When an emergency physician becomes a patient, familiar clinical encounters can take on a different meaning. This 2016 reflection on Rob Rogers’ publicly shared heart-attack experience considers wellbeing, the patient’s perspective and the lasting value of investing in other clinicians’ education.
Life and Learning from Rob Rogers on the other side of that ECG 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
Could a single high-sensitivity troponin I result help rule out acute coronary syndrome at presentation? This 2015 appraisal examines a diagnostic cohort study, distinguishing negative predictive value from sensitivity and asking how the findings fit with ECG interpretation, clinical risk and different patient populations.
JC: High sensitivity Troponin I on presentation. Is it enough to rule out ACS? St.Emlyn’s Read More
How much does describing chest pain as ‘typical’ tell us about the final diagnosis? Simon Carley reviews a 2015 observational study of clinician judgement, questioning the value of experience alone and examining how patient selection, specificity and the presentation of diagnostic performance affect interpretation.
JC: Are typical chest pain symptoms predictive of outcome? St.Emlyn’s Read More
How can emergency departments reduce delays for patients who need transfer for primary PCI? This 2015 account of Manchester’s DIDO-30 project examines early ECG recording, recognition and escalation, with practical ideas for improving pathways through staff feedback, shared responsibility and rehearsing the whole process.
Good times part 1: DIDO-30 for STEMI Read More
Could an automated blood test make the original MACS chest pain rule practical to use? This 2015 research update explains validation with a new heart-type fatty acid binding protein assay, how the rule was recalibrated and why testing its effects in clinical practice was the next step.
The MACS rule: a new user-friendly version Read More
Does more severe chest pain make a heart attack more likely? Rick Body describes a 2014 study of emergency department patients, showing the difference between a statistically significant association and a useful diagnostic test, and why mild discomfort alone cannot provide reassurance about the underlying cause.
Is severe chest pain more likely to be a heart attack? Read More
Rick Body examines NICE’s 2014 recommendations on high-sensitivity troponin testing for early exclusion of NSTEMI. The article and podcast explain the guidance’s limited assay-specific scope, the distinction between excluding infarction and deciding on discharge, and the practical challenge of fitting repeat testing into emergency department workflows.
New NICE high sensitivity troponin guidance: 3 hours and done? Read More
