Serum lactate levels are frequently measured in patients with undifferentiated conditions in emergency departments. This article uses a case-based reflection to critically analyse the role of lactate measurement in these patients. It examines the rationale for testing, and the potential causes of raised levels, to remind clinicians that this diagnostic intervention must be taken in the context of patients’ clinical presentations and not in isolation.

Arterial and venous blood gases are commonly performed operations in emergency departments. This case-based critical reflection examines the contemporary literature relating to the topic. An evidence-based approach to selecting the most appropriate test for each patient is discussed, aiming to minimise the need for unnecessary arterial sampling.

Acute heart failure (AHF) is a leading cause of hospital admission in the UK and is associated with significant mortality. The National Institute for Health and Care Excellence (2014) has published guidelines for the management of AHF but, after a clinical event in which a patient’s management differed from that recommended in the guidelines occurred in the author’s emergency department, he conducted a critical analysis of them. This article provides a case study of the clinical event, reviews the treatment methods adopted and explores the rationale for taking a different approach from that recommended in the guidelines. The evidence base for the use of diuretics, nitrates and non-invasive ventilation in the management of patients with AHF is also appraised.

The Midlands regional trauma network was established in March 2012 to improve and standardise the care offered to patients with major trauma. This article discusses the results of a survey of formal training in, and self-assessed knowledge of, trauma management among emergency department nurses working in the network. Less than one third of the nurses had received formal training against which standards can be benchmarked, and the article recommends that nurse education standards are reinstated as key performance indicators in the region.

In the management of critically ill patients in emergency departments, rapid sequence induction (RSI) of anaesthesia is often required. This article examines the elements of RSI that are necessary before before endotracheal tube placement and reviews the findings of a national audit project, conducted by Royal College of Anaesthetists and Difficult Airway Society. It also considers the role of nurses in RSI procedures.

The information technology systems used in most modern emergency departments alert staff to patients who require special management, including those with infections or histories of violence, or children on the child protection register. These systems can improve care for patients, protect staff and prevent infection, although their benefits must be weighed against the risks involved in storing sensitive data on computers. It is essential, therefore, that such systems are professionally maintained and updated. This article reports how one UK emergency department uses a computerised alert system to improve patient care.

Prompt treatment of patients with cardiorespiratory arrest can mean the difference between life and death. This article analyses the use of therapeutic hypothermia and aims to educate practitioners about its advantages and disadvantages as an immediate treatment.