 2012 appraisal examines a randomised trial in acute abdominal pain, considering blinding, exclusions, the comparison treatment and how pain was measured, with additional explanations of area under the curve and block randomisation.
JC: Patient Controlled Analgesia in the ED Read More
Persistent swelling after a shearing injury may be more than a simple haematoma. This 2012 overview introduces Morel-Lavallée lesions, their sometimes delayed presentation and the role of ultrasound, then discusses treatment options and the uncertainty surrounding how best to manage them.
Morel-Lavallee – Mushrooms in the valley Read More
How do you act on an ECG suggesting STEMI when the rest of the presentation does not fit? This hypothetical cardiology case from 2012 combines altered consciousness, abdominal findings and no chest pain to explore competing diagnoses, bleeding risk and the urgency of reperfusion.
When was the last time fundoscopy changed your management? Prompted by missed retinal findings in severe hypertension, Simon Carley reflects on declining confidence with direct ophthalmoscopy, alternative ways of examining the fundus and the value of practising and teaching basic clinical skills.
Clinical skills – Does anyone use Ophthalmoscopes anymore? Read More
What matters more in a fluid trial: haemodynamic targets or outcomes that matter to patients? This 2012 appraisal of CRYSTMAS examines hydroxyethyl starch versus saline in severe sepsis, questioning the analysis population, clinical relevance of the primary outcome and interpretation of mortality findings.
JC All I want for CRYSTMAS in ITU land…, are some more potatoes, and a drink! Read More
