COPD becomes easier to manage when treated as a phenotype, not one label. Spirometry confirms obstruction, but symptom burden, sputum production, CT change and falling activity level should guide inhalers, airway clearance, rehabilitation and smoking cessation.

This journal club sharpens emergency decision-making: a stable blunt traumatic pneumothorax may not need immediate drainage, underpowered trials do not prove no benefit, and intracerebral haemorrhage care worsens when blood pressure treatment overshoots. The bedside lesson is to protect physiology before reflex protocol use.

LVAD troubleshooting starts with physiology, not pump numbers alone. A new low-flow alarm with rising vasopressor need or high central venous pressure should trigger rapid assessment for right ventricular failure or tamponade, while blood pressure, rhythm, filling and echo often explain controller changes.

Suicide risk is not reduced by grandiosity. This psychiatric teaching point highlights that narcissistic and antisocial traits can coexist with severe self-harm risk, and that formulation should separate impulsivity, entitlement and planning rather than relying on loose labels such as the dark triad.

Lung transplant medicine rewards thinking by timing. Early graft dysfunction, later rejection and shifting opportunistic infection risk require a structured differential, while tacrolimus interactions, new hypoxaemia and falling lung function should prompt early transplant-team involvement rather than routine ward management.

Iron deficiency anaemia in children is often hiding in the diet history. Microcytosis, low ferritin, pica and poor growth should prompt questions about excess cow’s milk, selective eating and menstruation, with treatment focused on oral iron plus correcting the cause.