RCEM Learning December 2024
16 snips
Dec 2, 2024 In this festive discussion, the hosts explore innovative surgical techniques for treating hemorrhagic strokes, including minimally invasive methods. They tackle the pressing issues of acute pain management in emergency settings, stressing the importance of a pain-vigilant culture and effective communication among healthcare professionals. The revival of the BestBETS project aims to enhance evidence-based practices in emergency medicine. Listeners are also invited to reflect on the past year while looking forward to 2025 and upcoming conferences.
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New Minimally Invasive Surgery Shows Promise
- Minimally invasive clot evacuation shows promising functional and mortality signals in a selective group with 30–80 ml hemorrhages treated within 24 hours.
- Beware study limits: highly selective recruitment, industry sponsorship, and unblinded care may bias outcomes.
Prognostication Drives Mortality Outcomes
- Mortality differences in neurosurgical trials can be driven by withdrawal of life-sustaining treatment, creating self-fulfilling prognostic bias.
- Unblinded trials risk differential intensity of care that may influence survival and functional endpoints.
Start Pain Care Before Triage
- Make pain a continuous priority starting at booking and triage, not an afterthought later in the ED journey.
- Embed pain vigilance into departmental culture so staff proactively identify and treat pain early.