#slo3

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St Emlyn's practical guide to ketamine use as a Trauma Team Leader, including analgesia, procedural sedation, delayed sequence induction, dosing and monitoring. #FOAMed

TTL tips 16: Ketamine in trauma patients.

[stemlyns]

How should we resuscitate patients with septic shock in the emergency department? It remains one of the most controversial questions in emergency medicine and critical care. For years, clinicians have debated whether early aggressive fluid resuscitation should remain the cornerstone of sepsis management, or whether earlier vasopressor use might offer a safer and more effective approach. Presented this week at Critical Care Reviews 2026 and simultaneously published in the New England Journal of Medicine, the ARISE-FLUIDS trial is one of the largest randomised studies to compare early vasopressors and restricted fluids against a more traditional fluid-based resuscitation strategy in septic shock. The results are important, thought-provoking and, perhaps surprisingly, reassuring for clinicians on both sides of the debate.

To squeeze or not to squeeze. The ARISE-FLUIDS trial

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Amazing video from the perimortem c-section session at Incrementum in 2025. #FOAMed @stemlyns Learn how to do it here

Perimortem C-section from Incrementum: how to do it

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A JC review of intra-arrest stellate ganglion block for refractory cardiac arrest. Could this novel technique improve ROSC rates? Critical appraisal of scoping review. @stemlyns #FOAMed

JC: Intra-arrest Stellate Ganglion Block

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Our review of a small Feasibility study on arterial line placement during ED cardiac arrest shows high success and improved ROSC. Is it time to rethink resuscitation monitoring?

Arterial Line Placement During Cardiac Arrest: The ED experience.

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Is Diastolic Blood Pressure the New Resuscitation Target

There is increasingly evidence that diastolic blood pressure (DBP) is a crucial resuscitation target in trauma and cardiac care. Based on a great article by Dan and Rich we look at how optimizing DBP may improve survival rates in emergency medicine.

This week I read a great article in the EMJ by Dan Horner and Rich Carden on new resuscitation targets. notably the use of diastolic blood pressure. DBP is the prime driver of coronary perfusion and thus successful resuscitation. Not only in cardiac arrest, but seemingly also in trauma. This blog (with their permission and review) outlines the main points from that article and links their…

Is Diastolic Blood Pressure the New Resuscitation Target

[stemlyns]

JC: Do physician led prehospital teams improve outcomes?

This article explores the impact of physician-led interprofessional pre-hospital teams on survival and mortality outcomes for critically ill and injured patients. The article suggests a benefit, but how robust is that finding?

Background Physicians in prehospital teams are an increasingly common sight in the UK and internationally (though notably rarely in the US). However, this has been controversial and widely debated as to whether it really makes a difference to patient outcomes. This week we have a systematic review and meta-analysis by Lavery et al. that evaluates whether physician-led interprofessional teams…

JC: Do physician led prehospital teams improve outcomes?

[stemlyns]

Optimal Timing for Life-Saving Procedures in Critical Care: Finding the Goldilocks Moment

"Time Critical: Information Light" decision-making is vital in emergency medicine, requiring action with minimal data. The "Goldilocks" principle guides clinicians to find the optimal timing for life-saving procedures #FOAMed @stemlyns

Time Critical: Information Light decision making. A few years ago we described the concept of being able to manage ‘Time Critical: Information Light’ , decision making as one of the key attributes of working in emergency medicine. We illustrated this with the diagram below that illustrates that the earlier you see a patient in their illness, the more uncertainty there is, and as a result the…

Optimal Timing for Life-Saving Procedures in Critical Care: Finding the Goldilocks Moment