Looking for occlusion, not ST elevation, found twice as many blocked arteries within two hours

The edition in brief

Today's emergency and critical care edition closes on the occlusion myocardial infarction approach. In 4,398 patients without diagnostic ST elevation in the cluster-randomised DIFOCCULT-3 trial, occlusion-focused triage sent 45.4% for immediate invasive management against 13.6% under the STEMI/NSTEMI framework, and identified adjudicated acute coronary occlusion within two hours in 35.1% against 16.7%, without lowering angiographic yield. A Canadian technical update suggests intact umbilical cord milking may be considered for late preterm and term infants who remain non-vigorous after brief deferred clamping and stimulation, with possible reductions in moderate-to-severe HIE and need for cardiorespiratory support. An Intensive Care Medicine review sets out where beta-blockade has established benefit in critical illness and where evidence in septic shock, brain injury and acute heart failure remains conflicting. A three-hospital randomised trial of nurse communication facilitators for families of seriously ill ICU patients found no difference in family depression scores at six months. The pearl covers the posterior MI that a standard ECG hides.