Welcome back to November's Papers of the Month! This month we're looking at three papers that all ask a deceptively simple question: how confident should we be in the decisions we make before we have the full picture?
First up, we've got a huge Australian cohort of patients whom paramedics thought had a STEMI. How many actually ended up with that diagnosis, what else was going on, and what happened to those with alternative diagnoses?
Then we're getting the pelvic binder out. We all know the guidance around suspected pelvic haemorrhage, but can the physiology and mechanism of injury tell us which fracture patterns are actually mechanically suited to a binder? This paper might challenge some assumptions – although we need to be very careful about what it does and doesn't prove.
And finally, we're looking at the blood pressure drop after intubation. Could a prophylactic push-dose of metaraminol make septic ICU intubations more haemodynamically stable? The results are interesting, but is an observational improvement enough to change practice?
As ever, we'll unpack the numbers, pick apart the methods and work out what's useful for our patients.
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob