Intermediate-risk pulmonary embolism matters because initial stability can hide right heart strain, biomarker rise, and early deterioration. This episode is strongest on what current evidence does not show: thrombectomy may shrink right ventricular enlargement without proving better survival or less rescue treatment.

The reason not to dismiss a celebration episode is that it gathers practical reminders on syncope ECG red flags, naloxone, sepsis, burns, and uncommon diagnoses such as Lemierre syndrome. Worth opening when a familiar presentation starts behaving oddly.

The action is simple but often missed: 20 minutes of cool running water for a recent burn, ideally within 3 hours, followed by a non-adherent dressing and gauze. Open this one for a fast reset on pain reduction, limiting tissue damage, and why full-thickness burns are not excluded.

Central line choice is a long-term access decision, not just a quick procedure. When both neck veins are suitable, left internal jugular access may preserve the right side for later haemodialysis, CRRT, or ECMO and reduce downstream dialysis catheter problems.

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Stable epistaxis is usually controlled stepwise rather than packed on arrival. Clear clots, use topical anaesthetic with vasoconstrictor and a clamp for 15 minutes, then cauterise a visible point. Early ENT input matters when posterior bleeding is suspected or balloon packing is required.

D-dimer is a rule-out test, not a shortcut to certainty. Use it only when pre-test probability is low, apply the higher YEARS threshold in very low-risk pulmonary embolism, and do not let a blood test delay imaging when dissection or embolism is likely.