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I’m hopelessly obsessed with medical news. Yet I choose to gift it to you for free. Whilst I don’t accept cash, I do accept Optilube, M&S Food vouchers and firstborn naming rights. Heavy on the food vouchers(M&S can do no wrong)
👋 Happy Friday. Here’s what we got:
😨 SEPSIS: But Not as You Know It
💊 Ablations, DOACs and The Crippling Reality of FY2
🧠 QuickBits: Other Top Stories of The Week
If you want to read any previous editions of The Handover, you can on our website.
NATIONAL GUIDELINES UPDATE
😨 SEPSIS: But Not as You Know It
SEPSIS.
The NHS's boogeyman.
With more hospital posters than England flags in Clacton.
And a PR team better than Phil Foden.
It’s seemingly the scariest thing you could possibly encounter in clinical practice.
Sepsis is that disease you absolutely cannot miss.
You don’t get many other conditions with posters like this, do you?
And for all its celebrity, somehow NICE have managed to slip some major changes to the guidelines. And there’s been little mention of it to date🤔.
On the 19th November, the old 2016 Sepsis guidelines(NG51) were taken out back and shot 🪦
In its place, a trio of sepsis pathways, split by age and pregnancy status:
Suspected sepsis in people aged 16+(NG253)
Suspected sepsis in under-16s(NG254)
Suspected sepsis in pregnant or recently pregnant people(NG255)
Each follows the same structure as the OG guideline (recognition, early assessment, initial treatment, escalation, source control, monitoring, information/support and training) but tailored to each group.
Now. There were changes in all 3 groups, but the biggest changes occurred in the 16+ sepsis group(NG253). Here are the highlights:
1. Fluids Fluids Fluids
The Change: Standard fluid bags reduced from 500mL bolus to 250 mL bolus
The Why: Latest evidence couldn’t differentiate high vs low volumes, so the rationale is to prioritise individualisation and fluid-overload risk.
The Bag: Isotonic electrolyte crystalloids(Normal Saline/Hartmann's) remain the top choice.
2. Risk Control
The Change: NEWS2 is the spine of the adult pathway. It’s being used to evaluate the risk of death from sepsis
The Why: Latest evidence base shows NEWS2 >= 5 is associated with increased ICU admission and death + previous measures like mottled skin couldn’t really apply to POC.
The Who: This applies to over 16 in acute hospitals, acute mental health and ambulance settings.
3. Other Changes
Vasopressors approved: We all know vasopressors have been used for a while now, but the new guidelines formally approve their resistance in non-responsive hypotension.
Listen to the family: NG253 repeats taking family concerns seriously. Sometimes, mother does know best
Updates on those who are considered vulnerable.
New dedicated pathway for obstetrics groups, read here.
In short, sepsis guidance has grown up. It’s no longer one monolithic poster in A&E. It’s a classy, thoughtful, tailor-made portfolio.
Now go forth. Give fewer fluids. Trust the NEWS2.
And sound nerdier, smarter in your mock A-E’s. Read for yourself here
POWERED BY DOCTORS.NET.UK
💍 I Hearby Pronounce You… Doctor and Email
At 11, you made your first real connection.
She was goofy. Loyal. A little embarrassing.
But you loved her anyway.
And at the time, [email protected] felt like a forever thing.
By 16, you realised… it wasn’t.
Then came uni.
She was older. Respected. From the prestigious .ac.uk lineage.
But on your final day, she pulled a Leonardo DiCaprio and dumped you for a fresher.
Next… the @nhs.net era.
Every rotation, a new address. Messy. Endless awkward breakups.
You’ve had skidmarks last longer 😒
You're a great clinician.
You deserve better than flaky, forgettable inbox flings.
You deserve an email that’s loyal, professional, and safe to bring home to your portfolio.
Can I do some matchmaking? Introducing the one:
@doctors.org.uk — free with your Doctors.net.uk account.
Your email for life, even as a medical student!
No lost contacts. No awkward updates. No explaining why you’re now @randomtrust.nhs.uk.
Plus, you’ll also get access to the UK’s largest GMC-verified doctor community, including:
Daily clinical news and research (no paywalls)
A doctors-only chat that’s basically Reddit with qualifications
The Navigating Speciality Training playbook: No gatekeeping here!
Guidance for the stuff med school skips, but the GMC expects
Dr Ollie Burton says so too!
Over 270,000 doctors already have theirs.
Ditch your exes and commit to something better.
Join Doctors.net.uk today and claim your free @doctors.org.uk email address below 👇
RESEARCH UPDATE
💊 Ablations, DOACs and The Harrowing Reality of FY2
It’s 7:57 am.
You’ve been in ED for 12 hours straight.
You’re on the brink of hallucinating, Lewy-body style.
Just one more patient...
“Doc, my heart feels like it’s racing! Help!”
No problemo. You slap on ECG leads, praying it’s just a splash of anxiety …
Nope. It’s AFib
“A fib? I’m not lying, Doc, I swear!”
After explaining their atria are tweaking tf out (AF AF), you give the usual meds. Then book a catheter ablation. Zap away the dodgy pathways—problem (hopefully) solved.
They leave.
You go home and cry 💪
Fast forward 4 months.
You’ve escaped the ED. Now you're deep in GP misery. 🕺
Guess who walks in? Your anticoagulated, freshly-ablated AFib buddy.
They want to know if they can quit their DOAC post-op.
“Don’t like the blood thinner doc, can I quit it?”
Fair question. After all, they’ve had their AF zapped. No more funny rhythms, right?
Traditionally, we keep patients on anticoagulation based on their CHA₂DS₂-VASc score. If you're at risk, you stay on the meds, ablation or not. But that approach assumes your AF is still lurking.
What if ablation actually fixes the problem? Could aspirin do the job instead?
That’s exactly what the OCEAN trial set out to test.
1,284 patients who’d had a successful AF ablation a year earlier were randomised to EITHER rivaroxaban 15 mg OR aspirin 70-120 mg.
They were tracked over 3 years, with a cheeky double MRI brain (@baseline and 3 years) thrown in for good measure.
The primary outcome was a composite of stroke, systemic embolism, or new covert embolic stroke ≥15 mm on MRI.
Well…wtf did they find?
Primary events (the above): 5 in rivaroxaban vs 9 in aspirin. Relative risk 0.56 (95% CI 0.19–1.65). P = 0.28 → not statistically significant.
Bleeding: major/fatal bleeding was low overall, but clinically relevant non-major bleeding was higher with rivaroxaban (5.5% vs 1.6%). Minor bleeds also up on the DOAC (surprise surprise).
TLDR: no significant stroke-preventing advantage of DOACs over aspirin, yet they increase bleeding risks.
Of course, it wasn’t perfect:
Unblinded treatment allocation → patients and treating clinicians knew exactly what was going on
Super select population → all patients were at moderate stroke risk (mean CHA₂DS₂-VASc ~2.2) and had minimal cardiac disease + few prior strokes.
You explain everything. Confidence rising as you flawlessly drop the latest NEJM findings.
The patient thanks you, clearly impressed. You feel like a Good Doctor™.
You finish the rest of your list with something dangerously close to a smile.
Just as you're about to head home, your supervisor stops you
"I heard about the AF patient consultation."
Your chest puffs out slightly. You’re ready for the praise. The recognition.
"You took 23 minutes. You should be seeing two patients in that time. Report to your educational supervisor first thing tomorrow for a development concerns meeting."
You go home and cry.
Again.
QUICKBIT: OTHER NEWS YOU SHOULD KNOW
It’s not just sepsis with an update this week. NICE has issued additional guidance regarding tranexamic acid(TXA) in the surgical setting. Before, the antifibrinolytic was only advised in adults losing more than 500mL of blood in surgery. But actually, usage was variable. Guideline update allows TXA to be offered to anyone having surgery, with any risk of bleeding. Good stuff!
No, it cannot. But this study published in the European Heart Journal, did find an association between increasing troponin levels in your middle age and dementia. Using troponin as a proxy for subclinical myocardial injury, they found that each time troponin doubled, dementia risk increased by 10%. Fascinating, except for the fact that it’s a prospective study, so correlation =/= causation.
No, it’s not Uber-for-doctors. But this BMJ investigation did uncover thousands of NHS doctors(mostly international grads) stuck on insecure contracts with no training, no progression, and no real protections. Cheap for trusts, bleak for doctors. A good read if you have the time.
Our med tech fanatics don’t get as much love as they deserve. Some quick fan service, here is a microbot that’ll have interventional radiologists sweating(cursed clankers!!). This clot-busting bot follows thrombolysis, breaks down the clot, and then dissolves itself like Master Oogwey. Watch it do its thing here.
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Fun Fact: The antidote for Heparin, Protamine is derived from salmon sperm. Due to risk of seafood anaphylaxis, anaesthetists inject a tiny amount, wait to see the reaction, before injecting the full dose.
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