The St.Emlyn's Podcast: Recent Episodes
St Emlyn's Blog and Podcast
A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlym's team are all passionate educators and clinicians who strive to bring you the best evidence based education.
What does it really mean to become an expert in resuscitation and critical care?
It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think.
Sara explains how experts develop high-quality mental models that allow them to organise information, recognise patterns and approach difficult clinical problems. Crucially, these mental models do not have to remain hidden inside the heads of experienced clinicians: they can be identified, explained and deliberately taught.
The conversation moves from the limitations of mnemonics and assessment-driven education to the value of deliberate practice, feedback and safe failure. Sara describes how an expert might organise the differential diagnosis of cardiac arrest into respiratory, haemodynamic and metabolic problems, rather than relying solely on a memorised list of Hs and Ts.
Iain and Sara then discuss Rapid Sequence, the gamified clinical-learning platform Sara created with emergency physician Ryan Ernst. Learners work through realistic cases in a simulated clinical environment, managing several patients while dealing with interruptions, competing priorities and the consequences of their decisions.
After each block, Sara and Ryan deconstruct the cases, make their clinical reasoning explicit and introduce mental models that learners can immediately apply when they try again. It is a cycle of practice, failure, teaching and repetition—without putting a real patient at risk.
They also explore why attention, storytelling and visual design matter in medical education; how “multitasking” may be better understood as rapid task switching; and what Sara has learned from turning an educational passion project into a working product.
In this episode* Why expertise is about cognitive strategies and mental models—not simply knowledge * Why experts are made rather than born * The limitations of the “10,000-hour rule” * How deliberate practice differs from repetition * When learners are ready to be taught expert ways of thinking * Foundational knowledge versus clinically useful organisation * Moving beyond mnemonics such as the Hs and Ts * How experts can make their implicit reasoning explicit * Why acquiring a new mental model can produce a sudden leap in performance * The importance of inspiration—and giving learners an achievable pathway * How Rapid Sequence creates a safe place to make mistakes * Managing several patients, interruptions and cognitive load * Teaching shock, respiratory failure and acid–base physiology * Why engaging design is part of the educational method * The role of games alongside podcasts, lectures and clinical experience * Reframing multitasking as rapid task switching * The “pause and bookmark” technique for managing interruptions * The realities of building an independent medical-education project * Why partnership, persistence and a genuine belief in the project matter
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley catch up on the February blog posts, recorded in the rather unseasonal context of a UK heatwave. They begin with congratulations to Simon on his reappointment as Dean of the Royal College of Emergency Medicine, before reflecting on recent conferences including IFEM in Hamburg and Don’t Forget The Bubbles in Glasgow.
The clinical focus this month is trauma team leadership, with practical tips on interpreting trauma CT reports, maintaining momentum after the scan, performing safer log rolls, and making feedback more useful for learners and colleagues.
Key learning points* Look at trauma CT images yourself as part of your own clinical learning and to integrate the scan with your examination findings. * Treat the first CT report as a primary survey, not necessarily a definitive final report. * Speak to the radiologist and share clinical concerns or uncertainties. * Do not lose momentum after CT; this is a vulnerable phase in trauma care. * Log rolls should have a purpose and should minimise movement, pain and physiological risk. * Use clearer team communication: “Is anybody not ready to move?” and “ready, steady, move.” * Feedback sticks when it is specific. Add “because” to positive feedback so the learner knows exactly what to repeat. * Leadership and followership skills apply everywhere, not just in formal trauma team leader roles.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
In this episode of the St Emlyn’s Podcast, Iain Beardsell speaks with Anna Dobbie, consultant in emergency medicine and pre-hospital care, and Clinical Lead for London HEMS.
Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work.
The discussion also touches on the unique nature of pre-hospital care, where teams move rapidly between downtime and high-intensity clinical decision-making, and where trust, openness and mutual respect are essential. Anna describes the importance of making sure all voices are heard, not just the loudest, and explains why leaders need to be consistent, approachable and willing to have honest conversations when things do not go as well as they should.
Anna also reflects on learning leadership on the job, the value of formal leadership training, the challenge of maintaining boundaries when you care deeply about a service, and the relationship between London’s Air Ambulance and its supporting charity.
Finally, Iain and Anna look ahead to the future of trauma care and pre-hospital medicine, including research, ECMO, marginal gains, quality improvement, and the continuing ambition to reduce preventable deaths from trauma.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
Trauma 2030
TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.
In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift.
We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved.
We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before.
There’s a discussion about trauma units. Not the big centres. The places where most patients go. Fewer resources. Different pressures. The same expectations.
We talk about spinal cord injury and blood pressure targets. Numbers are useful. But they’re still just numbers.
And then corridor care. Not a new problem. But one we may have started to accept in ways that should make us uneasy.
We discuss:
• What the RSI trial actually showed — and what it didn’t
• Why secondary outcomes should make you pause, not pivot practice
• How and when to activate a massive haemorrhage protocol
• Why early senior decision-making matters more than perfect diagnosis
• What good trauma handover looks like — and why it often doesn’t happen
• How trauma teams function differently in trauma units
• The limits of blood pressure targets in spinal cord injury
• Why corridor care is not just operational — but ethical
This is not a guideline episode. It’s a conversation about practice. About judgement. About the small decisions that shape outcomes long before the data catches up.
If you’re listening after a shift, you’ll recognise most of it.
If podcasts are part of how you learn, you can log your listening, reflect, and build CPD through MedPod Learn. It works across podcasts, not just this one.
As always, thanks for listening.
these ideas are tested in practice.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
Shock is one of the most used words in emergency medicine. It’s also one of the most misunderstood.
In this episode, recorded at Trauma 2030 at the Royal College of Surgeons, I sit down with one of St Emlyn's own, Rich Carden — former emergency physician, now intensive care trainee and PhD graduate in trauma sciences — to explore what shock actually means beyond the blood pressure reading.
We discuss:
• Why shock is fundamentally about oxygen delivery and utilisation at a cellular level
• The difference between pressure and perfusion
• The concept of the “dose” of shock — magnitude and duration
• Why haemorrhage may only be the first phase
• How trauma patients transition between haemorrhagic, inflammatory, vasoplegic and septic states
• The glycocalyx — and why losing it matters
• The risks of early vasopressors in an empty system
• Why doing the basics exceptionally well remains our best intervention
This is not a protocol episode. It’s a physiology conversation. A systems conversation.
A reminder that restoring a number is not the same as restoring oxygen to mitochondria.
If you’re interested in pre-hospital and trauma systems thinking, do take a look at Tactical Trauma — spaces where these ideas are tested in practice.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
Trauma 2030
TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.
As always, thanks for listening.
What do we really know about treating refractory ventricular fibrillation?
And why are we still waiting to use strategies that might actually work?
In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice.
This is not just about adding another shock.
It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.
We also discuss:
- The difference between refractory and recurrent VF — and why it matters
- What DSED and vector change actually do in physiological terms
- Why guidelines have been slow to move despite emerging evidence
- The role of antiarrhythmics, adrenaline, and sequence of care
- Practical considerations for introducing DSED into real systems
- What comes next — from smarter detection to post-arrest recovery
This is a conversation grounded in real-world resuscitation.
It challenges current practice without overselling the evidence.
Key Learning Points* Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications * Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation * Timing matters — waiting too long to escalate may reduce the chance of success * Current guidelines remain cautious, reflecting the balance between evidence and implementation risk * Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care
Why This MattersCardiac arrest survival remains low.
Small improvements in early resuscitation can have large system-wide effects.
Understanding when standard care is failing — and what to do next — is where expertise matters.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.
The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.
You’re about to hear a conversation that ranges widely — from training reform and trauma leadership to ondansetron, paracetamol protocols, and artificial intelligence.
But it isn’t really about any single topic - It’s about where emergency medicine is heading. And whether we are ready for it.
This is our November and December 2025 round-up, and revisits the blog posts from the end of last year. A pause. A reset. A chance to look again at ideas that still matter on shift.
We explore
- The Medical Education Training Review and what it might mean for emergency medicine in the UK
- Flexibility, bottlenecks, and the portfolio route
- Why culture and team matter more than workload alone
- Trauma Team Leader tips — from missed wounds to managing presence in the room
- Ondansetron in paediatric gastroenteritis — symptom control or over-medicalisation?
- The SNAP protocol for paracetamol overdose in children
- How long it can take for good data to become everyday practice
- AI in the consultation room — and what happens when patients arrive with ChatGPT
What this means for trainers, medical schools, and the future of clinical judgement
This episode closes Season 12 of the St Emlyn’s podcast. Season 13 is coming — including London 2030 content and more from recent conferences.
Upcoming events
Tactical Trauma returns 2–4 November in Sundsvall, Sweden. It remains one of the most focused and practical trauma meetings in Europe — small faculty, serious discussion, no fluff. If you are interested in pre-hospital and in-hospital trauma care, it is worth your time.
IncrEMentuM is approaching fast, with limited places remaining. If you’ve heard us talk about it before, you’ll know why people come back.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.
The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.
More conversations from recent meetings — including Trauma 2030 — will follow in upcoming episodes.
Thanks for listening
You’re about to hear a conversation about doing less. But it isn’t really about doing less. It’s about time.
Recorded at Trauma 2030 at the Royal College of Surgeons, this episode explores a shift in mindset in pre-hospital trauma care — away from maximal intervention on scene and towards rapid recognition of the patient who cannot be fixed pre-hospital.
I’m joined by Harriet Tucker — consultant at London’s Air Ambulance, HEMS Governance Lead at Air Ambulance Kent Surrey Sussex, and Trauma Team Leader at St George’s Major Trauma Centre — to talk about damage control pre-hospital care.
We discuss:
- Using time as a treatment
- Recognising non-compressible haemorrhage
- Why one line may be enough
- Moving interventions into the ambulance
- Changing the pre-alert
- The “pit stop” resus
- Taking patients straight to theatre
- Cultural resistance to doing less
- Governance, debrief, and looking after teams
This approach focuses on a small but critically unwell group of patients — often penetrating trauma with rapidly exsanguinating haemorrhage — where the only definitive treatment is surgical control of bleeding.
The key intervention is speed.
Harriet also discusses the governance work behind this change, the importance of reviewing every case, and how to bring ambulance services and in-hospital teams along with the shift in thinking.
This episode is part of a series recorded at Trauma 2030. More conversations from the meeting will follow in upcoming episodes.
Upcoming events
Harriet will be speaking at Tactical Trauma, 2–4 November, Sundsvall, Sweden.
IncrEMentuM is now only eight weeks away, with limited tickets remaining.
Learning from podcasts?
If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
Trauma 2030
TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.
In this episode of the St Emlyn’s Podcast, we’re joined by Nigel Ruddell, Medical Director of the Northern Ireland Ambulance Service, recorded live at the BASICS Conference.
This is a conversation about Helicopter Emergency Medical Services (HEMS) — but not in the way you might expect.
It’s not really about aircraft. It’s about people.
Nigel talks us through the long, often uncomfortable journey to building Air Ambulance Northern Ireland. From early fundraising attempts in the 2000s, through the influence and legacy of Dr John Hinds, to the eventual partnership between charity and the statutory ambulance service that made a doctor–paramedic HEMS model possible.
We explore:
• Why the helicopter isn’t the intervention — the team is
• The charity–NHS partnership model in Northern Ireland
• Geography, rurality, and the realities of serving 1.9 million people
• Dispatch challenges and the use of video triage (including the GoodSAM platform)
• Cross-border working with the National Ambulance Service of Ireland
• The cultural work required to convince colleagues that HEMS is not a “Cinderella service”
• Humility, leadership, and the people who quietly build systems
We also reflect on John Hinds's legacy and how his passion catalysed change, including the significance of the Delta 7 callsign.
This is a thoughtful conversation about system design, pre-hospital care, and what it actually takes to introduce enhanced critical care capability into a region that has never had it before.
If you enjoy thinking about pre-hospital medicine, trauma systems, and the future of emergency care, you may also want to look at: the IncrEMentuM Conference and Tactical Trauma
And if you want to go deeper into the evidence behind the conversations we have on this podcast, explore MedPod Learn — now hosting nearly 5,000 medical podcast episodes with linked multiple-choice questions to support structured learning.
As always, thanks for listening.
In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest.
This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right.
What we cover Why the term resuscitative hysterotomy has replaced perimortem caesarean section* * The physiological rationale: relieving aortocaval compression to improve maternal resuscitation * What the evidence actually shows about timing, maternal survival, and neonatal outcomes * Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy * Why the “4–5 minute rule” does not reflect real-world pre-hospital care * Neonatal survival at far longer timelines than traditionally taught * Practical decision-making in pre-hospital and emergency department settings * Who should perform the procedure, and why speed matters more than seniority * Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it) * Team cognitive load, role allocation, and when termination at scene is appropriate * The emotional and professional impact on clinicians and families
Key takeaways* Maternal survival after out-of-hospital arrest is rare, but not zero * Neonatal survival is higher than often appreciated, even with prolonged timelines * Delaying purely to reach hospital or a specialist may reduce benefit * The hardest part is not the incision — it is the decision, coordination, and aftermath * Training should focus as much on judgement and communication as on technical skill
This episode is not about heroics.
It is about realism, evidence, and being prepared for one of the most confronting moments in emergency care.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.
Available on the App Store and Google Play.
IncrEMentum 2026 - April 22 - 24IncrEMentuM was born to revolutionise how we approach emergency medicine. It’s not a traditional conference — it’s an immersive experience that pushes professionals to act, think, and make decisions in real time.
Our mission is to bring together healthcare providers, experts, and emergency personnel from around the world to share experiences, train in realistic scenarios, and test their skills under extreme pressure.
In 2026, we return with an even more intense and lifelike edition — all with one clear goal: to prepare you for what cannot be predicted.
Tactical Trauma - April 22 - 24This is an international conference covering various aspects of working in high-stakes environments, primarily related to pre-hospital trauma and critical care, with a tactical twist.
Our program is rich and diverse, featuring state-of-the-art lectures from world-class speakers. We aim to bring together all organisations working with pre-hospital trauma in tactical/hostile environments, including physicians, HEMS, EMS, police anti-terror units, military, fire and rescue services and more.
In this (rather delayed!) October round-up, Iain Beardsell and Simon Carley catch up on recent St Emlyn’s blog posts and papers that continue to shape emergency and resuscitation practice.
The discussion moves across trauma, analgesia, cardiac arrest physiology, emergency department systems, and antimicrobial stewardship—less about novelty, more about what actually holds up on shift.
Trauma and haemorrhageThe episode opens with a discussion of the FIRST-2 trial, examining fibrinogen concentrate and prothrombin complex concentrate versus fresh frozen plasma in severe traumatic haemorrhage.
Despite promising physiological theory, the trial shows no meaningful reduction in blood product use compared with standard care, reinforcing the ongoing role of FFP in early trauma resuscitation.
Upper limb injuries and regional anaesthesiaThe team explore the SUPERB trial comparing supraclavicular brachial plexus blocks with Bier’s blocks for upper limb reductions.
Both techniques provide excellent analgesia. The conversation reflects on changing practice, procedural sedation pressures, ultrasound access, and how physical space—not evidence—often dictates what we do.
Cardiac arrest: signals worth paying attention toThree recent cardiac arrest papers are reviewed, focusing on physiological markers rather than new devices:
- End-tidal CO₂ as a CPR quality target
- Ventilation strategies during arrest, including chest-compression-synchronised ventilation
- Cerebral oximetry as a potential prognostic signal
These are not definitive answers, but they point towards cardiac arrest management that is more physiological and less ritualistic.
Emergency department systems: repair, not reinventionA reflective discussion on “designer repair” challenges the idea that emergency departments need constant transformation.
Instead, the focus shifts to recognising and supporting the clinicians quietly holding fragile systems together every day—and why fixing small, broken things often matters more than grand redesigns.
Sepsis and antibioticsThe episode closes with a critical look at broad-spectrum antibiotic use in suspected sepsis.
Observational data suggest significant overtreatment and real harm, reinforcing the need to pause, think, and choose the right antibiotic—not just the fastest one.
This episode is a reminder that good emergency medicine is rarely about silver bullets.
It’s about judgement, physiology, and paying attention to what actually works in the real world.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.
Available on the App Store and Google Play.
This bonus episode is a quick-fire collection of clinical pearls drawn from across the St Emlyn’s podcast in 2025.
Short, practical, and deliberately focused, these are the moments that make you stop and think:
“That’s useful — I want that in my head.”
There’s minimal commentary and no deep dives. Each clip stands on its own as a clear takeaway, designed to be listened to in one go or dipped back into when needed.
In this episode* Practical triage language that lowers thresholds and prompts earlier action * Time-critical decision-making in pre-hospital thoracotomy * Resuscitation physiology and why diastolic pressure matters * Intraosseous access and the reality of long-term complications * Analgesia strategies for rib fractures, including posterior injuries * Hydrofluoric acid burns and why improvised treatment is a trap * Recognising and acting on decompression illness * Cognitive HALOs and preparing for rare, high-load decision moments * Building excellence in teams, not just avoiding failure * Compassionate resuscitation and the value of the pause
This episode is designed to be saved, revisited, and shared — the kind of learning that pays off later.
Featured episodesClips in this episode are taken from the following full St Emlyn’s episodes:
- Episode 257 — Ten Second Triage with Sean Brayford-Harris
- Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more
- Episode 266 — Monthly Round Up (February 2025): Skills Fade and Resuscitation Targets
- Episode 260 — Monthly Round Up (December 2024): IO Access and Chest Trauma
- Episode 268 — Top Papers of 2024 from The Big Sick Conference
- Episode 275 — Targeted Resuscitation and Hydrofluoric Acid Burns
- Episode 263 — Hyperbaric Medicine with Jeff Kerrie
- Episode 277 — Cognitive HALOs and Advanced Simulation Training
- Episode 264 — High Performance Teams with Dan Dworkis
- Episode 258 — Compassionate Resuscitation with Matt Hooper
All full episodes are available in the podcast feed.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.
Available on the App Store and Google Play.
Some of the hardest moments in emergency medicine aren’t hard because they’re complicated.
They’re hard because they’re rare — and when they arrive, you’re relying on things you last thought about a long time ago.
This final episode in the Best Bits of 2025 series is the “file it away” collection: rare, high-stakes situations where preparation is largely cognitive, decisions are time-critical, and there may be no second chance.
The clips in this episode are drawn from full St Emlyn’s episodes released during 2025 and focus on recognition, decision-making, and human factors in uncommon but consequential scenarios.
In this episode, we explore* How community response and live video have changed what happens before patients reach hospital * Recognising and acting on decompression illness, even when presentations are subtle * Cognitive HALOs — what happens to our thinking in rare, high-acuity situations * Junctional haemorrhage and the role of the abdominal aortic junctional tourniquet * Human decision-making under extreme pressure, illustrated through aviation medicine
This episode is designed to be listened to slowly, and returned to when needed — the kind of learning that pays off long after you first hear it.
Featured episodesClips in this episode are taken from the following full St Emlyn’s episodes:
- Episode 262 — GoodSAM Update with Mark Wilson (London Trauma Conference)
- Episode 263 — Hyperbaric Medicine with Jeff Kerrie (London Trauma Conference)
- Episode 277 — Cognitive HALOs and Advanced Simulation Training with Halden Hutchinson-Bazely (BASICs)
- Episode 273 — Abdominal Aortic Junctional Tourniquet with Ed Barnard
- Episode 276 — Ejection Seats and the Injured Pilot with Phil Lucas (BASICs)
All full episodes are available in the podcast feed.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.
Available on the App Store and Google Play.
January often brings pressure to improve — to fix gaps, sharpen skills, and somehow be better than the year before. Done badly, that drive can become another source of burnout.
This third episode in the Best Bits of 2025 series focuses on how improvement actually works in emergency and acute care — and how to do it in a way that is realistic, sustainable, and kind to the people doing the work.
The clips in this episode are drawn from full St Emlyn’s episodes released during 2025 and reflect some of the most practical conversations about learning, feedback, and professional development from the year.
In this episode, we explore
- Why clinical skills fade faster than most of us realise — and why teaching is not the same as training
- How debriefing and video review can drive learning safely, when the culture is right
- The impact of artificial intelligence and algorithm-driven information on how clinicians learn and make decisions
- Why conferences, community, and being “in the room” still matter in medical education
This episode is designed for listening on the way to work, on the way home, or during a quieter moment when you’re thinking about how to improve practice without adding more weight.
Featured episodesClips in this episode are taken from the following full episodes:
- Episode 259 — Skills Fade with Nathalie Pattyn (Tactical Trauma 24)
- Episode 265 — Excellence in Debriefing with Richard Lyon (London Trauma Conference)
- Episode 267 — Social Media and Artificial Intelligence in Medicine with Peter Brindley
- Episode 274 — What Medical Conferences Offer in 2025 and How They’ve Changed
All full episodes are available in the podcast feed.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with optional tools to support reflection, CPD, and appraisal.
Available on the App Store and Google Play.
Winter pressure doesn’t just affect patient flow.
It affects people.
This second episode in the Best Bits of 2025 series focuses on the human side of emergency medicine: culture, moral injury, compassion, and the small but meaningful behaviours that help clinicians stay grounded when work is relentless.
The clips in this episode are drawn from full St Emlyn’s podcast episodes released during 2025 and reflect some of the most thoughtful conversations of the year.
In this episode, we explore:* What a genuine learning culture looks like on shift — and why it matters more than workload * Moral injury in emergency and prehospital care, and how it differs from day-to-day moral distress * Compassionate resuscitation and “the pause” after a death * Why small, practical actions can counter hopelessness, even when systems are broken * The EPICC framework and the role of self-compassion in clinical practice
This episode is designed for listening on shift, on the way home, or during a quieter moment over Christmas and New Year.
Featured episodes
Clips in this episode are taken from the following full St Emlyn’s episodes:
- Episode 256 — Monthly Update (November 2024): Learning culture in emergency medicine
- Episode 261 — Moral Injury with Caroline Leech (recorded at Tactical Trauma 24)
- Episode 258 — Compassionate Resuscitation with Matt Hooper (London Trauma Conference)
- Episode 264 — High Performance Teams with Dan Dworkis (Tactical Trauma 24)
- Episode 271 — Monthly Update (April and May 2025): EPICC and self-compassion
All full episodes are available in the podcast feed.
About MedPod LearnMedPod Learn is a medical podcast player designed to help turn listening into structured learning, with optional reflection and tools to support CPD and appraisal.
Available on the App Store and Google Play.
Emergency medicine strips decision-making back to its essentials when departments are full and time is short.
This first episode in the Best Bits of 2025 series brings together some of the most practically useful moments from the St Emlyn’s podcast this year — focusing on how clinicians make good decisions under pressure, when conditions are far from ideal.
Each clip comes from a full episode released in 2025.
In this episode, we explore:
- How ten-second triage is designed to work on “worst-day” scenarios, not in textbooks
- The uncomfortable truth about why procedures sometimes get done — and why that matters
- Why time, not technique, is often the limiting factor in resuscitative thoracotomy
- The case for earlier invasive monitoring in the sickest patients
- Where thinking around double sequential defibrillation may be heading
This episode is designed to be useful on shift, in the car, or during a quiet moment before the next job.
Featured episodes
Clips in this episode are taken from the following full St Emlyn’s episodes:
- Episode 257 — Ten Second Triage with Sean Brayford-Harris (Tactical Trauma 24)
- Episode 269 — Monthly Round Up (January 2025): Decision-making and prehospital RSI
- Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more
- Episode 266 — Monthly Round Up (February 2025): Targeted resuscitation and arterial lines
- Episode 268 — Top Papers of 2024 from The Big Sick Conference
All full episodes are available in the podcast feed.
About MedPod LearnMedPod Learn is a clinician-built medical podcast player designed to turn listening into structured learning, with optional MCQs, reflection prompts, and saved activity for appraisal and CPD.
You can find it on the App Store and Google Play.
Join Iain Beardsell and Hutch as they review key insights from the Trauma 2030 conference hosted by the Institute of Pre-Hospital Care, part of London's Air Ambulance.
The discussion highlights the emphasis on speed in damage control resuscitation, the ongoing debate on 'scoop and run' versus 'stay and play' approaches, and the nuanced use of resuscitative thoracotomy.
The episode delves into advanced therapies like ECMO, their expanding role in trauma care, and the importance of relentless self-evaluation in medical practice.
Discover how London's focused approach can provide broader lessons for trauma care and the potential for innovative treatments to become more widespread.
Look out for more podcasts from Trauma 2030 over the coming weeks, where we will talk about team leadership in pre-hospital teams, more on damage-control pre-hospital care, nuancing the management of traumatic cardiac arrest, the increasing use of ECMO, and the shocked trauma patient.
The Institute of Pre-Hospital Care
The Institute of Pre-Hospital Care is part of London’s Air Ambulance Charity, focused on advancing pre-hospital care. They train clinicians, use case studies to guide our priorities, develop new clinical interventions and conduct research. They are also proud to educate and inspire the next generation of pre-hospital care experts through our two degree programmes, co-convened with Queen Mary University London (QMUL).
Through the training and education of The Institute of Pre-Hospital Care, they ensure their unique team of doctors and paramedics are there for London, today, tomorrow, always.
Listen on MedPod Learn
MedPod Learn is a new app that turns medical podcasts into structured learning.
Alongside the audio, you get concise learning points, exam-style MCQs, and short reflection prompts — with listening time and activity logged automatically for CPD and appraisal.
If you already learn through podcasts, this is a way to make that learning count.
Available now on iOS and Android.
Recorded at the BASICS Conference 2025, Iain talks with Haldon “Hutch” Hutchinson-Basley about the idea of a “cognitive HALO” — those rare moments where your mental bandwidth hits maximum power.
Hutch describes a traumatic cardiac arrest he encountered alone, with no warning and no crewmate to share the load. He explains how he recognised cognitive overload and used simple strategies — “lighting a flare”, “norming the abnormal”, and dropping tasks he couldn’t safely achieve — to regain decision-making space.
The discussion links this experience to his work on the ATACC course and the emerging SPEAR programme, exploring how realistic, human-centred simulation prepares clinicians to function when the stakes and stress are highest.
MedPod Learn turns trusted FOAMed podcasts into structured CPD, adding concise learning notes, single-best-answer questions, and role-specific reflection prompts to thousands of episodes. Everything you do — listening time, MCQs, reflections — is saved automatically and downloadable in one click for appraisal. The app is free to download, with a one-month trial of the full learning tools. Just search MedPod Learn on the App Store or Google Play.
In this St Emlyn’s podcast, Ian Beardsell and Simon Carley speak with RAF GP Phil Lucas from the Royal Air Force Centre of Aerospace Medicine at the BASICS conference in Leicestershire. They explore what really happens when a pilot pulls the ejection handle, and what this means for pre-hospital and Emergency Department teams who may be the first to see an ejectee.
Phil explains:
• Why the aviation environment is so hostile to humans and how aerospace medicine supports aircrew
• How modern ejection seats work – from canopy jettison and rocket firing to parachute deployment and landing
• The decision making required to eject in a matter of seconds, and how pilots are trained to be “mentally ready”
• Typical injury patterns after ejection, how technology has reduced spinal compression injuries, and where the remaining risks lie
• Practical considerations for ED and pre-hospital teams when a pilot presents after ejection, including spinal precautions and safe removal of flight equipment
• The psychological impact of surviving a crash or ejection, how support needs can change over months, and what helps people return to flying
• Aviation medicine as a career path, including the role of the RAF Centre of Aerospace Medicine, the diploma in aviation medicine, and how this can sit alongside general practice or emergency care
This conversation draws strong parallels between aviation and emergency medicine: human factors, training under pressure, using simulation and mental rehearsal, and the importance of honest, individualised psychological support after critical incidents.
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Simon Carley review blog posts from August and September. They reflect on their experience at the BASICs Conference, highlighting discussions on resuscitation science and new resuscitation council guidelines.
Topics covered include the physiological-targeted resuscitation, arterial line placements during cardiac arrest, the PECan abdominal trauma rule in pediatric emergency care, intra-arrest stellate ganglion blocks, hydrofluoric acid burns treatment, and pediatric status epilepticus. They also delve into the evidence trial on moving patients with refractory out-of-hospital cardiac arrest to hospitals for specialised care, and review discussions on moral injury among emergency responders. Additionally, they mention the upcoming Geckos Global Health and Emergency Care Research Summit and explore the potential future of emergency medicine by 2038.
00:00 Introduction and Conference Highlights
02:55 Arterial Line Placement During Cardiac Arrest
05:27 Pediatric Abdominal Trauma Rule
10:25 Intra-Arrest Stellate Ganglion Blocks
14:35 Moral Injury in Emergency Responders
23:22 Hydrofluoric Acid Burns Treatment
25:38 Ketamine for Pediatric Status Epilepticus
28:57 Refractory Out-of-Hospital Cardiac Arrest
33:59 Global Health and Emergency Care Research
35:09 Conclusion and Future Episodes
Episode summary
- Why in‑person conferences still matter in a post‑COVID world.
- What formats work now: short talks, interviews, demos, strong hosting.
- How to turn “a great day out” into Monday‑morning change.
Guests
- David Carr — EM physician (Toronto). Leads the Annual Update in EM at Whistler. Focus: inclusive, high‑energy, “hard‑core EM” content.
- Haney Mallemat — EM & Critical Care (South Jersey/Philadelphia). Founder of ResusX; designs short, high‑engagement sessions that feel like live conversations.
Key themes
- Why travel when content is online?
Being in the room changes attention, reflection, and recall. Learning happens in corridors, evening sessions, and next‑day conversations. - From lectures to experiences.
Shift to shorter talks, couch discussions, live demos, and deliberate hosting. Format follows audience and venue. - Programme design starts with the audience.
Build for how people learn now. Coach faculty. Pick speakers for delivery and credibility. - Strong hosting is part of pedagogy.
Good chairs manage flow, time, and psychological safety so the audience can relax and learn. - Social learning drives change.
Purposeful social time and small‑group evening sessions create the “stickiness” that leads to projects and practice updates.
Practical takeaways for clinicians
- Arrive with intent: bring 1–2 real patient problems to solve.
- Choose your format: prioritise short talks, interviews, and hands‑on if your attention is fragmented.
- Make it stick on Monday: debrief with a colleague, write one practice change, set a review date. Present a short “what I learned” to your team.
- Borrow authority wisely: take clear, referenced points (e.g., contrast allergy/nephropathy policies) back to local committees.
Practical takeaways for organisers
- Audience first: define who you serve; let that drive length, tone, and format.
- Shorten and vary: fewer bullet‑heavy lectures; more interviews, panels, and no‑slide formats when it helps educators shine.
- Coach and curate: select speakers for content and delivery; build a pipeline for new voices.
- Invest in hosting: treat chairs as educators; they safeguard pacing, transitions, and safety.
- Design the socials: plan purposeful evening micro‑teaching and cross‑disciplinary meet‑ups.
- Measure impact: mandate feedback tied to CPD; analyse themes and close the loop next year.
Risks and tensions
- Edutainment vs evidence: keep the energy without losing rigour.
- Access and equity: budgets, visas, disability, and caring responsibilities exclude many; amplify content post‑event.
- “Too innovative?” Novel formats can struggle with recognition and funding; meet audiences halfway and iterate.
How conferences translate to patient care
- Prioritise topics that solve common bottlenecks.
- Put change agents on stage with take‑home resources (e.g., clear radiology guidance on contrast “allergy” and nephropathy).
- Encourage attendees to form local groups to implement one change within two weeks.
Recorded at the BASICS Pre-Hospital Care Conference at Sketchley Grange, this episode explores one of the most experimental tools in civilian trauma care — the abdominal aortic and junctional tourniquet. Dr Ed Barnard joins us to discuss why this device was developed, how it works, and where it might — just might — save lives when all other options have failed.
The conversation traces the problem of non-compressible haemorrhage, the leading cause of potentially survivable trauma death. Conventional limb tourniquets, pelvic binders and packing can’t reach these deep bleeding sites. The AAJT offers a radical alternative: external aortic compression to buy a few crucial minutes until surgical control or REBOA is possible.
Ed explains the mechanism — an inflatable, ratcheted belt that can occlude the aorta or major junctional vessels — and the evidence so far. Laboratory and volunteer data show that it can stop flow, but pain and tissue ischaemia make it difficult to tolerate for long. Clinical experience remains limited to small case series, mostly in military or research settings, and no human trials yet demonstrate a survival benefit.
The discussion is candid about risk and realism. The AAJT is a last-resort device, to be used only within strict governance, with clear time limits and immediate plans for definitive haemorrhage control. It’s not something you reach for on a normal shift — it’s something you might need once in a career, and only if every other option has failed.
Ed shares insights from ongoing research, including its potential role as a bridge to REBOA, and the governance frameworks that should surround any trial use. The episode ends with a look to the future: how civilian and military collaboration might refine indications, training, and data collection for this rare but potentially life-saving intervention.
Surgeon Captain Ed Barnard
Surgeon Captain Ed Barnard is a Consultant in Emergency Medicine at Addenbrooke’s Hospital, Cambridge, and a Professor of Emergency Medicine with the Defence Medical Services. He also serves with East Anglian Air Ambulance as a HEMS doctor (having had many years as a BASICS responder). His academic work focuses on prehospital and military trauma care, with a portfolio spanning clinical trials, blood product innovation, and trauma system development.
Ed’s academic work focuses on improving survival from catastrophic bleeding, particularly non-compressible and junctional haemorrhage. He has published and presented widely on trauma resuscitation, traumatic cardiac arrest, and the evolving role of devices such as the abdominal aortic and junctional tourniquet (AAJT) and REBOA. He is a co-author of the 2025 BMJ Military Health systematic review examining the utility of the AAJT-S in military practice.
He is also an experienced educator, contributing to trauma training for BASICS, HEMS, and Defence Medical Services, and continues to combine clinical work with research aimed at translating lessons from military to civilian trauma care.
About BASICS:
The British Association for Immediate Care (BASICS) is a UK charity uniting clinicians dedicated to pre-hospital emergency medicine. Founded in 1977, it supports regional immediate-care schemes, delivers national training, and hosts the annual BASICS Pre-Hospital Care Conference, bringing together experts in trauma, retrieval, and critical care — like this conversation with Dr Ed Barnard.
In this episode of the St Emlyn's Podcast, Iain and Simon discuss the latest updates in emergency medicine during the hot UK summer. They discuss the latest research and content from the St Emlyns blog, touching on topics like serotonin syndrome, the impact of the new urgent and emergency care plan in the UK, and the use of salbutamol as an analgesic for renal colic.
They also highlight the growing issue of nitazenes, a new class of synthetic opioids, and their implications for emergency medicine. Lastly, they emphasise the importance of staying updated on toxicology to effectively manage high-acuity, low-occurrence events such as drug-induced hyperthermia.
00:00 Introduction
01:35 Upcoming Conferences
03:41 Med Pod Learn
05:09 Serotonin Syndrome Deep Dive
10:22 Urgent and Emergency Care Plan
18:04 Salbutamol for Renal Colic
22:07 Hypothermia in Toxicology Emergencies
27:04 Nitazines: A Growing Problem
Iain and Simon return after a brief hiatus to discuss key blog posts from April and May on the St Emlyn's Podcast. They highlight notable conferences including IncrEMentum 2025 in Spain, The Big Sick in Zermatt, and the BASICs Conference.
Discussions cover content from recent emergency medicine research, the importance of compassion and patient-centred care, and operational strategies to avoid emergency department overcrowding. Insights are also shared from fieldwork in South Africa on emergency thoracotomies and their impressive survival rates.
In the March 2025 episode of the St. Emlyn's podcast, Iain Beardsell and Simon Carley discuss a variety of topics covered in their latest blog posts and podcasts. Key discussions include the implications of cannabis edibles in emergency departments, expert viewpoints on pre-hospital resuscitative thoracotomy for traumatic cardiac arrest, and the use of ketamine for opioid-dependent patients. Highlights from recent conferences such as The Big Sick, IncrEMentuM 2025, and the Royal College of Emergency Medicine (RCEM) conference in Birmingham are shared. The episode also delves into department culture, addressing resilience, risk management, and other critical topics in emergency medicine. The podcast concludes with a recommendation of Matt Morgan’s book "A Second Act: What Nearly Dying Teaches About Really Living." 00:00 Introduction and March 2025 Roundup01:45 Cannabis Edibles in the Emergency Department05:25 Pre-Hospital Resuscitative Thoracotomy12:38 Ketamine for Opioid Users in Acute Pain15:17 Conference Highlights and Reflections27:13 Matt Morgan's Inspirational Talk30:50 Conclusion and Farewell
In this episode of the St Emlyn's Podcast, Iain Beardsell and Simon Carley revisit January's blog posts and podcasts, covering several seminal studies relevant to emergency and pre-hospital care.
Topics include the Sub 30 Feasibility Study on pre-hospital ECMO, comparisons of pre-hospital versus in-hospital emergency anaesthesia, variations in maintenance of pre-hospital anaesthesia in trauma patients, and the effectiveness of physician-led pre-hospital teams.
They also discuss the economic implications of advanced pre-hospital interventions and highlight reviews from the London Trauma Conference.
00:00 Introduction and January Recap
01:58 Pre-Hospital ECPR Study: The Sub 30 Study
07:09 Emergency Anaesthesia: Pre-Hospital vs. Emergency Department
13:55 Maintenance of Pre-Hospital Anaesthesia: Variations in Practice
16:57 Physician-Led Pre-Hospital Teams: Do They Improve Outcomes?
22:12 Additional Insights and Upcoming Content
In this special edition of the St Emlyn’s podcast, Iain Beardsell and Simon Carley review the top medical papers of 2024, originating from Simon’s talk at The Big Sick conference in Zermatt. The discussion includes a comparison of non-invasive versus arterial pressure monitoring, the association of intra-arrest arterial blood pressure with ROSC, the efficacy of serratus anterior plane blocks for rib fracture management, and the evaluation of a micro axial flow pump in cardiogenic shock.
They also delve into double sequential external defibrillation in refractory out-of-hospital cardiac arrest and provide a rapid-fire review of additional critical papers discussed at the conference. Notable mentions include the HEMOTION trial, PRE OXI trial, BLING III, and PARAMEDIC-3, among others.
A must-listen for those passionate about evidence-based medicine in emergency and pre-hospital care.
You can read more about all the trials, including links to all the papers here (part 1) and here (part 2)
00:00 Introduction and Conference Highlights
01:51 Non-Invasive vs. Arterial Pressure Monitoring
03:28 Intra-Arrest Blood Pressure and ROSC
05:34 Serratus Anterior Plane Blocks for Rib Fractures
08:38 Micro Axial Flow Pump in Cardiogenic Shock 10:49 Double Sequential Defibrillation in Cardiac Arrest
13:17 HEMOTION Trial
15:01 PRE OXI and BLING III Trials
17:08 Fluid Management in Septic Shock
18:37 Expedited Transfer vs. On-Scene Resuscitation
20:39 Intraosseous vs. Intravenous Access
21:48 Conclusion and Final Thoughts
Join hosts Iain Beardsell and Natalie May at the London Trauma Conference as they welcome Peter Brindley back to the St Emlyn’s podcast. In this engaging episode, they delve into the nuances of social media, digital footprints, and the burgeoning influence of artificial intelligence in medicine. Brindley discusses the importance of maintaining an authentic digital presence and addresses the impact of misinformation and disinformation in the digital age. They explore the challenges and opportunities presented by AI in clinical decision-making and share insights on navigating this evolving landscape as healthcare professionals. Tune in for a thought-provoking conversation on staying relevant and responsible in a digitally-driven world.
00:00 Introduction and Welcome01:40 Understanding Digital Footprint03:53 Navigating Information and Misinformation05:41 The Role of AI in Information Search08:45 AI in Clinical Decision Making15:28 The Kardashian Index and Social Media Influence17:39 Conclusion and Final Thoughts
In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley reflect on their experiences at recent conferences, including the IncrEMentuM 2025 and The Big Sick. They discuss the exceptional quality and innovative formats of presentations at IncrEMentuM, emphasizing the enthusiasm and positive atmosphere. The discussion also covers key emergency medicine topics from February's blog posts, including the maintenance of clinical skills, the importance of diastolic blood pressure in resuscitation, and a systematic review on resuscitative hysterotomy. Additionally, they explore new guidance on the diagnosis of death, particularly in intensive care settings. Special thanks to Galen Pharmaceuticals and PM Cardio for their support.
00:00 Introduction and Recent Conferences00:42 Highlights from IncrEMentuM 202504:47 Emergency Medicine Blog Posts Overview05:10 Maintaining Competency in Rare Procedures11:23 Diastolic Blood Pressure in Resuscitation15:37 Resuscitative Hysterotomy Insights20:43 Understanding Death Criteria24:48 Conclusion and Acknowledgements
In this episode of the St Emlyn's Podcast, Iain Beardsell and Natalie May speak with Richard Lyon, an emergency doctor and deputy medical director of the air ambulance service at Kent, Surrey, and Sussex. Recorded at the London Trauma Conference 2024 in Kensington, Richard shares experiences and lessons from his talk on five critical cases that shaped him as a clinician and human being. Discussion topics include the importance of case debriefing, the impact of video recording in clinical practice, overcoming the challenges of self-reflection, and the evolving culture of pre-hospital emergency medicine. Richard emphasizes the significance of supportive and structured debriefing processes and offers insights on integrating video reviews into emergency practices for improved education and reflection. 00:00 Introduction and Guest Welcome00:37 Richard Lyon's Background and Talk Overview01:00 The Importance of Case Learning and Debriefing02:12 Challenges and Strategies in Case Learning04:24 The Power of Video Recording in Clinical Practice07:30 Implementing Video Recording: Practical Steps08:24 Addressing Concerns and Building Trust12:56 Senior Clinicians and Vulnerability17:33 Supporting Pre-Hospital Clinicians20:35 Conclusion and Final Thoughts The Guest - Richard Lyon Professor Lyon is an active UK NHS Consultant in Emergency Medicine and Pre-hospital Care in Edinburgh and Deputy Medical Director for Air Ambulance, Kent Surrey & Sussex. A globally recognised leader in pre-hospital and emergency medical care, Prof Lyon works for multiple world class organisations, helping to develop current and future state-of-the art medical devices, systems and concepts aiming to save lives across the globe. A respected clinical leader and senior medical advisor to both governments and global corporations, with a track record of delivering high quality output and success across clinical, academic, research and innovation. Prof Lyon was made a Member of the Most Excellent Order of the British Empire (MBE) by HM The Queen in the 2017 Honours, for Services to Emergency Healthcare, after he established a programme of work on out-of-hospital cardiac arrest for Scotland. Prof Lyon holds a personal Chair of Pre-hospital Emergency Care at the University of Surrey and has an established research portfolio in pre-hospital resuscitation and trauma care, with an extensive publication record. Prof Lyon is a current member of the Faculty of Pre-hospital Care and author of several international guidelines. Prof Lyon is a Physician with the UK International Search & Rescue Team.
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome Dan Dworkis, an ER doctor from Los Angeles and host of the Emergency Mind podcast. Dan shares his expertise on optimizing team and individual performance in high-stress medical environments. The discussion delves into the concept of excellence beyond merely avoiding negative outcomes, using a rosebush metaphor to illustrate the need for proactive growth. They explore how teams can benchmark and improve performance, the importance of creating a culture of continuous improvement, and strategies to maintain positivity and energy even in challenging conditions. Dan also highlights the Mission Critical Team Institute and its role in supporting teams in life-or-death situations. This episode is essential listening for medical professionals committed to pushing the boundaries of excellence in their practice. 00:00 Introduction and Guest Welcome01:06 Defining Excellence in Medicine02:29 Measuring and Achieving Team Performance06:13 Small Changes for Big Impact10:03 Maintaining Positivity and Energy15:30 Mission Critical Team Institute16:33 Conclusion and Farewell The Guest - Dan DworkisDan Dworkis, MD, PhD, FACEP is the Chief Medical Officer at the Mission Critical Team Institute, the founder of The Emergency Mind Project, a board-certified emergency medicine physician, and an assistant professor at the Keck School of Medicine at USC.
His work focuses on the optimal development of mission critical teams in and out of emergency departments. He completed the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and also earned an MD and PhD in molecular medicine from Boston University School of Medicine. Dr. Dworkis is the author of The Emergency Mind: Wiring Your Brain for Performance Under Pressure.
In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Natalie May discuss hyperbaric medicine at the London Trauma Conference with Dr. Jeff Kerrie, an internal medicine physician from Canada. Dr. Kerrie provides insights into dive and hyperbaric medicine, covering the basics of hyperbaric therapy, its applications, and key practices for emergency departments when treating patients with decompression illness. The conversation also touches on misconceptions and unregulated uses of hyperbaric chambers, emphasizing the importance of consulting certified medical professionals.
00:00 Introduction to the Podcast and Guests00:58 Understanding Hyperbaric Medicine01:33 Dive Medicine and Decompression Illness04:15 Emergency Response and Treatment Protocols07:26 Hyperbaric Chamber Mechanics10:05 Beyond Dive Medicine: Other Uses of Hyperbaric Therapy11:43 Challenges and Misuses of Hyperbaric Therapy12:38 Conclusion and Final Thoughts The GuestFor the last three years, Jeff Kerrie has served as the Island Health Medical Director of Quality, Safety, and Ethics. Dr. Kerrie has a master’s degree in clinical bioethics from Clarkson University/Icahn School of Medicine at Mt. Sinai in New York. Over the last six years, Dr. Kerrie helped build the Island Health ethics program, where he has provided ethics consultations and teaching to staff, patients, and families.
Dr. Kerrie underwent medical training at the University of Manitoba before completing residency in Internal Medicine at UBC. He practices as a general internist in Victoria, and is an Assistant Clinical Professor with the University of British Columbia and the University of Victoria. Other medical work has included medicine in atypical environments (including dive/hyperbaric medicine, ski patrol, and high altitude environments), obesity medicine, and international health. Dr. Kerrie is also a graduate of the Physician Quality Improvement program at Island Health.
In his spare time Dr. Kerrie enjoys aviation, skiing, and SCUBA diving.
In this episode, Iain Beardsell and Natalie May speak with neurosurgeon Mark Wilson at the London Trauma Conference. Mark provides an in-depth look at the evolution of the GoodSAM app over the past decade. Initially designed to alert off-duty trained individuals to assist in emergencies, particularly for cardiac arrests and impact brain apnoea, the app has grown to include applications in police services, public health during COVID-19, and community volunteer efforts. It employs advanced technology, such as real-time video guidance and AI, to offer immediate assistance and improve outcomes in medical emergencies and other crises. Mark's insights shed light on how this innovative platform is saving lives and transforming emergency and public response systems worldwide. 00:00 Introduction and Reunion 00:47 The GoodSAM App: A Decade of Evolution 01:52 GoodSAM's Impact on Cardiac Arrests 02:09 Expanding GoodSAM: Police and Community Involvement 02:35 How GoodSAM Works 05:54 GoodSAM's Role During COVID-19 13:42 The Future of GoodSAM: AI and Community Support 15:04 How to Get Involved with GoodSAM 16:26 Conclusion and Final ThoughtsThe GuestMark is a Consultant Neurosurgeon and Pre-Hospital Care Specialist working at both Imperial College (mainly St Mary's Major Trauma Centre) and as an Air Ambulance doctor.
He am a Clinical Professor specialising in Brain Injury at Imperial and Honorary Professor of Pre-Hospital Care (the Gibson Chair) at the Faculty of Pre-Hospital Care, Royal College of Surgeons, Edinburgh.
His specialist areas are acute brain injury (mostly traumatic brain injury) and its very early management. He is co-director of the Imperial Neurotrauma Centre and am co-founder of GoodSAM, a revolutionary platform that alerts doctors, nurses, paramedic and those trained in basic life support to emergencies around them.
Mark have worked extensively overseas (India, Nepal, South Africa, as a GP in Australia, Researcher for NASA and as an expedition doctor on Arctic and Everest expeditions). He also wrote The Medics Guide to Work and Electives Around the World. His research is mainly into the brain in trauma and in hypoxia (using it as an injury model) in humans.
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome back Caroline Leech, a emergency medicine consultant with extensive pre-hospital care experience. Caroline discusses the concept of moral injury, delving into its distinction from moral distress. She introduces three mechanisms of moral injury: acts of commission, acts of omission, and betrayal. Caroline provides insightful examples from emergency medicine to illustrate these concepts, emphasizing the importance of identifying and addressing moral injury to support healthcare professionals. The discussion highlights the emotional and cognitive distress faced by emergency responders and the necessity for professional psychological support when moral distress accumulates into moral injury. 00:00 Introduction and Welcome 00:23 Introducing Caroline Leech 01:10 Defining Moral Injury and Distress 03:42 Acts of Commission 07:12 Acts of Omission 12:30 Betrayal in Healthcare 15:00 Conclusion and Final Thoughts The Guest - Caroline LeechCaroline Leech is Deputy Clinical Lead of The Air Ambulance Service and has 25 years of prehospital clinical experience. She is a Consultant in Emergency Medicine at University Hospital Coventry, the West Midlands Trauma Network Director, and the Trauma Lead for the Institute for Applied & Translational Technologies in Surgery (IATTS). Caroline is currently undertaking a NIHR funded Clinical Research Scholarship with Warwick University. Her research interests include maternal out-of-hospital cardiac arrest, calcium in traumatic haemorrhage, and frailty in major trauma. She is committed to improving equality and diversity in PHEM, and promoting strategies for supporting the wellbeing and psychosocial care of prehospital responders.
In this season-ending episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley come together in Zermatt, Switzerland, to discuss recent studies and updates.
They highlight a randomized control trial on early exercise in blunt chest wall trauma, revealing its limited impact on recovery outcomes. Additionally, they explore the long-term safety of intraosseous access based on new evidence from Denmark.
The episode also provides insights into updated imaging guidelines for paediatric trauma and broad considerations on the growing role of AI in healthcare, especially in emergency settings. There are closing remarks on recent blog posts about toxic alcohol poisoning and the Difficult Airway Society meeting, while looking forward to upcoming conferences in Spain and Vienna.
00:00 Welcome to St Emlyn's Podcast
00:31 Exploring the Big Sick Conference in Zermatt
01:25 Evidence-Based Medicine: Early Exercise in Blunt Chest Wall Trauma
04:30 Intraosseous Access: Long-Term Complications
06:37 Imaging Decisions in Pediatric Trauma
09:17 The Promise and Perils of Artificial Intelligence in Healthcare
13:10 Toxic Alcohol Poisoning: A Critical Review
16:17 Conference Highlights and Future Events
19:19 Season 11 Finale and Looking Ahead to Season 12
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe talk with Nathalie Pattyn at TacTrauma24 in Sweden about the phenomenon of skills fade amongst emergency physicians.
Nathalie discusses her extensive background in medicine, psychology, and neuroscience, and shares insights from her research on how skills can deteriorate during low workload deployments, such as her 15-month clinical stint in Antarctica.
They delve into the lack of systemic measures to address returning to practice after long absences, how cognitive and psychomotor skills are affected by skill fade, and the contrast between teaching technical skills and ensuring they become automatic and stress-resilient.
The conversation highlights the need for evidence-based guidelines to ensure healthcare professionals maintain their proficiency, which ultimately benefits patient care and the healthcare system.
00:00 Introduction and Guest Introduction 00:13 Natalie's Background and Expertise 00:38 Skills Fade in Emergency Medicine
01:01 Personal Experience with Skills Fade
02:14 Regulations and Policies on Skills Maintenance
04:19 Imposter Syndrome vs. De-skilling
06:42 Aviation vs. Medical Field: Skills Certification
08:27 Aging and Cognitive Decline in Medical Skills
09:57 Teaching vs. Training in Medical Education
12:42 Future Directions and Systemic Solutions
14:31 Conclusion and Contact Information
The GuestNathalie Pattyn, MD, MPsy, PhD, received a degree in medicine from the Université Libre de Bruxelles (magna cum laude, 2001), a Master in Clinical Psychology from the Vrije Universiteit Brussel (cum laude, 2004), a PhD in Psychological Sciences from the Vrije Universiteit Brussel (2007) and a PhD in Social and Military Sciences from the Royal Military Academy (2007).
She also holds a postgraduate degree in Aerospace Medicine; a postgraduate degree in Emergency Medicine; a postgraduate degree in General Practice ; a postgraduate degree in Disaster Medicine ;and a Master in Global and Remote Healthcare.
She completed her Junior Officer Course with the Belgian Defense College in 2005, and her Staff Officer Course in 2008. She has a mixed clinical, research and operational background, having been deployed as a medical officer in various Middle Eastern and African countries, and having completed missions in Antarctica for a total duration of more than two years.
Her longest deployment was 15 months to the Halley VI Research Station in Antarctica, where she worked as the station physician while setting up a new biomedical research laboratory for the European Space Agency. She is currently still working as an emergency physician and a flight surgeon.
Her research interests include the psychophysiological measures of performance in elite populations; and Human Factors approach to isolated and confined environments, ranging from space to submarines.
In 2010, she founded a research unit within the Royal Military Academy, dedicated to the multidisciplinary study of human performance in operational environments. This led her to be the project manager for designing a tailored Human Performance Program for the tier one unit of the SOF community in Belgium.
She is currently an Associate Professor in Physiopathology at the Vrije Universiteit Brussel and in Human Performance at the Royal Military Academy.
You can read Nathalie's excellent book "Handbook of Mental Performace" for free here.
Welcome to our first episode recorded at the London Trauma Conference 2024.
In this episode, hosts Iain Beardsell and Natalie May are joined by Matt Hooper from Adelaide to discuss his unique career path, from emergency medicine to pre-hospital and retrieval medicine, intensive care, and more recently, palliative and end-of-life care.
The conversation centres around the principles of end-of-life care, particularly in acute and traumatic scenarios, and how these can be integrated with life-saving efforts. Key points include the challenges of shifting focus from survival to quality of death, the importance of recognizing and supporting witnesses and caregivers, and the concept of 'compassionate resuscitation.'
Practical tools such as the 'pause' are also explored, aiming to humanize highly charged medical environments and potentially prevent burnout and PTSD among healthcare providers.
00:00 Introduction and Guest Welcome
01:00 Key Messages on Death and Palliative Care
02:12 Challenges in End-of-Life Care
03:20 Improving Quality of Death and Relationships
04:32 Emotional Impact on Care Providers
06:41 Navigating End-of-Life Conversations
12:17 Practical Applications in Intensive Care
16:41 The Pause: A Tool for Reflection 21:58 Conclusion and Final Thoughts
The Guest - Matt HooperMatt is an accomplished intensive care specialist with a diverse background in emergency medicine, prehospital & retrieval medicine, and palliative care.
Notable for his leadership in developing critical care service models, he founded South Australia’s MedSTAR Emergency Medical Retrieval Service. He has also co-authored a highly regarded case-based text book and held key teaching and examining roles nationally and internationally in prehospital and retrieval medicine.
With a strong focus on high-performance teams working within high acuity, high consequence environments, Matt's expertise has also extended to human factors in healthcare, cardiothoracic intensive care, ECMO, and clinical ultrasound. More recently however, he has pivoted towards palliative and end of life care, pursuing a Master's degree at Cardiff University and consulting at Mary Potter Hospice in Adelaide. He is passionate about exploring new and innovative ways to prevent potentially avoidable suffering and enhance end of life outcomes for patients in acute care clinical environments.
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe speak with Sean Brayford Harris, a paramedic and interoperability development officer with the London Ambulance Service, about the development of the 10 second triage tool—a new, streamlined method for triaging casualties in high-stress environments like major incidents.
They discuss its creation and implementation, including collaboration with the Metropolitan Police and other emergency services. Key points include the shortcomings of the previous 'sieve and sort' system, the challenges of developing a simplified tool, and the benefits of this new approach for non-medical first responders.
The episode emphasizes the importance of cross-team collaboration in emergency scenarios and the potential impact of the tool on reducing distress and improving outcomes for both responders and patients.
00:00 Introduction
00:37 Background on Major Incident Triage
01:01 Challenges with Existing Triage Systems
01:15 Designing the 10 Second Triage Tool
05:16 Implementing the Triage Tool
06:50 How the 10 Second Triage Tool Works
13:48 Real-World Applications and Benefits
18:54 Conclusion and Final Thoughts
During Winter's Challenges, Iain Beardsell and Simon Carley reviewed the November 2024 blog posts for St Emlyn's podcast, marking the start of 2025. They discuss the busy state of emergency departments, critical incidents, and the importance of maintaining a learning culture.
They highlight the upcoming Big Sick Conference in Zermatt and the IncrEMentuM in Spain, noting their potential benefits for networking and education.
Simon emphasizes creating a psychologically safe environment and fostering curiosity, growth, and knowledge-sharing among emergency department staff. They also review a range of medical studies, including those on small bore vs. large bore chest tubes for haemothorax, intra-arrest arterial blood pressure monitoring, and the new GLP-1 receptor antagonists for obesity treatment.
Lastly, they address the importance of handling bad behavior in the team and maintaining kindness and professionalism, even during high-stress periods.
00:00 Introduction and New Year Greetings
00:35 Current State of Emergency Departments
01:17 Upcoming Conferences: The Big Sick and IncrEMentuM
03:43 Building a Learning Culture in Emergency Medicine
12:24 Pre-Hospital ECPR and ECMO
13:58 Small Bore vs Large Bore Chest Tubes
17:37 Intra-Arrest Arterial Blood Pressure Monitoring 24:01 New Drugs and Toxicology
24:47 Care in the Hot Zone
27:12 Addressing Bad Behaviour in Emergency Departments
30:42 Conclusion and Future Plans for St Emlyn's
In this episode of the St. Emlyn's podcast, Rick Body and Greg Yates delve into the concept of likelihood ratios, an advanced yet practical tool for diagnosing patients in the emergency department. Building on the previous episode about predictive values, they explain how likelihood ratios help compare the probability of test results between diseased and non-diseased patients. They provide examples, like evaluating chest pain and using the Smith Calculator for Anterior ST Elevation, to show how likelihood ratios can change clinical decision-making.
Rick and Greg also discuss Bayesian reasoning and how pretest and post-test probabilities are used in practice.
00:00 Introduction to the Podcast
00:34 Understanding Likelihood Ratios
02:05 Practical Example: Chest Pain Case
03:53 Calculating Likelihood Ratios
07:17 Applying Bayesian Reasoning
09:50 Recap and Conclusion
In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley provide a comprehensive update for October 2024. They discuss key blog posts covering diverse medical topics, including highlights from the Royal College of Emergency Medicine's academic science conference focusing on toxicology, high-potency opioids, novel benzodiazepines, and the use of flumazenil.
They also explore the Green ED project and the impact of climate change on healthcare. Additionally, they delve into recent research on ventricular fibrillation pad positions, the use of tranexamic acid (TXA) in trauma care, and the importance of maintaining a positive outlook amidst winter challenges by seeking small wins and engaging in enjoyable aspects of emergency medicine. The episode offers valuable insights and updates for emergency medicine professionals.
00:00 Welcome and Introduction
01:27 Highlights from the Royal College of Emergency Medicine Conference
01:50 Toxicology Insights: High Potency Opioids and Benzodiazepines
05:11 Climate Change and Healthcare: The Green ED Project
08:23 Medical Conferences: A Phoenix from the Ashes
10:38 Ventricular Fibrillation and Pad Position: New Insights
17:22 Tranexamic Acid (TXA) in Trauma Care
24:01 Maintaining Positivity in Challenging Times
In this episode of the St Emlyn's podcast, Iain Beardsell and Natalie May reflect on their experiences at the London Trauma Conference, a four-day event covering various aspects of trauma and pre-hospital care.
They discuss key takeaways from sessions on cardiac arrest, including talks on perioperative cardiac arrest and the prognostication of cardiac arrest patients.
The episode also delves into wellness in the medical field, featuring insights from senior emergency physician Rod McKenzie and pre-hospital expert Matt Hooper on practical psychosocial care. Additionally, the podcast highlights advancements in trauma care, defibrillation strategies, and the importance of correct pad placement and basic practices.
The episode underscores the holistic approach to patient care and the significance of personal well-being for medical professionals.
00:00 Welcome to the St Emlyn's Podcast
00:52 Highlights from the London Trauma Conference
01:13 Cardiac Arrest Symposium Insights
03:53 Prognostication After Cardiac Arrest
06:44 Defibrillation Strategies and Basics
08:29 Wellness and Mental Health in Emergency Medicine
11:10 Palliative Care in Pre-Hospital Settings
12:32 Trauma Conference Highlights and Innovations
16:48 Poster Presentations and Stand-Up Science 17:58 Key Takeaways and Reflections
18:43 Closing Remarks
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe are joined by Chris Bishop, a clinical research fellow at the Centre for Trauma Sciences at Queen Mary University of London. Chris discusses his PhD research on veno-arterial ECMO support for cardiogenic shock following major trauma haemorrhage and explains the principles and applications of ECMO, particularly in trauma patients. The conversation covers the current practices, challenges, and future directions in the use of ECMO for trauma care, including multidisciplinary decision-making, patient selection criteria, and pioneering techniques like selective aortic arch perfusion and emergency preservation and resuscitation.
00:00 Introduction
01:12 Understanding ECMO and Its Applications
02:20 ECMO in Trauma Patients
04:17 Challenges and Resistance in ECMO Adoption
05:36 Current Research and Practices
11:31 Future Directions in Trauma Resuscitation
13:28 Conclusion
This episode, recorded live at Tactical Trauma 24 explores the concept of bad behaviour within high-performing medical teams. Liz Crowe, who will be well known to regular listeners, discusses what constitutes bad behaviour, its impacts on team dynamics and patient safety, and the importance of self-awareness among medical professionals.
Key findings from recent research highlight that even subtle actions like eye-rolling can negatively affect patient safety as much as overt harassment. The speaker emphasises the importance of psychological safety, trust, competence, authenticity, consistency, and empathy in maintaining a healthy team environment. Practical advice includes assessing one's own behaviour and seeking honest feedback from colleagues and loved ones.
Comprehensive show notes are available here
00:00 Introduction: Addressing Bad Behaviour
01:18 Defining Bad Behaviour
01:49 Impacts of Bad Behaviour
03:15 Psychological Safety and Team Dynamics
04:24 Personal Experiences and Observations
05:46 Types of Bad Behaviour
07:19 Research Findings on Workplace Behaviour
09:10 Self-Awareness and Behavioural Impact
14:21 The Karpman Drama Triangle
17:29 Conclusion and Final Thoughts
In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley discuss various facets of emergency medicine.
They highlight a study on patient experience in emergency departments, focusing on issues like loss of autonomy, unmet expectations, and vulnerability. Suggestions for improvement include better communication, effective signage, and patient comfort.
The podcast also covers a 'dirty adrenaline drip' study from Australia, emphasizing remote inotrope management.
Discussions include the use of arterial blood pressure monitoring in pre-hospital settings and the merits of CT scans beyond the traditional six-hour window for diagnosing subarachnoid haemorrhage.
The episode wraps up with reflections on the positives of emergency medicine and the importance of maintaining enthusiasm and mastery in the field.
00:00 Introduction01:08 Patient Experience in the Emergency Department02:33 Improving Patient Experience: Practical Tips04:05 Qualitative Studies in Healthcare06:43 Dirty Adrenaline Drip: A Practical Insight10:44 Emergency Endoscopy for Caustic Ingestions14:15 Subarachnoid Hemorrhage Diagnosis: The S.H.E.D. Study18:14 Arterial Blood Pressure Monitoring in Pre-Hospital Settings24:18 Reflections on Emergency Medicine as a Career27:41 Conclusion
In this episode, recorded live at Tactical Trauma 2024, Dr Claire Park explores the critical lessons learned from civilian and military incidents, focusing on her extensive experience in the Army and their role as chief investigator in a UK trial examining responses to terrorist attacks. The talk covers the significance of 'hot zones,' illustrated by detailed analyses of the London Bridge and Fishmongers' Hall attacks and key topics include risk assessment, the importance of rapid medical intervention, the concept of survivability, the need for integrated communication among emergency services, and the human factors influencing decision-making in high-pressure environments. Claire also delves into practical strategies like the 10-second triage and bridging interventions, emphasizing the need for timely and effective medical responses to save lives. 00:00 Introduction to Learning from Incidents01:52 Setting the Scene: Hot Zones01:55 Case Study: London Bridge Attack04:23 Understanding Hot Zones05:51 Case Study: Fishmongers Hall07:58 Risk Assessment in Pre-Hospital Care09:23 Communication and Coordination Challenges10:16 International Models and Time Management12:13 Triage and Life-Saving Interventions15:18 Data and Research on Causes of Death21:43 Human Factors in Emergency Response24:00 Conclusion Dr Claire Park is a consultant in pre-hospital emergency medicine for London's HEMS, as well as anaesthesia and critical care medicine at Kings College Hospital in London. She also is an army consultant with over 20 years of deployed military experience. Claire is the Medical Adviser to the Specialist Firearms teams of the Metropolitan Police Service and has worked closely with all of the emergency services in London on developing the joint response to high-threat incidents, particularly following the attacks of 2017. She is the Chief Investigator on a UK nationally-funded research grant looking at evidence for improving patient outcomes in the hot zone of major incidents. She is also a CTECC Committee member.
Join Iain Beardsell and Liz Crowe in an engaging discussion with Alice Hutton, an emergency physician from Paris, at Tactical Trauma 24 in Sundsvall, Sweden.
The episode delves into the implementation and logistics of pre-hospital eCPR (Extracorporeal Cardiopulmonary Resuscitation) by SAMU in Paris. Alice shares insights from her PhD research on refractory cardiac arrest and discusses the use of therapeutic hypothermia, including experimental approaches like total liquid ventilation.
Key topics include team composition, decision-making for patient eligibility, real-time management strategies, bypassing traditional emergency rooms for specialized facilities, and the challenges of scene management, family communication, and post-event debriefing.
This conversation offers a comprehensive look at the latest innovations that could transform pre-hospital emergency medical services.
Read more here...
00:00 Introduction and Guest Introduction
01:29 eCPR in Paris: Current Practices
02:35 Dispatch and Response Protocols
03:32 On-Scene Procedures and Challenges
04:23 Decision Making and Scene Management
05:53 Training and Handling Difficult Situations
06:59 Challenges of eCPR Decision-Making
08:07 Importance of Team Debriefing
08:52 Post-Resuscitation Procedures
10:12 Operational Logistics and Success Rates
11:20 Innovative Research in Therapeutic Hypothermia
13:13 Future of Pre-Hospital Cooling Techniques
13:46 Conclusion and Final Thoughts
In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Simon Carley share their insights from recent conferences, including Gateshead's RCEM scientific conference, Tactical Trauma 24 in Sweden, and the Premier Conference.
They explore 'Goldilocks moments' for executing life-saving procedures in critical care, emphasizing optimal timing for interventions like thoracotomies. The episode also discusses innovative training methods like shadowboxing to enhance decision-making in high-stress medical scenarios. In addition, they review a significant trial on smoking cessation in emergency departments, highlighting its potential role in broader public health initiatives, including sexual health and HIV screening.
Discussions also cover various pain management strategies, such as the use of intranasal vs. intravenous Ketorolac for renal colic. The hosts critique the traditional peer review process in medical research and advocate for open peer review to support equitable and accessible scientific publishing.
00:00 Introduction and Catching Up
02:07 The Goldilocks Moment in Critical Care
05:25 Training and Decision-Making in Emergency Procedures
07:23 Smoking Cessation in Emergency Departments
10:07 Challenges in Implementing Preventive Health Strategies
10:38 Successful Public Health Projects in Emergency Medicine
11:19 Exploring Alternative Interventions in Emergency Departments
11:52 Highlights from the Premier Conference
12:54 Intranasal Ketorolac for Pain Management
15:46 The Future of Peer Review in Medical Research
20:09 Concluding Thoughts and Upcoming Content
In this episode, recorded at Tactical Trauma 2024, Andrew Petrosoniak discusses real-world experiences in trauma care, and the innovative use of simulation to resolve systematic issues in blood delivery and overall trauma resuscitation protocols.
Key takeaways include the concept of intelligent failure, reducing cognitive overload for medical staff, and the creation of efficient medical environments. Moreover, the episode delves into the significant improvements achieved through simulation, such as a 50% reduction in blood delivery times, and the integration of performance data to enhance CPR and clinical space design. Emphasizing the importance of using data to drive improvements, the conversation explores the implementation of roles like a CPR coach and the scalable application of these practices across individual, team, and systemic levels.
Listeners are encouraged to view failures constructively and leverage simulations and data for better patient outcomes and team performance.
00:00 Introduction to Simulation in Emergency Medicine
01:05 A Real-Life Trauma Case
02:18 Identifying Systemic Issues
02:46 Implementing and Testing Solutions
05:45 The Concept of Intelligent Failure
09:41 Scaling and Impact of Simulation
10:22 The Power of Simulation in Experimentation
10:56 Data Integration in Healthcare and Sports
11:29 Evaluating CPR Quality Through Simulation
12:14 Using Data to Improve Clinical Performance
13:47 Designing Clinical Spaces with Simulation Data
15:28 Scaling Impact with Simulation
18:02 Efficient Team Communication in Trauma Bays
19:04 Broadcasting and Recording Simulations for Education
19:39 Conclusion and Future Directions
The SpeakerDr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital and an Assistant Professor in the Department of Medicine at the University of Toronto. He has completed a Master of Science in medical education where he focused on the use of in situ simulation (practice in the actual workplace) in procedural skill acquisition.
Andrew’s field of research includes in situ simulation and simulation-based technical skill acquisition. His work focuses on usability testing and the identification of personnel- and systems-based safety threats within acute care medicine. He is the principal investigator of the TRUST study (Trauma Resuscitation Using in Situ simulation for Team Training) that includes a partnership with human factors experts to evaluate systems and processes during high-stakes trauma simulations.
Recorded at Tactical Trauma 2024, in this episode of the St. Emlyn’s podcast, Iain Beardsell and Liz Crowe sit down with Kevin Cyr, commander of a SWAT-like unit in the Royal Canadian Mounted Police, to discuss leadership, failure, and resilience in high-stakes environments. Kevin shares the powerful story of a tragic hostage situation that resulted in the unintended death of the hostage by the police, a failure of the highest order. Through this tragedy, Kevin highlights the importance of visible leadership, team resilience, and learning from failure in both law enforcement and healthcare settings.
Key Themes:
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Handling Failure in High-Pressure Situations:
Kevin discusses a significant incident where a hostage was killed by his SWAT team during a rescue attempt, describing it as the “epitome of failure.” This tragic event not only made national news but left an indelible mark on the team. The podcast dives into the lessons learned from this event and how the team used it to drive growth and improvement. In healthcare, much like in policing, failure can feel devastating and highly public, but it’s also a critical aspect of development for teams and leaders. -
Visible Leadership and Unwavering Support:
In the aftermath of a traumatic event, Kevin emphasizes the importance of leadership being present and supportive. He recounts how he and his commanding officer went to visit the officers involved in the shooting immediately after the event, providing what he calls “unwavering support.” In healthcare, leaders should adopt similar strategies, offering visible and sustained support to their teams in the immediate aftermath of difficult cases. -
Sustained Support Over Time:
While initial support following a traumatic event is crucial, Kevin points out that it’s often after 48 hours, or even weeks later, that people start feeling isolated. Leaders must continue to check in with their teams weeks after the event, when the immediate crisis may have passed, but the emotional toll is still present. This ongoing visibility and emotional support are key to retaining staff and ensuring their well-being in both law enforcement and healthcare. -
Debriefing to Learn, Not to Blame:
Kevin advocates for a debriefing process that focuses on learning from failure rather than assigning blame. After their tragic event, his team didn’t just move on; they dissected the event to understand what went wrong and how to prevent similar failures in the future. In healthcare, this process is equally valuable—debriefs should aim to identify learning opportunities and reinforce positive actions, not to point fingers. -
The Role of Organizational Culture:
Kevin touches on how organizational apathy, or a lack of emotional and psychological support, can cause more damage than the actual traumatic event itself. He highlights the importance of developing a high-trust environment where team members feel safe to express vulnerability. In healthcare, fostering a culture of open communication and mutual support is essential to prevent burnout and moral injury. -
The Value of Failure in Team Growth:
One of the most profound insights Kevin shares is the idea that failure is a necessary part of growth. Three years after their tragic hostage situation, his team was called to a similar event, but this time they were successful in rescuing both hostages. Kevin attributes this success directly to the lessons learned from their earlier failure, emphasizing that failure, when handled correctly, can lead to transformational change. -
Selection and Resilience in High-Performance Teams:
Kevin discusses the importance of selecting team members with high emotional intelligence and the humility to ask for help when needed. He explains how his team differentiates between rank and role, giving autonomy to those with the most subject matter expertise, regardless of their rank. In healthcare, this is a critical point—leaders must recognize that true leadership isn’t just about authority, but about empowering others to take charge when appropriate. -
Managing Expectations and Mental Health:
The episode also delves into how individuals in high-stakes roles, whether in policing or healthcare, cope with the psychological aftermath of traumatic events. Kevin explains how his team has shifted from the belief that emotional support is unnecessary to recognizing the value of helping team members process their experiences in a healthy way. This parallels the increasing focus in healthcare on preventing burnout and ensuring emotional well-being through proactive support.
Key Takeaways:
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Failure is Inevitable: In high-stakes environments like policing and healthcare, failure will happen. What matters is how teams respond to failure—learning from it, growing stronger, and preventing future mistakes. Leadership Requires Visibility: Leaders must be present, especially in the aftermath of failure. Showing unwavering support and maintaining visibility over time is crucial for maintaining team morale and trust.
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Debriefing to Learn: After a failure, it’s essential to have structured debriefs that focus on learning and improving, rather than blaming. This helps teams identify areas of improvement and ensures they grow stronger from difficult experiences.
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Long-Term Support is Critical: Immediate support after a traumatic event is important, but equally important is sustaining that support over time, checking in with team members weeks or even months later to ensure their well-being.
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Resilience through Humility: Teams should be built on trust and humility, where members can ask for help when needed and offer help to others. Selecting individuals with high emotional intelligence is key to creating a resilient team.
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Failure Leads to Growth: When handled correctly, failure can drive transformational change within teams. It allows for the development of new skills and ensures that teams are better prepared for future challenges.
Quotes:
- “Failure is a necessary part of growth. It’s not just something to get over, it’s something you get better from.”
- “Visible leadership and unwavering support are critical in the immediate aftermath of failure. Your team needs to know you’re there with them.”
- “Debriefing to learn, not to blame, is essential. We must focus on what went well, what went wrong, and how to improve next time.”
- “In high-pressure environments, we can’t control every variable, but we can control how we respond to them and how we prepare for the future.”
Welcome back to the St. Emlyn’s podcast. This episode covers some of the most important developments in emergency medicine and critical care from July 2024. Whether you're practicing on the frontlines or keeping up with the latest research, this episode has something for you. From coronary risk scoring tools to cutting-edge AI in ECG interpretation, and the management of non-fatal strangulation, it’s packed with insightful updates. Here's a breakdown of the key topics:
The Manchester Acute Coronary Score (MACS Rule) is a valuable tool for risk-stratifying patients presenting with chest pain in the emergency department (ED). MACS uses both clinical characteristics and biomarkers like troponin to assess a patient's likelihood of experiencing an acute coronary event. A recent systematic review found that the T-MACS model (which uses troponin) has a sensitivity of 96%, making it highly effective at ruling out serious coronary events.
Though the specificity is lower, MACS’s real strength lies in its ability to drive clinical decisions and patient referrals. This tool is already integrated into the Electronic Patient Record (EPR) in Manchester, where it helps streamline the decision-making process for patients with chest pain. If you’re looking for a reliable method to quickly and accurately stratify risk, MACS could be the answer.
Artificial intelligence (AI) is revolutionizing healthcare, and its application in ECG interpretation is particularly exciting for emergency medicine. In this episode, Steve Smith joins us to talk about how AI can enhance the detection of occlusive myocardial infarction (OMI)—a concept that might one day replace the traditional ST-elevation and non-ST-elevation classifications.
By integrating AI into rapid assessment areas (like pit-stop zones in the ED), clinicians can benefit from real-time ECG analysis. This reduces the burden of interruptions and helps detect subtle abnormalities that might be missed in high-pressure environments. AI-driven ECG tools could dramatically improve patient outcomes, particularly in cases of high-risk cardiac events.
Non-fatal strangulation (NFS) is an often underdiagnosed condition in emergency medicine, but it carries significant risks, including carotid artery dissection. A new guideline from the Faculty of Forensic and Legal Medicine emphasizes the importance of detecting these cases and suggests that clinicians use contrast angiography to rule out vascular injuries.
Beyond the medical consequences, non-fatal strangulation is also a major indicator of future violence, including homicide. The guideline highlights the ethical challenges clinicians face when deciding whether to involve law enforcement, especially when patient consent is lacking. Safeguarding and appropriate referrals are essential for these high-risk patients.
REBOA has been evolving in recent years, and now it’s moving from the emergency department into the pre-hospital setting. In the latest advancements, partial REBOA—which allows for some blood flow below the balloon—is being used to resuscitate patients in traumatic cardiac arrest.
This partial occlusion technique may be more effective in maintaining coronary perfusion, essentially resuscitating the heart in cases of extreme hemorrhage. Early data from a feasibility study shows promise, with an 18% survival rate in patients who otherwise would have had little chance of survival. REBOA could become a life-saving pre-hospital intervention for trauma patients in the near future.
Paediatric eating disorders, particularly anorexia and diabulimia, remain under-recognized in emergency medicine. In this episode, we explore some of the red flags—such as rapid weight loss, bradycardia, and postural hypotension—and why emergency clinicians need to be more attuned to the signs of eating disorders.
Of all mental health disorders, anorexia has the highest mortality rate, and in cases of diabulimia, patients intentionally stop taking insulin to induce ketosis and lose weight. Given the severity of these conditions, it's crucial that we recognize them early and respond appropriately, especially when young diabetic patients present with unusual symptoms.
The advent of hybrid closed-loop insulin pumps is transforming the care of type 1 diabetes. These pumps act as an artificial pancreas, continuously monitoring blood glucose levels and adjusting insulin delivery automatically. The latest guidelines from NICE recommend these devices for all patients with type 1 diabetes in the UK.
However, these pumps come with their own set of challenges, especially in the emergency department, where clinicians need to know how to troubleshoot common problems, such as cannula blockages or starvation ketosis. In this episode, Nicola Trevelyan walks us through the essential steps for managing patients who use these devices.
Lidocaine patches have long been used as a low-risk intervention for managing pain in elderly patients with rib fractures, particularly when nerve blocks or NSAIDs aren’t viable options. But how effective are they? A recent feasibility study compared lidocaine patches with standard care and found that while the pulmonary complication rate remains high, the patches may offer some benefit for pain relief.
While more research is needed, lidocaine patches continue to be a low-harm option that might provide relief in certain patient populations, particularly where other pain management strategies are contraindicated.
Button battery ingestion remains one of the most dangerous emergencies in pediatric medicine. Francesca Stedman, a pediatric surgeon, explains the dangers of battery-induced burns, which can occur within hours of ingestion. Time is of the essence in these cases, and quick identification through radiographic imaging followed by rapid removal is critical to prevent long-term damage.
Even when batteries are lodged in places like the nose, they can cause significant tissue damage in a short time, making early intervention absolutely vital.
That’s a wrap for our July 2024 podcast update! From life-saving interventions like REBOA and AI in ECG analysis to the everyday challenges of managing pediatric emergencies and coronary risk, this month’s highlights offer a wealth of knowledge for clinicians. Be sure to check out the full blog posts and podcasts for more in-depth discussions on each of these topics. Thanks for listening and stay tuned for more cutting-edge insights from St. Emlyn’s!
In this episode of the St Emlyn's podcast, Iain Beardsell is joined by Dan Horner, a consultant in Emergency Medicine and Neurocritical Care, and Tom Roberts, an Emergency Medicine Registrar and clinical lecturer, to discuss their recently published SHED study on subarachnoid haemorrhage in the Emergency Department (ED). This landmark study, published in the Emergency Medicine Journal, explores the safety of CT scans in diagnosing subarachnoid haemorrhage up to 24 hours after headache onset and evaluates the role of further investigations like a lumbar puncture.
The study examines acute severe headache presentations in the ED and the diagnostic approach to ruling out subarachnoid haemorrhage, a critical and often feared diagnosis among emergency physicians. Conducted through the Trainee Emergency Research Network (TURN), the study included over 3,600 patients from 88 UK EDs with acute severe headaches reaching maximum intensity within one hour and no focal neurology. Data collection included CT scans, lumbar puncture results, and 28-day follow-up to identify missed cases of subarachnoid hemorrhage.
Key findings from the study revealed a 6.5% prevalence of subarachnoid haemorrhage, with a significant number presenting within six hours of headache onset. The sensitivity of CT scans remained high beyond the traditional six-hour window, suggesting that CT alone could safely rule out subarachnoid haemorrhage up to 18 hours in many cases, potentially reducing the need for lumbar puncture. The risk of missing an aneurysmal subarachnoid haemorrhage after a negative CT was found to be extremely low, around 1 in 1,000.
These findings challenge the routine use of lumbar puncture in patients presenting beyond six hours if the CT scan is negative, potentially changing ED practice and reducing unnecessary invasive procedures. The discussion also emphasized the importance of shared decision-making and recognizing that diagnostic testing is about managing probabilities, not certainties. For clinicians, the episode highlights the need to expedite CT scans for patients with acute severe headaches, especially those presenting within 10 minutes of onset, as they are more likely to have significant pathology. Emergency physicians are encouraged to own the decision-making process for ruling out serious causes of headaches and not defer solely to 'specialists'.
The SHED study supports extending the diagnostic window for CT scans in ruling out subarachnoid hemorrhage up to 18 hours, reducing the need for lumbar puncture in many cases. This data empowers emergency clinicians to make informed decisions, manage patient expectations, and streamline ED processes.
For more information, listeners are encouraged to read the SHED Study in the Emergency Medicine Journal and explore the related blog post on the St Emlyn’s website. Emergency clinicians are also invited to connect with TERN to get involved in future research opportunities.
This episode provides valuable insights for clinicians in managing acute severe headaches, emphasizing a more nuanced approach to subarachnoid hemorrhage diagnosis and the importance of clinical decision-making in the ED.
In this episode, we delve into the critical role of neuroprotection in pre-hospital care, particularly in pediatric head injuries. Through a real-life case study of a 13-year-old boy who suffered a traumatic brain injury after being hit by a car, we explore the steps taken by paramedics and critical care teams to stabilize him and prevent further neurological damage. From airway management to advanced interventions, this episode highlights the challenges of pre-hospital neuroprotection and the incredible teamwork that led to the patient’s remarkable recovery.
There is more detail on the full blogpost here.
This podcast was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organizing team for hosting us and allowing us to use the audio. The PIER and PREMIER websites are full of amazing resources for anyone working in Paediatric Emergency Medicine, and we highly recommend them.
The SpeakerEd is a Speciality Trainee in Emergency Medicine in Wessex and a trainee Critical Care Practitioner with Dorset and Somerset Air Ambulance. Ed is also the co-founder and Managing Director of Enhanced Care Services, a Southampton-based company delivering enhanced and critical care to the event medical sector, providing frontline ambulance services across Hampshire and clinical education at all levels, employing over 200 clinicians. Ed holds the Diploma in Immediate Medical Care (RCSEd) and, having promised to not take on any more work, is currently undertaking a Masters in Resuscitation, Pre-hospital and Emergency Medicine at QMUL.
Enhanced Care ServicesEnhanced Care Services' mission is to provide and influence excellent patient care, irrespective of injury, illness or location, through the delivery of high-quality clinical operations and education. Founded in 2015, ECS now provide frontline ambulance operations across the South, delivers extensive medical cover to some of the most prestigious events across the UK and provides education from its bespoke education centre in Southampton and beyond.
In this episode, Dr Tim Warlow, a consultant in Paediatric Palliative Care, explores the complexities of caring for children with life-limiting conditions in the emergency department (ED). The discussion highlights the increasing prevalence of paediatric life-limiting conditions and the growing medical complexity of these cases, which pose significant challenges for ED staff.
The episode begins by clarifying what paediatric palliative care truly involves. Contrary to common misconceptions, palliative care is not about withdrawing care but rather enhancing the quality of life for children from the point of diagnosis, whether the condition is present from birth or develops as the child deteriorates. This proactive approach often involves increasing the level of care and support as the child’s needs evolve.
As the number of children with life-limiting conditions continues to rise, EDs are encountering more medically complex cases, including children who are technology-dependent and require high levels of care at home. These challenges are compounded by the evolving expectations of parents, who are often better informed and more involved in their child's care decisions. Post-COVID, community services have struggled to recover, particularly in nursing support, making the role of the ED even more critical.
The episode provides practical tips for ED professionals to better manage these cases. Key strategies include:
- Recognising Life-Limiting Conditions: With over 400 recognized life-limiting conditions and many more undiagnosed, it’s crucial to assess whether a child might have palliative care needs.
- Listening to Families: Families often have an intimate understanding of their child’s unique medical baseline. Listening deeply to their insights, even when they seem unusual, is essential for providing appropriate care.
- Building Rapid Rapport: Quickly establishing a connection with the family is vital, as these children can deteriorate rapidly. Acknowledging the child’s presence, summarizing the situation, and validating the family’s experience can help build trust.
- Understanding the Child Beyond Their Illness: Families worry that healthcare professionals only see their child when they are unwell. Taking the time to learn about the child’s life outside of the hospital can lead to better care decisions.
- Reading the Advanced Care Plan: If available, review the child’s advanced care plan before discussing the case with the family. This ensures that the family doesn’t have to recount their entire journey and that care decisions are based on the most current information.
The episode also addresses the importance of being aware of unconscious prejudice. Healthcare professionals must ensure that decisions are based on the child’s specific needs rather than assumptions about their quality of life due to their disability.
In conclusion, the episode emphasizes that while caring for children with life-limiting conditions in the ED is challenging, it is also deeply rewarding. The key to providing excellent care lies not just in medical interventions but in being present, listening, and supporting the family through difficult times. Whether things go as planned or not, your presence and compassion are what families remember most.
This episode is a must-listen for anyone involved in pediatric care, offering valuable insights into the critical role of the ED in supporting children with life-limiting conditions and their families. There is more detail on the blogpost here.
As the UK enjoys its unpredictable summer, with everything from sunshine to hailstorms, we bring you a mix of updates and discussions on emergency medicine, blog content, upcoming conferences, and insightful research reviews. So, whether you're basking in the sun or sheltering from the rain, sit back and enjoy our latest insights into the world of emergency medicine.
In this round-up of Month Year, we talk about a wide range of issues relating to emergency medicine, including nebulised ketamine for analgesia in the ED, risky intubations, presentation skills, more about the DOSE VF trial and analysis of the much-hyped PREOXI trial about preoxygenation before tracheal intubation.
We're excited to announce our participation in two upcoming conferences. The Tactical Trauma Conference in Sweden this October promises to delve into pre-hospital emergency medicine, offering sessions from renowned speakers. It's a fantastic opportunity to learn and network, with flights to Sweden being relatively affordable. The event takes place just north of Stockholm, providing a chance to explore the beautiful city.
In March next year, we look forward to the Incrementum Conference in Murcia, Spain. This is a significant event as emergency medicine has recently been recognized as a specialty in Spain. The conference will feature an impressive lineup of speakers from the FOMED world, including Scott Weingart, Ken Milne, Hany Malamatt, and Slim Resie , among others. Our very own Simon Carly will also be presenting. We'll be there to conduct interviews and gather exclusive content for our listeners.
Thank you for joining us, please do like and subscribe wherever you get our podcasts.
In this podcast from the PREMIER conference 2024, Francesca Stedman, a consultant paediatric surgeon from Southampton Children's Hospital discusses the care of the child who has ingested a button battery.
Button batteries are ubiquitous and come in various types and sizes. There are about 85 different kinds available or in use in the UK alone, found in everything from toys to hearing aids. The most notorious is the CR2032, which is about 20 millimeters in diameter and 3.2 millimeters thick. It contains lithium manganese oxide, and while its small size makes it convenient for electronics, it poses a significant risk if ingested.
The danger with button batteries lies in their potential to cause severe injuries when lodged in the esophagus. They can cause necrosis, which is essentially tissue death, due to a strong alkaline substance produced by the battery. This substance acts like a potent oven cleaner, rapidly causing damage. The esophagus has three natural narrowing points where these batteries often get stuck, increasing the likelihood of injury. The situation becomes critical very quickly, often within two hours of ingestion.
One of the most concerning aspects of these incidents is that button battery ingestions are rarely witnessed. Children might present with vague symptoms like drooling, difficulty swallowing, or even just being generally unwell. These can easily be mistaken for other common illnesses, leading to delays in diagnosis. In one particularly harrowing case, a child presented multiple times with symptoms of a respiratory infection, only for an x-ray to reveal a button battery lodged in the esophagus. By then, the damage was extensive.
When ingestion is suspected, immediate action is crucial. Getting a chest x-ray is the first step, and if necessary, a lateral x-ray can confirm the presence of a button battery by revealing a characteristic double rim or halo sign. Pre-hospital measures can include giving honey or jam, depending on the child’s age, to help mitigate the damage. However, these should never delay getting the child to the hospital.
Once at the hospital, the primary goal is to remove the battery as quickly as possible to prevent further injury. Depending on the location of the battery and available specialists, either ENT surgeons or paediatric surgeons may perform the removal. Post-removal care involves monitoring for complications like perforations or fistulas, which can develop days or even weeks later. In severe cases, these injuries can lead to life-threatening conditions, such as aorto-esophageal fistulas, which require immediate surgical intervention.
In summary, button battery ingestion is a serious and often underappreciated risk. Even in homes where precautions are taken, accidents can happen. The key is quick recognition and action. As parents and caregivers, we need to be vigilant about keeping these small, dangerous objects out of children's reach. And if an accident does occur, immediate medical attention is essential to minimize the risk of serious injury.
More details are available on the blogpost here.
In this St. Emlyn's podcast, Rick Body and Greg Yates, continue our exploration of diagnostic test accuracy, shifting our focus to positive predictive value (PPV) and negative predictive value (NPV). These concepts are vital for anyone preparing for exams or looking to enhance their application of diagnostic tests in clinical practice. While our last podcast discussion centred on sensitivity and specificity, PPV and NPV offer a different, arguably more clinically practical perspective on interpreting test results.
Positive predictive value (PPV) and negative predictive value (NPV) are essential tools for understanding the effectiveness of diagnostic tests. PPV helps us determine the likelihood that a patient with a positive test result actually has the condition, whereas NPV helps us gauge the probability that a patient with a negative test result does not have the disease. These values are crucial for making informed clinical decisions, particularly when considering the prevalence of a condition in the population. Today, we’ll delve into these concepts, their practical applications, and why it's important to consider both PPV and NPV alongside sensitivity and specificity.
You can find more about this on the St Emlyn's Blog and please don't forget to like and subscribe.
In today's episode, taken from live recordings at PREMIER 2024, we dive into an increasingly common treatment for type 1 diabetes: hybrid closed loop insulin pumps. We'll begin with a brief overview of traditional insulin pumps and explain how hybrid closed loops are different. The core of our discussion will be centered around three case studies, illustrating potential scenarios you might encounter in a pediatric emergency department and how to manage them effectively.
With NICE's recent technology appraisal advocating for universal access to hybrid closed loop systems for all type 1 diabetes patients, it's crucial to understand these devices. Over the next few years, you'll likely encounter these systems frequently. We'll cover the essentials of how these pumps work, their benefits, and potential issues that might arise, such as connectivity problems, cannula issues, and handling intercurrent illnesses.
Join us as we explore the revolutionary impact of hybrid closed-loop systems, which offer better glucose control and significantly improve the quality of life for those with type 1 diabetes.
Dr Nicola Trevelyan has been the Clinical Lead for the Paediatric Diabetes Service in Southampton for the last 20 years. During this time, she has seen huge changes in the management of CYP with diabetes. She has been involved in several large multicentre trials for paediatric diabetes, helping to better our understanding of how best to use new technologies in diabetes management in children and move forward access to new treatment technologies. She was one of the founding committee members for the Assoc of Children's Diabetes Clinicians (ACDC) in 2006 and has been on working parties for BSPED helping evidence base and re-write the national DKA guidelines in 2020 and for the National Paediatric Diabetes Audit. For the last 4 years, she has been on the Clinical Advisory Group for the RCPCH Quality Improvement Programme for Paediatric Diabetes.
It was a huge pleasure to sit down with Steve Smith, a name synonymous with ECG expertise. Steve, renowned worldwide for his influential ECG blog, has been a pivotal figure in advancing our understanding of ECGs. Many of us have honed our ECG skills thanks to Steve’s insights. I had the opportunity to meet Steve about a decade ago at one of the SMACC conferences. Today, we delve into the fascinating world of occlusive myocardial infarction (OMI) and its comparison to STEMI (ST-elevation myocardial infarction), and explore the promising future of artificial intelligence in ECG interpretation.
A comprehensive blog post with references is available here
Eating disorders are a critical health concern that tragically lead to numerous deaths, especially among young women during their transition age. Anorexia nervosa, in particular, is the most deadly psychiatric condition with a 10% lifetime mortality risk. Recent coroner reports highlight significant medical failings and a dire lack of knowledge among healthcare providers. Given the 90% increase in eating disorder admissions over the last five years, this issue demands urgent attention.
In this podcast Anna Kyle, a consultant paediatrician, covers all you need to know when looking after a young person or young adult with an eating disorder in the Emergency Department.
Comprehensive notes can be found here
Welcome to the St Emlyn's Monthly Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Simon and Iain will bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development.
In this round-up of May 2024, we talk about a wide range of issues relating to emergency medicine, including highlights from the RCEM conference, including the future management of head injury, crowding, RATing and what it takes to be an awesome ED for training. There's also advice on how to be a epic Emergency Physician In Charge, as well as discussion about the use of ChatGPT for medical exams, serratus anterior blocks for rib fractures, whether first pass success matters and the return of measles.
Thank you for joining us, please do like and subscribe wherever you get our podcasts.
The sudden death of anyone is a tragic event, but even more so a child, particularly when it comes completely unexpectedly. We've all seen stories in the papers or even been involved in caring for these young people. In this podcast Harshil Dhutia talks about the common causes fo sudden cardiac death, and gives a roadmap for the investigation of young people with worrying symptoms and ongoing care for their families.
There are more details in the comprehensive post on the St Emlyn's blog site
This podcast was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organising team for hosting us and allowing us to use the audio. The PIER and PREMIER websites are full of amazing resources for anyone working in Paediatric Emergency Medicine and we recommend them highly.
The SpeakerHarshil Dhutia is a consultant cardiologist at Glenfield Hospital, University Hospitals of Leicester the lead for inerited cardiac conditions service in the region, providing specialist care for patients with genetic heart diseases and their family members. He is a International Board of Heart Rhythm Examiners certified heart rhythm specialist for all aspects of cardiac device implantation and management including pacemakers, defibrillators and cardiac resynchronisation therapy. He is an expert in sports cardiology and has extensive clinical and research interests in the management of competitive and recreational athletes with cardiovascular disease. He is the medical lead for the Joe Humphries Memorial Trust, a Leicestershire based charity that raises awareness of sudden cardiac death in young people and provides cardiovascular resuscitation and AED training in schools, sports clubs and to members of the community.
Welcome to St Emlyn's Monthly Round Up Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Iain and Simon bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development.
You can find an in-depth set of shownotes on St Emlyn's. Please do also like and subscribe, wherever you get your podcasts.
This month's content includes...
Introduction00:00 - 00:34Do Bougies increase first pass success?00:34 - 04:28Cardiac arrest management - dual sequence defibrillation, personalised care and drones for AEDS.04:28 -10:50Trauma - Cardiac tamponade vs exsanguination10:50 - 13:35Sepsis - effect of the microcirculation13:35 - 15:23A history of race and medicine16:54 - 18:36Differential attainment18:37 - 19:27What can we do about addressing EDI issues?19:28 - 22:20Choosing with intention20:21 - 26:55The ARC-H Principle26:56 - 28:32Closing thoughts28:33 - 30:10Recommended ConferencesPremier Conference - 11th-12th June 2024, Winchester
Tactical Trauma 24 - 7th-9th October, Sundsvall, Sweden
RCEM Annual Scientific Conference
After the bumper double paper review episode, we fit two months of blog content into one episode. Iain and Simon discuss the management of the patient with chronic liver disease who has an acute decompensation, global health connections, whether mechanical CPR is more effective than human CPR and the potential effects on elderly patients staying in the ED overnight.
ReferencesConor Crowley, Justin Salciccioli, Wei Wang, Tomoyoshi Tamura, Edy Y. Kim, Ari Moskowitz, The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study, Resuscitation, 2024, 110142, ISSN 0300-9572, https://doi.org/10.1016/j.resuscitation.2024.110142.
Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, Bloom B, Catoire P, Berard L, Cachanado M, Simon T, Laribi S, Freund Y; FHU IMPEC-IRU SFMU Collaborators; FHU IMPEC−IRU SFMU Collaborators. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961. PMID: 37930696; PMCID: PMC10628833.
Recommended ConferencesPremier Conference - 11th-12th June 2024, Winchester
Tactical Trauma 24 - 7th-9th October, Sundsvall, Sweden
RCEM Annual Scientific Conference
In this second of a two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site.
In Part 2 they discuss papers about major haemorrhage, trauma, cardiac arrest and more.
In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.
PapersJansen JO et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1862-1871. doi: 10.1001/jama.2023.20850. PMID: 37824132; PMCID: PMC10570916.
Davenport R et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1882-1891. doi: 10.1001/jama.2023.21019. PMID: 37824155; PMCID: PMC10570921.
PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jul 13;389(2):127-136. doi: 10.1056/NEJMoa2215457. Epub 2023 Jun 14. PMID: 37314244.
Shepherd JM et al Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial. Intensive Care Med. 2023 Aug;49(8):922-933. doi: 10.1007/s00134-023-07135-3. Epub 2023 Jul 20. PMID: 37470832; PMCID: PMC10425486.
Bouzat P et al. Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Apr 25;329(16):1367-1375. doi: 10.1001/jama.2023.4080. PMID: 36942533; PMCID: PMC10031505.
Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg. 2023 May 1;158(5):532-540. doi: 10.1001/jamasurg.2022.6978. Erratum in: JAMA Surg. 2023 Apr 5;: PMID: 36652255; PMCID: PMC9857728.
Marsden MER, Kellett S, Bagga R, Wohlgemut JM, Lyon RL, Perkins ZB, Gillies K, Tai NR. Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study. Emerg Med J. 2023 Nov;40(11):777-784. doi: 10.1136/emermed-2023-213086. Epub 2023 Sep 13. PMID: 37704359; PMCID: PMC10646861.
Wohlgemut JM, Pisirir E, Stoner RS, Kyrimi E, Christian M, Hurst T, Marsh W, Perkins ZB, Tai NRM. Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome. Trauma Surg Acute Care Open. 2024 Jan 12;9(1):e001214. doi: 10.1136/tsaco-2023-001214. PMID: 38274019; PMCID: PMC10806521.
Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151.
Siddiqua N, Mathew R, Sahu AK, Jamshed N, Bhaskararayuni J, Aggarwal P, Kumar A, Khan MA. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial. Emerg Med J. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. PMID: 38050078.
Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2023 Feb;40(2):108-113. doi: 10.1136/emermed-2021-212294. Epub 2022 Sep 30. PMID: 36180168.
Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR; ARREST trial collaborators. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023 Oct 14;402(10410):1329-1337. doi: 10.1016/S0140-6736(23)01351-X. Epub 2023 Aug 27. PMID: 37647928.
Issa EC, Ware PJ, Bitange P, Cooper GJ, Galea T, Bengiamin DI, Young TP. The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture. J Emerg Med. 2023 Mar;64(3):400-404. doi: 10.1016/j.jemermed.2023.01.013. PMID: 37019501.
In this two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site.
In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.
Check out part 2 for papers about major haemorrhage, trauma, cardiac arrest and more.
PapersDunton Z, Seamon MJ, Subramanian M, Jopling J, Manukyan M, Kent A, Sakran JV, Stevens K, Haut E, Byrne JP. Emergency department versus operating room intubation of patients undergoing immediate hemorrhage control surgery. J Trauma Acute Care Surg. 2023 Jul 1;95(1):69-77. doi: 10.1097/TA.0000000000003907. Epub 2023 Feb 28. PMID: 36850033.
Prekker et al: Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults August 3, 2023 N Engl J Med 2023; 389:418-429 DOI: 10.1056/NEJMoa2301601
Landefeld KR, Koike S, Ran R, Semler MW, Barnes C, Stempek SB, Janz DR, Rice TW, Russell DW, Self WH, Vonderhaar D, West JR, Casey JD, Khan A. Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults. Crit Care Explor. 2023 Mar 6;5(3):e0855. doi: 10.1097/CCE.0000000000000855. PMID: 36895888; PMCID: PMC9990830.
Snyder BD, Van Dyke MR, Walker RG, Latimer AJ, Grabman BC, Maynard C, Rea TD, Johnson NJ, Sayre MR, Counts CR. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation. 2023 Dec;193:109991. doi: 10.1016/j.resuscitation.2023.109991. Epub 2023 Oct 5. PMID: 37805062.
Freund Y et al. Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA. 2023 Dec 19;330(23):2267-2274. doi: 10.1001/jama.2023.24391. PMID: 38019968; PMCID: PMC10687712.
Eastwood G et al, TAME Study Investigators. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jul 6;389(1):45-57. doi: 10.1056/NEJMoa2214552. Epub 2023 Jun 15. PMID: 37318140.
Downing J, et al. Prevalence of peri-intubation major adverse events among critically ill patients: A systematic review and meta analysis. Am J Emerg Med. 2023 Sep;71:200-216. doi: 10.1016/j.ajem.2023.06.046. Epub 2023 Jun 28. PMID: 37437438
It's episode one of season 11 and Simon and Iain chat through the blog content from St Emlyn's from January 2024. There's discussion about New Year resolutions and how to make them habits, intubating poisoned patients with a decreased conscious level and what we can possibly do to improve the working conditions in our Emergency Departments.
As ever, we hope you enjoy the podcast. Please do like and subscribe, and if you'd like to contribute to St Emlyn's in any way please get in touch.
It's the last episode of season 10 and Iain and Simon discuss December 2023's blog posts. In a packed podcast they discuss prehopsital blood transfusion decision making, E-scooter injury patterns, the potential for AI in medicine and selective aortic arch perfusion.
Please do get in touch if you would like to contribute to St Emlyn's and as ever do like and suscribe and tell your friends (if you think the podcast is any good).
Mentioned in the podcast
- Gary Klein - Streetlights and Shadows
- Critical Appraisal Nugget - Semi Structured Interviews
- EMCrit - Shadowboxing
- EMCrit - Interview with Gary Klein
- A Skeptic's Guide to Emergency Medicine
- Life in the Fast Lane - What is AI and How Does it Work
- T-MACS scores
- Homo Deus: A Brief History of Tomorrow by Yuval Noah Harari
- East Anglia Air Ambulance RAID Conference
In this bumper double edition Simon and Iain chat through all the recent content on the St Emlyn's blog site, including a review of CRYOSTAT-2 and the DAShED study, a review of the new ILCOR guidelines, flow in the ED and why silence might just be the tonic we all need.
All of us at St Emlyn's wish you all, wherever you are on the world a peaceful, happy and restful Christmas.
Please do like and subscribe and get in touch if you'd like to contribute to our ongoing work.
One of the benefits of the use of online platforms for meetings is the ability to record and disseminate talks more widely. This is an edited version of a talk given by Dr Andy Curry, Consultant Cardiothoracic Intensive Care Consultant at University Hospital Southampton, covering the origins of Extra Corporeal Membrane Oxygenation (ECMO) right up to the present day. Throughout the talk, he gives real world experience, coupled with a knowledge of the literature to communicate all you could ever want to know about this fascinating and potentially very exciting therapy.
ReferencesPeek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, Killer H, Mugford M, Thalanany M, Tiruvoipati R, Truesdale A, Wilson A. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006 Dec 23;6:163. doi: 10.1186/1472-6963-6-163. PMID: 17187683; PMCID: PMC1766357.
Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, Hockings L, Shaw J, Duffy SJ, Burrell A, Cameron P, Smit de V, Kaye DM. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015 Jan;86:88-94. doi: 10.1016/j.resuscitation.2014.09.010. Epub 2014 Oct 2. PMID: 25281189.
Belohlavek J, Smalcova J, Rob D, et al. Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2022;327(8):737–747. doi:10.1001/jama.2022.1025
Martje M. Suverein, M.D., Thijs S.R. Delnoij, M.D., et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. The INCEPTION trial. N Engl J Med 2023; 388:299-309. DOI: 10.1056/NEJMoa2204511
The Alfred ECPR Role Cards
The Bottom Line ECMO Reviews
An EBM-packed episode where Iain and Simon go over ten of the top papers from the last year discussing all manners of things Emergency Medicine, including TXA in trauma, use of video laryngoscopy, defibrillation strategies in refractory VF, and ten-second triage in major incidents. There's also a very pertinent discussion about whether the age of your Emergency Physician might affect your outcome...
Thank you again for listening to the St Emlyn's podcast. Please do like and subscribe and get in touch if there is anything you'd like us to discuss or if you'd like to get involved.
After a long, hot and relaxing summer (!) Simon and Iain return with all the content from the St Emlyn's blog in July and August. They discuss four papers in detail, including the ARREST trial about cardiac arrest centres, whether clinical examination can identify life threatening injuries in trauma, the TOP-ART study looking at a novel agent in trauma management and the use of REBOA.
Please do like and subscribe and get in touch if you would like to contribute to the blog site.
Welcome to a bumper edition of the podcast discussing content from St Emlyn's for June 2023.
In this episode, Simon and Iain talk about DL vs VL, the PATCH trial, drug pushers, packers and stuffers, the new head injury guidelines from NICE and the AMAX4 algorithm and much more.
If you would like to submit something to St Emlyn's for consideration we'd love to hear from you.
Times are tough in the NHS at the moment, but we hope at St Emlyn's we can remind you of all the best parts of the incredibly important and rewarding job we do.
Take care.
The clue to these is very much in the Title – BRUE is a diagnosis in itself. Children often do weird stuff, but they rarely do weird scary stuff.
In this talk, Jilly goes talks through how we can define these events as high and low risk and gives us tools to manage these patients (and their parents)
Along with colleagues, Jilly has written a guideline for BRUE, the full version of which you can find here
Jilly also mentions a flowchart from Peds Cases, which you can find here
There is also this superb blog post from Natalie May on the St Emlyn's website which accompanies this podcast, which goes through some really useful cases.
As a Wessex ST7 in Paediatric Emergency Medicine (RCPCH), Jilly Boden currently works in Queen Alexandra Hospital (Portsmouth). Her specialist interests include acute stabilisation and transfer of the critically ill patient, having spent a year with the 'Southampton & Oxford Retrieval Team' (SORT) and hopes to find a way of combining this with her future PEM career.
Jilly has a passion for education, particularly 'PEM to the non-paediatrician', including international teaching of the tri-service military GPs, and being on the national committee to write a new standardised paramedic paediatric curriculum.
In her free time (you know, apart from the kids and all that) she works as part of the track medical team for the 'British Motorcycle Racing Club', providing pre-hospital care to high velocity polytrauma patients in the 'golden hour' following collisions often exceeding 120mph.
This episode of the podcast is a live recording from the PREMIER Conference of John O Neil discussing penetrating injuries with learning points that are useful for clinicians who look after both adult and paediatric patients.
There are three main mechanisms – violence, impalement and self harm, although the first is by far the most common.
Penetrating injuries are rare but have significant morbidity and mortality. The key is early and accurate diagnosis, and many can be managed conservatively. The distribution of penetrating injuries across the UK differs widely, with most in the London area, although as seen in the news recently can happen anywhere.
Remember how traumatic it is to be a trauma patient. We put you on a bed, cut off your clothes, stick needles in you and take your family away. Some will also just not engage with you (teenage boys particularly) making assessment difficult. Be kind. Don’t get frustrated.
Physiologically there may be a strong vagal response that can hide some of the signs we’d expect. Also, bear in mind the events prior to the injury – the child may have been running a considerable distance (before and after the incident) raising their lactate (but don’t assume this is the cause). Children tend to ‘fall off a cliff’ – they appear well, but can suddenly decompensate – keep the momentum to definitive management going and do not be falsely reassured.
John mentioned a great friend of St Emlyn’s Vic Brazil and we would heartily endorse you have a look at her work.
You can find more information about the Reducing Knife Crime initiative here
Chris brought us his reflections amnd knowledge from some of his extensive experience as a military EM consultant in two wars. Blast injury could be blunt, penetrating, may involve major haemorrhage: you have to expect any injury possible. It’s worldwide and it’s getting more common.
Blast injury affects every body cavity, but it is the CABC approach that matters, Doing the basics well is still the key. Bleeding points may not be obvious so apply tourniquets wherever stops the bleeding.
Often patients will not arrive in ones or twos but as a whole group affected by an incident, so it is vital we are prepared. The Paediatric Blast Injury Field Manual is a free resource available to download here and is highly recommended.
Chris Hillman is a Consultant in Emergency Medicine and Paediatric Emergency Medicine, working in Southampton. Serving in the Royal Navy since university, he has deployed on Ships, Submarines and with Commando units globally, and with the Army to Afghanistan and Iraq. He is the outgoing Consultant Advisor in Emergency Medicine and Clinical Director Commando Forward Surgical Group.
This is the second in our series of talks recorded live in June 2023 at the PREMIER conference.
Looking after patients with non-epileptiform seizures are a challenging, and common, event in the Emergency Department. 10% of attendances at paediatric neurology clinics are thought to be 'functional' and a lot of these will also present to the ED. These problems can involve a wide range of physical or sensory manifestations, almost all of wide have significant differentials which we cannot miss.
A large number of these patients can end up with an incorrect diagnosis, some of this due to confirmation bias by clinicians, but also some with psychogenic non-epileptiform seizures may coexist with organic problems.
The history is key and can be helped significantly by watching videos of events. There may be other factors giving a clue to a non-epileptic cause. Sometimes this will only happen in one place, like school, and the history may be inconsistent. Awareness and generalised bilateral movements, with episodes that are different each time all point to a non epileptiform origin. And then there are symptoms just 'not fitting' with our knowledge of dermatomal distribution.
There are Red Flags - Events happening during exercise, neurological signs, unpredictability and patterns to the events all point to a more sinister diagnosis
Management is incredibly difficult, particularly in trhe ED. Don't suggest an organic diagnosis and leave some ambiguity. There is time to get more information and there are few definitive diagnostic tests. EEGs are notoriously unreliable. Self help groups can help.
Steve Warriner has worked as a paediatrician at the QA in Portsmouth for the last 16 years. He trained in various regions in the UK including the Midlands, Yorkshire and the North East of England before working in Somerset for a brief period. He has a particular interest in epilepsy and neurological conditions in children and lead the district epilepsy service in Portsmouth. He teaches on the British Paediatric Neurology Association epilepsy training courses both in the UK and across the world. He was part of the team who designed and implemented the training course (initially in Myanmar) and the method of cascade training has recently been recognised by the World Health Organisation and the course now runs in nearly 30 counties in 3 languages. Steve recently chaired a multidisciplinary working group to update the Advanced Life Support Group guideline for management of prolonged seizures. In his spare time, Steve is a triathlete who qualified for and competed in the World Ironman Championship race in Hawaii in 2022.
This is the first in a series of podcasts, recorded live at the Premier Conference in Winchester.
In this episode, David James challenges our current practice when we give a 'weaning plan' for children discharged with wheeze.
There is a plan here that you can review and give to patients and their carers.
More information at these excellent websites
- PIER Network
- Southampton Oxford Retrieval Team
- Healthier Together
David James has been a PEM Consultant at University Hospital Southampton since 2018. His main interests are in training and education, adolescent emergency medicine and Quality Improvement. He is the Divisional Director of Medical Education and a Training advisor on the PEMISAC. He is the acute care lead for Wessex Healthier Together and has led several projects including those around acute wheeze at UHS and regionally. Outside of work he enjoys swimming, cycling and running and is extremely average at triathlons.
The monthly round up of all the blog posts at St Emlyn's, including a deep dive into HALO (high acuity, low occurrence) procedures and blood transfusion.
Thanks again for listening. Please do like and subscribe here.
Our monthly podcast round up from St Emlyn's Blog. This month Simon and Iain discuss the prehospital use of troponin measurement in the assessment of patients with chest pain and the use of AI in medicine, as well as an update about St Emlyn's WILD.
Please do like and subscribe
This is the first podcast in our new series from St Emlyn's Medical School. They are specifically aimed at healthcare students and focus on the Medical Licensing Assessment (UK) presentations in particular but will be useful wherever you listen in the world.
Each episode has a standard format with a case to set the scene, a set of learning objectives, a discussion, a summary and a case resolution.
There are comprehensive listening notes on the dedicated website, as well as a growing set of other resources.
We hope you enjoy listening. The rest of the podcasts can be found on Spotify, or wherever you get your podcasts.
The music for this series (just as it is for the St Emlyn's Podcast) is composed by Greg Beardsell
The latest CAN is one of our brand-new 'revision editions' -- brief podcasts aimed at covering the essentials of critical appraisal for medical students and junior doctors preparing for exams.
With the help of Gregory Yates, an academic doctor based in Manchester, this episode introduces two core concepts: sensitivity and specificity. These are two ways of thinking about the accuracy of a diagnostic test. Knowing the sensitivity and specificity of an investigation will give you a decent idea of how it should be used in the emergency department.
Sensitivity (Sn) describes the chance that a test will be positive if your patient has the condition you're testing for. Some people call it the 'true positive rate' or alternatively the positivity in disease (PID) rate. If you need a hand remembering it, you can always remember that PID is a sensitive issue.
Meanwhile, specificity (Sp) considers the chance of a test being negative if the patient doesn't have the condition you're testing for. It's the 'true negative rate' or alternatively the negativity in health (NIH) rate. There are times when we particularly need a test to have a high sensitivity. This is generally when we want to be particularly confident that a test accurately identifies everyone with the relevant condition because we really don't want to miss it. We need a high sensitivity to rule out disease. (Sn-uff it out). At other times, we need to be confident that a patient with a positive test actually has the disease - for example, if the treatment is unpleasant or involves exposing patients to risk. In that case, we want a high specificity to rule in disease. (Sp-in it in).
In this CAN, we use D-Dimer as an example of a very sensitive investigation: it’s positive in nearly 100% of cases of venous thromboembolism. Specificity describes the likelihood that the test will be negative if your patient does not have the disease. We use HbA1c as an example of a highly specific investigation: it’s rarely used in the emergency department, but if it’s elevated, we can be almost certain that the patient is diabetic. HbA1c is almost never (
Our regular monthly round up and chat from the St Emlyn's blog. We talk about the use of artificial intelligence in research and the use of remifentanil instead of neuromuscular blockade in rapid sequence intubation. Plus more about the StEmlynsWILD conference and Simon's new role as Dean of RCEM and how you can get involved.
Long term listeners to the St Emlyn’s podcast may remember our series entitled ‘Critical Appraisal Nuggets’ (CANs). We are absolutely delighted to reinvigorate this project under the leadership of Professor Rick Body, with the episode on semi structured interviews.
In this easily digestible and succinct podcast Rick and Laura Howard go through the pros and cons of setting up semi structured interviews and how these can be used effectively in qualitative research.
In the latest episode, we cover a qualitative research technique: semi-structured interviews. Qualitative research might be out of your comfort zone: we’re generally more comfortable with quantitative measures – numbers and statistics. It’s something they have experience with, having previously published a paper exploring the impact of events that happen at work on the wellbeing of emergency physicians. This was a labour of love for Laura. Laura wrote a powerful blog about it here.
Semi-structured interviews are a great way to get the really rich data we need to understand something in greater depth. They allow us to ask ‘why?’ as well as just ‘what?’, ‘who?’ and ‘when?’. But reading qualitative research papers can be difficult when it takes us out of our comfort zone. In this CAN podcast, Laura and Rick take us through what semi-structured interviews are, why we might use them, how you design and conduct them, and they also have some pearls of wisdom about how to make transcribing them a lot less painful. By the end, we hope that you’ll feel confident with the basics of the technique. And if you want to practice your critical appraisal, why not put their study under the microscope?
Lots of chat about St Emlyn's WILD and just what you can expect if you join us in the Lake District in June, as well as discussion about ECMO in cardiac arrest and just how many of our patients with 'minor head injuries' will actually have ongoing symptoms weeks and even months later.
Click here to buy tickets for #StEmlynsWILD
A special double edition covering the blog posts from November and December and more. We discuss evidence based medicine with the DoseVF trial, and more from RECOVERY, discussion about 'what is downtime' and how we organise follow up for patients who don't live in our area and what happened at the amazing London Trauma Conference
We also announced some of the plans for StEmlynsWILD. Look out for booking details and more in the coming weeks.
Wellbeing is very complex, as it is an individual construct that is strongly aligned and interpreted through a lens of personal values, philosophy, culture, faith, and goals for life. Most importantly, wellbeing is dynamic rather than homeostatic and a subjective state determined by the individual.
Yet we use the term wellbeing to describe a wide variety of different things (often in terms of being the opposite of burnout which it most certainly isn't).
In this second episode of our series Liz Crowe discusses in detail what the literature says about wellbeing and how we may be able to use this going forward.
Please do like and subscribe. Thanks for listening.
Burnout is a term that seems to be used a lot these days, but what does it really mean? In this episode Dr Liz Crowe explains all, and will almost certainly change the way you view burnout.
Liz, who be well known to St Emyn's audiences, has just completed her PhD on "Understanding the risk and protective factors for burnout and wellbeing of staff working in the Paediatric Intensive Care Unit: PICU staff wellbeing" and has an unrivalled real world and evidence based experience of what these terms really mean.
In this first in a special series Loz goes into depth describing not only what burnout is, but how it can be measured (and the limitations of this) and most importantly how this is a system issue and not a diagnosis.
In the next episode we will discuss another commonly used term 'wellbeing'.
We think this series is incredibly important and hope you will help us share it far and wide.
In our new regular slot of the middle Monday of the month we're delighted to bring you the highlights from the St Emlyn's blog this month.,
Iain and Simon chat about batching in EDs, Ossilation in decision making and a whole lot more about trauma (chest drains, extrication, sex and TXA and rib fixation).
Please do like and subscribe and keep an eye out for our new sister website St Emlyn's Medical School and it's podcast series coming soon.
Join Iain and Simon for this month's round up of September's blog content from St Emlyn's. They discuss managing harm in the ED; management of traumatic brain injury; Head Up mechanical CPR and fentanyl in RSI.
Lots to think about and discuss. Please do like and subscribe and get in touch if there is anything you'd like us to cover on the blog and podcast, or perhaps you'd even like to write something for publication.
This is our round up of all that happened on the St Emlyn's blog in August 2022 (yes - we know it's a bit late, but there's been a lot going on!).
Listen to Simon and Iain discuss the latest therapies in COVID, particularly Baricitinib, calcium in trauma and how we find balance in our work-life blend.
Please do like and subscribe to the podcast and tell your friends and colleagues. We've lots of exciting stuff coming your way over the next few months.
Our monthly round up of all from the St Emlyn's blog. We discuss pathways into emergency care research, pad positioning in cardioversion of AF and possible gender differences in the presciption of TXA in trauma.
We also chat about travel in Lithuania, memories of defibrillating with hand held paddles and Simon's recent forst infection with COVID.
We mention a post on Lyme disease which you can read here (especially if you live near the New Forest...)
After a brief hiatus we're back with more from the St Emlyn's Blog. We discuss a wide range of topics from crowding in Emergency Departments and the RePHILL trial to breastfeeding, genetic testing and diagnosing DVTs, as well as our highlights from the recent RCEM CPD Conference in Bournemouth. There really is something for everyone!
We made it! A double century of podcasts. In this month's update Iain and Simon talk through myth busting in resuscitation, Rick Body's airway expertise (with a side mention for high sensitivity troponin), a paper about resuscitative thoracotomy, ACPs in EM and how we all could set future research priorties.
Thank you again for listening to the St Emlyn's podcast. We really do hope that you enjoy it and have found our witterings over the last 200 episodes useful.
Hopefully we'll see some of you at the RCEM CPD Conference in Bournemouth next week.
Please do rate us on iTunes, like, subscribe, tweet and tell you friends about the podcast.
Simon and Natalie discuss some of the complexities of feedback when it involved different specialities and patients. We also review our general rules of feedback.
See https://www.stemlynsblog.org/?s=feedback for more.
The first episode of our 9th Season with discussion about Calcium in cardiac arrest, a deep dive into the physiology of exsanguinating haemorrhage, a comparison of ketamine and etomidate for induction of anaesthesia and the ECG Thrust.
Please do like, subscribe and tell your friends about the St Emlyn's podcast.
The Season Finale that you've all be waiting for. Our last episode of season 8 includes discussion about racial bias in sats monitoring, CT scans to investigate subarachnoid haemorrhage and the importance of (consensual) touch.
Thanks again for listening. Please like and subscribe and all that. We look forward to seeing you next season (in about a month...)
Iain and Simon
Iain is flying solo this month, with discussion about narrative story tellling, airway management in the ED and using pigtail catheters in management of haemothorax.
We hope all you all have a very happy Christmas and chance over the festive period to relax. Do explore our back catalogue of podcasts for more on wellbeing and grief at Christmas.
Please do subscribe and rate and review us on your chosen podcast provider.
Take care all.
Our round up of all the blog had to offer in October 2021. There's discussion about evidence based medine in the REST and CTCA for intermediate chest pain trials, more about cauda equina and highlights from the Paediatric Colloquium in Australia, as well as the good humoured chat.
Please see the website for more information and don't forget to subscribe and rate the podcast (if you think it's any good).
The round up of the St Emlyn's blog posts in August 2021, featuring discussion about therapeutic anticoagulation in hospitalised COVID-19 patients, non invasive ventilation vs usual care for critically hypoxic COVID-19 patients and the recent EMTA (Emergency Medicine Trainees Association) survey. Oh, and Simon's mid-life crisis.
Iain and Simon discuss the best from the blog in June and July. There's COVID chat (of course). thunderstorm asthma, a glance into the future and much, much more.
It's been a busy month on the blog with plenty for Iain and Simon to talk about. The Manchester Arena bombing, new guidelines for Anaphylaxis management, Adult Congenital Heart Disease, Calcium in Major Haemorrhage and Spontaneous Coronary Artery Dissection all get a mention alongside the usual witterings of two middle aged emergency physicians.
This is the second in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.
In this episode we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta.
This is the first in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.
Look out for Part 2, which will be released next week, where we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta.
Background With advances in paediatric cardiac surgery, more and more patients with complex congenital heart disease are surviving to adulthood: in the 1950s you might expect a survival rate of about 10%, whereas now this is more like 85%. In fact, there are more patients in the adult congenital heart disease population than there are in the paediatric one (with 2.3 million adults vs 1.9 million children in Europe).
Many patients with Adult Congenital Heart Disease are young and able to live a relatively normal life. This means that they can travel and take part in just the same sort of activities as those without ACHD. They may well turn up in your Emergency Department one day, regardless of whether you are a tertiary centre or a district general hospital (DGH).
They are experts, and know their disease well, but this does not abstain you from a responsibility to know about them too! When these patients become unwell, they can go downhill very fast and you may not have the chance to discuss with them their exact lesion and its management.
The anatomy and physiology of these patients is abnormal, so they may present in atypical ways, and may not respond to usual medical interventions: in fact, some of our usual treatments may even be harmful.
However, starting with our usual 'ABC' approach is by far the best way to go, whilst gathering more information and contacting their specialist centre. Many patients will have their last clinic letter and ECG with them (which will also have the direct dial number of their specialist). And if they, or their relative, say there is something wrong you must believe them and do all you can to make sure they are fully investigated.
The presence of scars may give you some clues as to the patient's underlying condition and previous surgical repairs. (BMJ 2016; 354: i3905)
A General Approach
- Do your usual ABC assessment.
- Pay particular attention to the respiratory rate - this should be normal.
- Give oxygen if they look unwell.
- They should have a 'normal' blood pressure - any hypotension should be taken as abnormal and investigated.
The Fontan Circulation
This is not a condition in itself, but in fact the resulting circulation after a series of operations that could've been performed due to a number of different underlying conditions:
- Tricuspid Atresia
- Double Inlet Left Ventricle
- Atrio-ventricular Septal Defect – unbalanced
- Pulmonary Atresia
- Hypoplastic Left Heart Syndrome
In essence these patients are born with a single functioning ventricle, that has to be utilised to supply the systemic side of the circulation, whilst the Fontan acts as a passive means of returning blood to the pulmonary circulation.
It was first devised in the early 1970s by Dr Francis Fontan, so the majority of patients with this are in their mid thirties and younger.
Potential reasons for admission to the ED - Fontan circulation 1, Arrythmia As the patient is entirely dependent on their systemic ventricle to work optimally, any disturbance of the delivery into it is very poorly tolerated. Thus, any arrhythmia is life threatening, even a mild atrial tachycardia.
These patients need to be returned to sinus rhythm as quickly as possible and the recommended method for this is DC cardioversion in expert hands.
Fontan patients have an incredibly fragile circulation and any change in their respiratory physiology can be life threatening, especially if it increases their pulmonary pressures (and thus prevents the passive flow within the Fontan circulation). These patients are not candidates for sedation in the ED and should have an experienced anaesthetist to manage them during the procedure.
Beware if the patient comes in and tells you they are fasted! This means they have been in this situation before and needed DC cardioversion.
2, Haemoptysis Over time the patient develops venous hypertension within the Fontan connection. This causes the formation of collateral vessels, that may link into the bronchial arterial tree.
If the patient presents in shock treat them as you would any other patient with emergency blood transfusion.
Any haemoptysis, however small, may herald the beginning of a massive bleed. These patients need further investigation, probably a CT chest with contrast. These vessels may then be coiled by interventional radiology.
3, Cyanosis If the patient has a non fenestrated Fontan they should have normal oxygen saturations. However, if there is a fenestration there will be shunting and therefore a reduction in oxygenation.
For patients this is trade of between being pink or blue, each of which have complications.
Dr Sam Fitzsimmons Dr Sam Fitzsimmons is a Consultant Cardiologist in Adult Congenital Heart Disease (ACHD) at the University Hospital Southampton, UK. Sam also subspecialises in pulmonary hypertension and maternal cardiology. Working within a tertiary surgical ACHD centre, Sam delivers an ACHD on call service for emergency admissions, inpatient care, routine outpatient follow-up, intra-operative imaging and post-surgical care, as well as specialist clinics in Pulmonary Hypertension and Maternal Cardiology. Sam holds a Honorary Senior Clinical Lecturer post with the University of Southampton as she is passionate about teaching and in particular, she is enthusiastic about helping demystify congenital heart disease for many non-specialist to improve patient care. Sam is well published in peer review journals, cardiology textbooks and specialist guidelines.
A podcast with Iain and Simon summarising all the latest content from the St Emlyn's blog in April 2021. Topics discussed include Vaccine Induced Thrombocytopenic Thrombosis, how our own biases can effect our critical appraisal and whether we need to worry about grading the quality of FOAMed resources.
Thanks for listening. Please check out the blogs themselevs at www.stemlynsblog.org and consider subscribing and rating us on iTunes.
If you'd like to see some more from Peter Brindley you can watch one of his SMACC talks here.
Simon joins Ankur Verma from Delhi, to talk about the impact of COVID in the latest wave devastating India.
A discussion about all the latest from the St Emlyn's blog, including a hot off the press article about vaccine induced thrombocytopenic thrombosis and the new FRCEM revision guide.
Simon and Iain also talk about the latest results from the RECOVERY trial, Major Trauma Triage tools, cricothyroidotomy, thromboprophylaxis in COVID19 and the new Medical Licensing Assessment for medical students and the new St Emlyn's Undergraduate Curriculum
An audio review of a paper in the Journal of Intensive Care Medicine with two of the authors.
Assessing on-line medical education resources: A primer for acute care medical professionals and others
Peter G Brindley, Leon Byker, Simon Carley, Brent Thoma https://doi.org/10.1177/1751143721999949
Our regular podcast round up from February 2021. Iain and Simon highlight the key learning points from this month on the St Emlyn’s blog and podcast.
Topics discussed this month include tocilizumab in COVID19, TIA risk scores, new Emergency Care standards (targets) and TXA use in epistaxis. We also pay tribute to Dr Cliff Mann, former President of RCEM who sadly died this month.
Please remember to subscribe to the podcast on iTunes/Google Play and please do leave us some reviews and ratings there.
Our regular round up of the best of the blog and podcast from January 2021 with Iain and Simon. The St Emlyn's blog posts from January 2021 are discussed, including plenty about Coronavirus as well as other topics relevant to anyone interested in Emergency Medicine and evidence based care.
Going into hospital as an emergency during the COVID-19 pandemic must be extremely scary for patients and their relatives. With no relatives allowed to visit and staff dressed in full PPE, the experience must be so much more unnerving than usual. Add to that the incredible worry about catching COVID-19 for those who don’t already have it; or the worry about what might happen for those who do. Will they pull through? Could this be the end?
I’m privileged to be co-leading the COvid-19 National DiagnOstic Research and evaluation programme (CONDOR), which involves a collaboration between amazing teams in Manchester, Oxford, Leeds, Newcastle, London and Nottingham. The programme evaluates diagnostic tests for COVID-19.
We’re extremely lucky to have two very experienced and proactive patient and public representatives as members of our steering committee: Graham Prestwich from Leeds and Val Tate from Oxford.
I recently spoke with Graham and Val to get their thoughts about how we, as clinicians, might effectively communicate with patients during the COVID-19 pandemic. They provide their important insights from a lay perpsective about what they would want from their clinician.
We cover everything from the challenges of communicating while wearing PPE to the way to answer important questions like, “Am I going to die?”, which many of us have, I’m sure, had to answer on a number of occasions over the past 12 months.
I hope that you enjoy the podcast. We realise that 25 minutes wasn’t long enough to cover everything we’d have liked to.We’d really like to know what you think. Are there things that we haven’t covered that you’d like us to? What are your experiences? We’d love you to share your thoughts in the chat!
Rick
A vaccine update with Rick Body, Simon Carley, Pam Vallely, Paul Klapper and Charlie Reynard. Bringing RCEM, St Emlyn's and the University of Manchester together for the latest thoughts and wisdom on the vaccines that might get us out of this pandemic.
Moderna vaccine phase 3 trial - https://www.nejm.org/doi/full/10.1056/nejmoa2022483
Oxford vaccine phase 2/3 - https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)32466-1.pdf
Pfizer vaccine trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
vaccines #COVID19 #coronavirus
A special festive edition of our round up podcast featuring six weeks of blog posts and plenty more besides.
From all at St Emlyn's we hope you have a very happy festive season and we cannot wait to talk to you again in 2021.
Take care,
Simon and all the team
Rick leads the FALCON and CONDOR studies that are currently evaluating COVID-19 studies in the UK. Nobody knows more about how we can practically use COVID-19 testing than Rick and in this podcast he takes us through what is available and how we might use it in the future.
A great listen and lots to learn.
A bumper edition of the podcast where Iain and Simon discuss TXA (twice), antibiotics in appendicits, VTE, Blood products in trauma, use of ultrasound in cardiac arrest and plasma in traumatic brain injury. Oh, and COVID19 (but not for long)...
An evidence based cornucopia of aural pleasure.
Please like and subscribe (as all podcasters seem to say).
Take care,
Iain
In this special edition of the podcast, Liz Crowe discusses with Iain how we can find contentment, despite the relentless nature of COVID19 and the impending second wave. She gives practical, realistic advice that everyone can consider and encourages us all to be kind to ourselves in these strange and difficult times.
Welcome to our audio round up of everything on the blog during September.
It's been a relatively quiet on the blog post this month, but we chat through not only blogposts on the REMAP-CAP trial, TXA in Head Injury and the ISARIC COVID Risk prediction tool, but also the situation in the North of England and the recent RCEM Virtual Conference.
The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think. If you're interesed in learning more about Baysian thinking this Lesson Plan is a good place to start.
Take care,
Iain
Interview with Ian Roberts on the pharmacokinetic trial of intramuscular tranexamic acid.
Blog link here
Welcome to our audio round up of everything on the blog during August.
As the world continues to be in the grips of the Coronavirus pandemic there have been more papers looking at all aspects of this disease.
Simon reviewed the latest paper on Hydroxychloroquine and Charlie collated some of the top papers covering aspects from aerosol spread and use of CPAP to the effect on vulnerable groups and the effect on staff psychological health
It's not all COVID though. Sepsis is a condition we all want to be able to treat more effectively. Sadly there doesn't seem to be any encouraging news about the use of Vitamin C, Steroids and Thiamine in this latest RCT.
Many of the St Emlyn's group have special expertise in toxicology and Gareth wrote this incredibly informative post about the use of GBL. If you're not sure what "ChemSex" is then this post from a few years ago by Janos is worth a read.
The anonymously written "Look at what they make you give" post really struck a chord with readers, with an astonishing number of views. There are messages here for us all.
The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think.
Our own version of Buy One Get One Free* this month, where you get a round up of two months of blog content.
Coronavirus continues to dominate the medical (and non-medical) headlines, and we discuss the two major results from the RECOVERY trial published recently, one positive and one not so (depending on who you talk to....). Simon also catches up with Roberto Cosentini, who you'll remember from the very powerful podcast at the beginning of the pandemic.
COVID isn't the only EBM circus in town though: we've reviewed HALT-IT and Simon has given a talk about the "Ten Top Trauma Papers" of the last year and Laura reviewed a paper looking at haloperidol for headaches.
We're having to think even harder about how we communicate in the ED, both for clinical care and to deliver education. Two ideas to help learning have been featured this month: The St Emlyn's Lesson Plans and "Background Learning".
Good luck to all those starting in Emergency Medicine, and a huge thank you to all those who are moving to other areas of medicine or other departments. It's been a curious few months...
Take care,
Iain
*It's actually Get One Free Get Another Free, but whose ever heard of that?
We are delighted to introduce you to the "St Emlyn's Lesson Plans", which we hope will help structure some of your education sessions over coming months (and years).
Each lesson plan starts with a descrete learning outcome, to set the scene, as well as details of the RCEM curriculum item(s) that will be covered.
The first tasks are aimed at aquiring some background knowledge and can either be done as part of the session, or beforehand. These utilise the vast "FOAMed" resources (including, but not exclusively, those of St Emlyn's).
Our experience is that time constraints often mean that "background reading" isn't achieved before the session, so would encourage allowing time within it to complete these. They are designed to take about 30 minutes and occupy the first half of the session.
Everything you need for each lesson is included in the plan. We would recommend that each learner has an internet enabled device available (with headphones) to read and listen to the background material at their own pace.
The second half of the session should be facilitated by an expert. This can happen in person, but also online, via any of the interfaces that are now so familiar.
In many plans we have given some case examples, but it would be even better if learners can bring cases of their own for discussion. This element is very much within the control of the facilitator (who should been fully cogniscent of the contents of the knowledge section).
The session finishes off with a summary, this should emphasise again the most important learning points. To really embed the knowledge and skills the particiapants should be encouraged to reflect on what they have learned, and to even talk to thse who were unable to attend about what they missed.
For learners this also gives an opportunity to easily link teaching sessions to their portfolio.
You may want to record the "face-to-face" elements, so that those who were not present are able to access them when they can (and those that did can rewatch to refresh their learning).
Although these plans are designed for delivery in a single centre, there is absolutely no reason why regional (or even national) teaching could take place in this way. The recent COVID19 Journal Clubs have demonstrated beautifully how a group of learners can engage with an online panel.
We would be very happy to receive lessons plans to add to the collection. This is very much a collaborative effort.
Please let us know what you think of these lesson plans and if you are using them in your Department. We'd love to hear your ideas about how we can take medical education forward.
St Emlyn's three professors, Carley, Body and Horner* critically appraise the Press Release regarding Dexamethasone in the treatment of COVID-19.
What does this mean for the future of Evidence Based Medicine? Can we really start using a medication when the trial hasn't been peer reviewed and the full dataset not released?
The blog post by Josh Farkas, that is mentioned in the podcast, is here.
*Professor Simon Carley, Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in Adult and Paediatric Emergency Medicine at Manchester Foundation Trust, Professor Rick Body Professor of Emergency Medicine in Manchester and Honorary Consultant in Emergency Medicine at Manchester Foundation Trust. Professor Dan Horner, Professor of Emergency Medicine of the Royal College of Emergency Medicine and Consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust.
Lots to chat about on the podcast this month, and not just COVID! There's been blog posts about clots, troponin and even telly, as well as the Journal Club series.
Keep a look out for the new St Emlyn's Lesson Plans that we hope will help usher in a new era of medical education in a socially distanced world.
If you would like to donate to the fund in the memory Adel Aziz you can find the link here.
We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.
Take care
Iain
Podcast edited by Izzy Carley
PS You can find the Lesson Plans here. Still a work in progress, but as you've read these "shownotes" you deserve to have a sneak preview...
Welcome to our seventh webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.
The live event took place on Tuesday 26th May.
Today's panel will be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Ellie Hothershall (Consultant in Public Health), Prof Simon Carley and special guest Kelly Ann Janssens (Emergency Physician in Ireland) to discuss five papers about COVID-19 infection.
This will be the last weekly journal club, but we will be back with more EBM goodness very soon. Do let us know what you like to be included at stemlyns@gmail.com
References
- Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. N Engl J Med. Published online May 22, 2020. doi:10.1056/nejmoa2007764
- Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 2020. doi:10.1016/s0140-6736(20)31180-6
- Gray N, Calleja D, Wimbush A, et al. “No test is better than a bad test”: Impact of diagnostic uncertainty in mass testing on the spread of Covid-19. Published online April 22, 2020. doi:10.1101/2020.04.16.20067884
- Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019. Annals of Emergency Medicine. Published online May 2020. doi:10.1016/j.annemergmed.2020.05.022
- Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatr. Published online May 19, 2020. doi:10.1111/apa.15371
Podcast edited from a live webinar by Iazzy Carley
Welcome to our sixth COVID-19 Journal Club Podcast.
The panel was hosted by Rick Body and included Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Liz Crowe (Advanced Clinician Social Worker and PhD candidate in health staff wellbeing in Brisbane) to discuss four papers about COVID-19 infection. We were especially pleased to welcome Liz this week, which enabled us to focus on the important topics of grief, loss and communication during the COVID-19 pandemic.
References
- Williamson E, Walker AJ, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. May 2020. doi:10.1101/2020.05.06.20092999
- Menni C, Valdes AM, Freidin MB, et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med. May 2020.
- Liu Y, Ning Z, Chen Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. April 2020. doi:10.1038/s41586-020-2271-3
- Selman LE, Chao D, Sowden R, Marshall S, Chamberlain C, Koffman J. Bereavement support on the frontline of COVID-19: Recommendations for hospital clinicians. Journal of Pain and Symptom Management. May 2020. doi:10.1016/j.jpainsymman.2020.04.024
Podcast edited from a live webinar by Izzy Carley
Welcome to our fifth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The live event took place on Tuesday 12th May at 11.00am BST (10.00am GMT).
The COVID-19 Journal Club Panel Today’s panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Dan Horner, Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Lauren Westafer (Attending in Emergency Medicine and Co-Creator of the Foamcast blog and podcast) and Ellie Hothershall (head of undergraduate medicine at the University of Dundee and an expert in Public Health) to discuss six papers about COVID-19 infection.
- Lai S, Ruktanonchai NW, Zhou L, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature. May 2020. doi:10.1038/s41586-020-2293-x
- Paranjpe I, Fuster V, Lala A, et al. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. Journal of the American College of Cardiology. May 2020. doi:10.1016/j.jacc.2020.05.001
- Thanh L, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. 2020;19(5):305-306. doi:10.1038/d41573-020-00073-5
- Bryan A, Pepper G, Wener MH, et al. Performance Characteristics of the Abbott Architect SARS-CoV-2 IgG Assay and Seroprevalence in Boise, Idaho. J Clin Microbiol. May 2020. doi:10.1128/jcm.00941-20
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Treibel TA, Manisty C, Burton M, et al. COVID-19: PCR screening of asymptomatic health-care workers at London hospital. The Lancet. May 2020. doi:10.1016/s0140-6736(20)31100-4
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Altmann S, Milsom L, Zillessen H, et al. Acceptability of app-based contact tracing for COVID-19: Cross-country survey evidence. May 2020. doi:10.1101/2020.05.05.20091587
Podcast edited from a live webinar by Izzy Carley
Over the last few years many of us in the UK have started to incorporate high-sensitivity troponin into the assessment of patients presenting with chest pain.
We have seen these samples taken at ever shorter intervals, aiming to discharge low risk patients safely, sooner from the Emergency Department (ED). This has been driven in part by the "Four Hour Emergency Access Target" as well as increased crowding in overwhelmed EDs.
In this podcast, internationally renowned researcher Prof Rick Body discusses the latest in troponin research and the recent LoDED study.
The Shownotes
The various organisations mentioned by Rick can be found here:
The Innovation Agency Webinar Series
The NHS Accelerated Access Collaborative
The CQUIN that will be implemented later this year (page 15 for the Troponin section)
The Draft NICE recommendations
Welcome to our fourth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.
The live event tool place on Tuesday 5th May at 11.30am BST (10.30am GMT).
The panel was again be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar (Academic Clinical Lecturer), Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Justin Morgenstern to discuss six papers about COVID-19 infection.
There will be another COVID 19 Journal Club next week (Tuesday 12th May at 11am).
References
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He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online April 15, 2020. doi:10.1038/s41591-020-0869-5
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Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? The Journal of Infectious Diseases. Published online April 16, 2020. doi:10.1093/infdis/jiaa189.
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Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. Published online April 2020. doi:10.1016/s0140-6736(20)31022-9
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Rajendran K, Narayanasamy K, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID‐19: Systematic review. J Med Virol. Published online May 2020. doi:10.1002/jmv.25961
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Tedeschi S, Giannella M, Bartoletti M, et al. Clinical impact of renin-angiotensin system inhibitors on in-hospital mortality of patients with hypertension hospitalized for COVID-19. Clinical Infectious Diseases. Published online April 27, 2020. doi:10.1093/cid/ciaa492
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Docherty AB, Harrison EM, Green CA, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. Published online April 28, 2020. doi:10.1101/2020.04.23.20076042 Podcast edited from a live webinar by Izzy Carley
It's been another busy month at St Emlyn's, with the publication of 15 blog posts and five podcasts, but there does seem to be an awful lot to talk about!
Of course there have been multiple posts and podcasts about COVID-19, and you can fiind all of these on our special St Emlyn's page. Highlights have included the three RCEM/St Emlyn's Webinars which we are delighted to host in podcast form.
It's not just been coronavirus though, we have also dipped out toes into exercise and nutrition, graphic design and horticulture!
Parts of the site have also undergone a bit of a redesign with the curriculum pages now easier to navigate to find that post to fioll an e-portfolio hole.
We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.
They'll be much more to come in May I am sure.
Take care
Iain
Podcast edited by Izzy Carley
Welcome to our third webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The live event took place on Tuesday 28th April at 11am BST (10am GMT).
The panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Dan Horner (RCEM Professor), Prof Pam Vallely (Professor of Medical Virology), Salim Rezaie (Emergency Physician and Founder of REBEL EM) and Prof Simon Carley (you know him…) to discuss five papers about COVID-19 infection. There will be another COVID 19 Journal Club next week (Tuesday 5th May at 11am).
Edited by Izzy Carley and Iain Beardsell
References 1. Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine. April 2020:1-21. https://www.esicm.org/wp-content/uploads/2020/04/863_author_proof.pdf. 2. Caputo ND, Strayer RJ, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID‐19 Pandemic. Acad Emerg Med. April 2020. doi:10.1111/acem.13994 3. Garcia FP, Perez Tanoira R, Romanyk Cabrera JP, Arroyo Serrano T, Gomez Herruz P, Cuadros Gonzalez J. Rapid diagnosis of SARS-CoV-2 infection by detecting IgG and IgM antibodies with an immunochromatographic device: a prospective single-center study. April 2020. doi:10.1101/2020.04.11.20062158 4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. April 2020. doi:10.1001/jama.2020.6775 5. Metzler B, Siostrzonek P, Binder R, Bauer A, Reinstadler S. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. April 2020. doi:10.1093/eurheartj/ehaa314
Welcome to our second webinar on recent research about COVID-19, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The panel was hosted by Rick Body. The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer), Dr Casey Parker and Prof Simon Carley (you know him…) to discuss six papers about COVID-19 infection.
The live event took place on Tuesday 21st April 2020
References:
Paper 1 (00:00) Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. April 2020. doi:10.1101/2020.04.10.20060558
Paper 2 (12:09) Bendavid E, Mulaney B, Sood N, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. April 2020. doi:10.1101/2020.04.14.20062463
Paper 3 (16:40) Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. April 2020. doi:10.1038/s41586-020-2196-x
Paper 4 (23:33) Favas C. Guidance for the Prevention of COVID-19 Infections among High-Risk Individuals in Camps and Camp-like Settings. London School of Hygiene and Tropical Medicine; 2020:1-15. https://www.lshtm.ac.uk/sites/default/files/2020-04/Guidance%20for%20the%20prevention%20of%20COVID-19%20infections%20among%20high-risk%20individuals%20in%20camps%20and%20camp-like%20settings.pdf. Accessed April 21, 2020.
Paper 5 (30:30) Zeng J-H, Liu Y-X, Yuan J, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. April 2020. doi:10.1007/s15010-020-01424-5
Paper 6 (35:02) Caruso D, Zerunian M, Polici M, et al. Chest CT Features of COVID-19 in Rome, Italy. Radiology. April 2020:201237. doi:10.1148/radiol.2020201237
Podcast edited by Izzy Carley and Iain Beardsell
In this podcast, Dan and Iain talk about the clinical journey of a COVID-19 patient, beyond the ED, with insights from the critical care unit. There are some concepts here that we don’t have time to do full justice to in the podcast, so there is a comprehensive set of "show notes" and all the references at www.stemlynsblog.org/covid-19-and-critical-care
Professor Rick Body is joined by Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynolds (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer) and Prof Simon Carley (you know him...) to discuss six papers about COVID-19 infection.
03:10 - Paper 1 – Guan et al. Clinical characteristics of Coronavirus disease 2019 in China. NEJM Feb 28 2020
https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
16:54 Paper 2 – Zou et al. Single Cell RNA-SEQ Data Analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-NCOV infection. Frontiers of Medicine. Mar 12 2020.
https://link.springer.com/content/pdf/10.1007/s11684-020-0754-0.pdf
21:43 Paper 3 – Gautret et al. Hydroxychloroquine and azithromycin treatment of COVID-19: Results of an open-label non-randomised clinical trial. International Journal of Antimicrobial Agents. 20 Mar 2020
https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub
25:25 Paper 4 – Cao et al. A trial of Lopinavir-Ritonavir in adults hospitalized with severe COVID-19. NEJM Mar 18 2020
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2001282
29:35 Paper 5 – Cui et al. Prevalence of venous thromboembolism in patients with severe Coronavirus pneumonia. Journal of Thrombosis and Haemostasis. Apr 9 2020 doi:10.1111/jth.14830
https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14830
34:14 Paper 6 – Lynarts et al. Prediction models for diagnosis and prognosis of COVID-19 infection: systematic review and critical appraisal. BMJ. Apr 7 2020 BMJ 2020;369:m1328
https://www.bmj.com/content/bmj/369/bmj.m1328.full.pdf
Iain and Simon discuss Covid19 and more in this review of the best of the blog from March 2020.
Simon interviews Dr John Rogers and Dr Nathan Lewis on respiratory infection prevention.
John a Sports and Exercise Medicine Consultant in Manchester. He is also Chief Medical Officer for British Triathlon and Visiting Professor in Sport & Exercise Medicine at Manchester Metropolitan University.
Nathan is lead performance nutrition scientist at the English Institute of Sport and at ORRECO.
These two academics take us through how sports science might be able to support our wellbeing during the Covid19 pandemic.
References
- Recommendations to maintain immune health in athletes https://www.tandfonline.com/loi/tejs20
- Probiotics https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006895.pub3/epdf/full
- Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/23840373/
- Vitamin C for prevention and treatment of pneumonia https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013134/full
- Vitamin C and common cold https://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold
- Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/27184276/
- Vitamin C and Infections https://pubmed.ncbi.nlm.nih.gov/28353648/
- Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage https://pubmed.ncbi.nlm.nih.gov/28515951/
The world is consumed by the Coronavirus pandemic, but how do we look after ourselves? Liz and Iain discuss some strategies to stay well over the coming weeks and months. Recorded on 25th March 2020.
Simon chats to Sarah Thornton, consultant anaesthetist, intensivist and head of the NW school of anaesthesia on preparing to work in a critical care unit during the Covid-19 pandemic.
Iain and Simon chat about the current Corona pandemic and the blog in Feb 2020.
Iain remains positive, but Simon thinks the glass is half full. Time will tell who is right (though in truth there is a lot of common ground).
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Dr Roberto Cosentini is an old friend of St Emlyn's who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid19 outbreak. He kindly found an hour to record a podcast with us on his experiences.
There are so many essential lessons in this podcast. Please share with clinical and non-clinical colleagues, as we need to plan NOW. Roberto is quite clear that if we don't train and get plans into place before the wave of cases hit us then both ourselves and our patients will suffer.
In the interest of speed I'm not going to summarise the whole podcast. You have to listen to it all yourself to see what's relevant to you. These are some of my take away messages.
- Divide your department into resp patients and non-resp patients
- Wear PPE and know how to use it
- You will need clinicians who do not usually work in ED. Train and orientate them now (before you need them).
- Most patients are hypoxic and this responds to O2 and CPAP. You're going to need a lot of CPAP and how that happens could be tricky. They found hoods the best (Ed - but how many of those do we have?).
- Although hypoxic, patients have good lung compliance.
- They regularly saw diurnal variation with many patients presenting in the early afternoon.
- It's emotionally exhausting. Prepare yourself and your team psychologically and support them during the pandemic. Roberto's department has an embedded psychologist.
- Health care worker infections were quite low (because they wore PPE for all resp cases).
- Flow through the department and onto wards is absolutely vital.
- Flow out the the main hospitals to other units that can rehabilitate is vital.
- Decisions for ICU level care were similar to normal (in his hospital)
We rarely declare one of our podcasts a 'must listen' but this is an exception. Please listen and share widely. Please think hard about the issues Roberto raises and PLEASE ACT NOW.
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How you can support St Emlyn's * Join us for #stemlynsLIVE conference May 12th 2020 * Subscribe to the blog (look top right for the link) * Subscribe to our PODCAST on iTunes * Follow us on twitter @stemlyns * PLEASE Like us on Facebook * Find out more about the St.Emlyn’s team * Find out more about the MMU MSc in Emergency Medicine here. * Download one of our FREE e-books here
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Iain is back on the podcast with Simon to talk through the best of the blog from January 2020.
Our regular round up of the best of the blog from December 2019. Published a little late, largely because of Coronavirus issues and general business.
Simon and Zaf talk about the practicialities of REBOA and discuss whether it's ready for prime time in the UK.
Further reading
EMCrit guest post - the good, the bad, the ugly of the (original) Joint Statement https://emcrit.org/emcrit/good-bad-ugly-of-joint-statement-reboa/ Updated 2019 Joint Statement from the ACS-COT, ACEP, NAEMSP, and NAEMT: https://tsaco.bmj.com/content/4/1/e000376.info London Air Ambulance Prehospital REBOA Case series: https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(18)31110-9
Our regular round up of the best of the blog from September 2019. A fairly quiet month for us, but some great content including a fabulous video from Cliff Reid on the Zero Point survey and on a related resus note, the concept of the UK resuscitationist with Dan Horner.
See more on the blog here https://www.stemlynsblog.org/jc-tranexamic-acid-txa-in-head-injury-the-crash-3-results-st-emlyns/
Our regular round up of the best and the brightest from the St Emlyn's blog. This is a round up of our August content.
Our latest podcast from the #stemlynsLIVE conference last year. Dan Horner talks on the concept and potential role of the UK Resuscitationist.
The best from the blog and podcast in July 2019.
JC: Clot’s the Problem? Vena Cava filters in trauma patients. St Emlyn’s Psychological performance in the resus room. Ashley Liebig at #stemlynsLIVE JC: The Resuscitative Care Unit. St Emlyn’s The great day paradox. St.Emlyn’s All you need to know about Listeria. St Emlyn’s. GI Emergencies – Chris Gray at #StEmlynsLIVE Similar challenges, different approaches – Mass Casualty Incident training lessons from Pakistan. St Emlyn’s
Prof. Rick Body is an internationally recognised expert in diagnostic testing. In this podcast he takes us through diagnostics today and also the near future which may change almost everything.
You can read more and see the slides/video at http://www.stemlynsblog.com
This talk focuses on how we can optimise our psychological performance in critical care situations, the type of situations that Simon describes as Time Critical, Information light. The Audio is available below, or watch the full presentation above.
Don't forget to watch the video on the St Emlyn's site http://www.stemlynsblog.org
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Here's our regular round up of the blog and podcast from June 2019.
Beyond ATLS https://www.stemlynsblog.org/beyond-atls-with-alan-grayson-at-stemlynslive-st-emlyns/
Traumatic Cardiac Arrest https://www.stemlynsblog.org/traumatic-cardiac-arrest-tca-podcast-with-prof-jason-smith-rn-st-emlyns/
The psychological impact of emergency medicine https://www.stemlynsblog.org/how-events-in-emergency-medicine-impact-doctors-psychological-well-being-st-emlyns/
Can we use IO aspirate for analysis https://www.stemlynsblog.org/jc-can-we-really-use-io-blood-for-analysis-st-emlyns/
Don't forget the Bubbles conference and site https://dontforgetthebubbles.com/
This is Chris's talk from #stemlynsLIVE on GI emergencies. Remember to check out the blog for the background, references and more.
Our regular monthly round up, this month with Ian and Simon chatting through the best of the blog.
The power of peer review: https://www.stemlynsblog.org/smacc2019-the-power-of-peer-review/
Virtual reality in PED: https://www.stemlynsblog.org/jc-virtual-reality-for-distraction-from-paediatric-procedural-pain/
Wellbeing for the broken: https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlyns/
Traumatic cardiac arrest https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlhttps://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/
Should we cardiovert AF in the ED or wait? https://www.stemlynsblog.org/should-we-rapidly-cardiovert-af-in-the-ed-st-emlyns/
Prolonged field care in the ED https://www.stemlynsblog.org/prolonged-field-care-in-the-ed/
Keppra or Phenytoin for status epilepticus in kids https://www.stemlynsblog.org/jc-enter-sandman-which-agent-as-second-line-in-paediatric-status-epilepticus/
This is the podcast that accompanies the recent blog post on Jason's latest research on traumatic cardiac arrest and closed chest compressions. This discussion is more wider ranging and explores how the management of TCA has changed, and is changing as we begin to gain a better understanding of the physiological mechanisms underpinning our resuscitation strategies.
Read the blog here. http://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/
Key references
Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest.Watts S, Smith JE, Gwyther R, Kirkman E. Resuscitation. 2019 May 9;140:37-42. doi: 10.1016/j.resuscitation.2019.04.048. [Epub ahead of print]
Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Nov;35(11):669-674. doi: 10.1136/emermed-2018-207739. Epub 2018 Aug 28.
5.
Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Rickard AC, Vassallo J, Nutbeam T, Lyttle MD, Maconochie IK, Enki DG, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Jul;35(7):434-439. doi: 10.1136/emermed-2017-207226. Epub 2018 Apr 28.
The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry. Barnard EBG, Hunt PAF, Lewis PEH, Smith JE. J R Army Med Corps. 2018 Jul;164(3):150-154. doi: 10.1136/jramc-2017-000818. Epub 2017 Oct 6.
Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. January 2015:11-16. doi:10.1177/0141076814560837
May N. Traumatic Cardiac Arrest. St Emlyn’s. http://www.stemlynsblog.org/traumatic-cardiac-arrest/. Published 2012. Accessed 2019.
Alan Grayson takes us through his thoughts on ATLS. Is it really as terrible the #FOAMed world makes out?
This is the podcast that links to the following two posts on how to deal with some of the hardest events we have to deal with in emergency and critical care.
You can read more about the topic on the following two blogs.
https://www.stemlynsblog.org/wellbeing-for-the-broken-part-1-liz-crowe-for-st-emlyns/
https://www.stemlynsblog.org/wellbeing-for-the-broken-part-2-st-emlyns/
This is a tough listen so if you are affected by the content do chat through with colleagues.
Back in late 2018 we gathered in Manchester for the inaugural #stemlynsLIVE conference. Our friend Dr George Wills gave a great talk on Aortic Emergencies.
All emergency physicians know that it's all to easy to miss an aortic catastrophe. Listen to George's wisdom on common pitfalls and top tips to make you a better emergency clinician.
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Also check out these excellent #FOAMed resources.
- Subscribe to the blog (look top right for the link)
- Subscribe to our PODCAST on iTunes
- Follow us on twitter @stemlyns
- PLEASE Like us on Facebook
- Find out more about the St.Emlyn’s team
Last year we were honoured to bring Kat Evans to Manchester to talk at the #stemlynsLIVE conference. We've covered emergency medicine in South Africa before on the blog, but there is no substitute to hearing about it from someone who actually works there.
Part of the critical appraisal nuggets series. You can read more here https://www.stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/
Also mentioned in this podcast
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Definition of p-values on the bottom line https://www.thebottomline.org.uk/blog/ebm/p-value/
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Fragility index https://lifeinthefastlane.com/ccc/fragility-index/
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Confidence interval https://en.wikipedia.org/wiki/Confidence_interval
The latest blog posts, ideas and thoughts from the St Emlyn's podcast. This month with Simon Carley and Rick Body,
This is a really important concept developed by Charlie Reynard and Rick Body here in Manchester. There is an accompanying paper in the EMJ that you can read via this link https://emj.bmj.com/content/34/12/A870
This concept could radically change how we make probabilistic prescribing decisions in the ED. Have a listen and look out for a blog post on St Emlyn's soon.
This podcast and presentation was recorded at the St Emlyn's LIVE conference in Manchester 2018. In this presentation Clare takes us through the rationale, principles, training and practice that we need in order to continually develop as prehospital and resuscitation practitioners.
You can read more from the event at http://www.stemlynsblog.org
This is a great presentation for anyone interested in continually developing their own and their colleagues practice, delivered by someone who really knows what they are talking about and who works for one of the best developed resuscitation services in the world.
Clare is an Emergency Physician and specialist in Pre-Hospital Care and Retrieval medicine based in Sydney, with Royal Prince Alfred Hospital and Sydney HEMS. She has completed a fellowship in simulation based education, and enjoys training with “real” people - patients, bystanders and the other clinicians we come across as we treat our patients every day. She is a lecturer with the University of Sydney, and is involved in education for the NSW Institute for Trauma Injury Management. When Clare is not working on helicopters or training teams, she is studying yoga or hanging out with her puppy, Archie.
This is the monthly round up of blogs from the St Emlyn's team
Tribalism with Ross Fisher https://www.stemlynsblog.org/breaking-down-tribalism-onetribeemta-st-emlyns/
Conservative management of chest trauma https://www.stemlynsblog.org/jc-conservative-management-of-chest-trauma-st-emlyns/
ICS SOA day 1 https://www.stemlynsblog.org/st-emlyns-on-tour-icssoa2018/
Handover principles https://www.stemlynsblog.org/handover-process-practice-and-controversy-icssoa2018-st-emlyns/
ICS SOA day 2 https://www.stemlynsblog.org/icssoa2018-day-2-st-emlyns-on-tour/
ICS SOA day 3 https://www.stemlynsblog.org/icssoa2018-day-3-st-emlyns-on-tour/
FeminEM part 4 https://www.stemlynsblog.org/fix18-part-four/
PEP, PEPSE and HIV https://www.stemlynsblog.org/pep-prep-and-all-things-hiv-st-emlyns/
Game of Thrones https://www.stemlynsblog.org/ste-journal-club-a-christmas-games-of-thrones-issue/
November was a busy month for the St Emlyn's team with a variety of blogs on conferences, EBM, philosophy and education. Here's the podcast and the links to the blogs mentioned in November.
FeminEM part 2 with Natalie May https://www.stemlynsblog.org/fix18-part-two/ FeminEM part 3 with Natalie May https://www.stemlynsblog.org/fix18-part-three/
Dan Horner on the POLAR trial of hypothermia in brain injury https://www.stemlynsblog.org/jc-hypothermia-in-brain-injury-the-polar-trial-st-emlyns/
Zaf Qasim on whole blood in trauma https://www.stemlynsblog.org/whole-blood-in-trauma-st-emlyns/
Nick Smith on Cognitive Load theory https://www.stemlynsblog.org/education-theories-you-should-know-cognitive-load-theory-st-emlyns/
Claire Bromley on her experience on elective in Cape Town https://www.stemlynsblog.org/south-africa-as-a-medical-student-elective-claire-bromley/
Natalie May on why resuscitation is not sexy https://www.stemlynsblog.org/so-unsexy/
Learning in the social age with Simon Carley https://www.stemlynsblog.org/learning-in-the-social-age-st-emlyns-at-emerge10/
Salim Rezaie on Advanced ACLS - beyonfd the guidelines https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/
This podcast was recorded at the Intensive Care Society State of the Art meeting in London 2018. Simon Carley interviews Prof Peter Brindley on the interface of technology, humans and humanity in critical care. The audio was recorded live and at the venue so there is a fair bit of background noise, but we hope that this does not distract from a wide ranging and fascinating podcast.
Five strategies to improve your resuscitations.
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Zero point survey
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Peer review
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10 in 10
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Hot debriefs
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Fly the patient
You can read about these strategies, watch the video and learn about the background on the St Emlyn's blog here https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/
Salim Rezaie from the REBEL EM podcast takes us through the optimal management of cardiac arrest and also explores some of the controversies and difficulties that make the difference to our patients.
You can read a lot more about the background to this talk, see the evidence and watch the video on the St Emlyn's site. Just follow this link. https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/
Here's our round up of the best of the blog from October 2018.
In Pursuit of Excellence with Natalie May from #stemlynsLIVE https://www.stemlynsblog.org/in-pursuit-of-excellence/
A FeminEM in NY with Natalie May Part 1. https://www.stemlynsblog.org/fix18-part-one/
JC: Cricoid Pressure, Do we still need it? Simon Carley https://www.stemlynsblog.org/jc-cricoid-pressure-and-rsi-do-we-still-need-it-st-emlyns/
Teaching and Learning in Stretched Environments with Simon Carley https://www.stemlynsblog.org/teaching-and-learning-in-stretched-environments-rsm-2018-st-emlyns/
Five free strategies to improve your resuscitations Simon Carley https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/
PTSD and me, EMDR therapy with Rusty Carroll https://www.stemlynsblog.org/ptsd-and-me-part-3-emdr-therapy-st-emlyns/
This presentation was given at the inaugural #stemlynsLIVE conference on the 8th of October 2018 in Manchester. You can read more about the presentation and the conference here. https://www.stemlynsblog.org/in-pursuit-of-excellence/
Here's our round up of the best of the blog from September 2018.
The following blogs are discussed.
OOHCA and airway management. Do we need a tube? http://www.stemlynsblog.org/jc-oohca-and-airway-management-do-we-need-a-tube-st-emlyns/
The Zero Point Survey. Optimising resuscitation teams in the ED. https://www.stemlynsblog.org/jc-the-zero-point-survey-optimising-resuscitation-teams-in-the-ed-st-emlyns/
Subacute and massive PE management https://www.stemlynsblog.org/we-call-it-massiiiiiiivve-pe-at-st-emlyns/
EMS Gathering and podcast https://www.stemlynsblog.org/ems-gathering-review-and-podcast-st-emlyns/
ResusTO: A simulation/resuscitation conference like no other https://www.stemlynsblog.org/resusto-a-simulation-resuscitation-conference-like-no-other/
Monkeypox has arrived https://www.stemlynsblog.org/monkeypox-has-arrived-is-the-panic-justified-st-emlyns/
Micro Machines: Sick neonates at RATH18 https://www.stemlynsblog.org/micromachines/
Equality and Diversity in EM. What I learned as a recovering racist. https://www.stemlynsblog.org/equality-and-global-health-what-i-learned-from-being-a-recovering-racist/
StEmlyn's at EusEM (Four posts)
- https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-4/
- https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-3/
- https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-2/
- https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-1/
A little later than planned, but here is the podcast round up of the St Emlyn's blog for August 2018.
The following blogs are discussed.
Lessons learned at EMSA https://www.stemlynsblog.org/lessons-learned-at-emsa18/
Troponin and Biotin https://www.stemlynsblog.org/troponin-and-biotin-a-lethal-combination/
Top apps at EMSA https://www.stemlynsblog.org/top-apps-at-emsa18-st-emlyns/
Navigating the CESR route in UK emergency medicine training https://www.stemlynsblog.org/et-tu-brute-one-mans-battle-with-cesr-st-emlyns/
JC: IV fluids review paper https://www.stemlynsblog.org/jc-intravenous-fluid-therapy-in-critically-ill-adults-review-st-emlyns/
Moral Injury in emergency medicine https://www.stemlynsblog.org/moral-injury-in-emergency-and-pre-hospital-care-esther-murray-on-st-emlyns-podcast/
EMS Gathering round up 2018 with Simon Carley and Aidan Baron. See www.stemlynsblog.org Apologies for the sound quality on this one, it was all done in a fairly noisy environment.
Don't forget to listen to special guests from 23 mins onwards.
This week we recorded a podcast inspired by a recent publication in the EMJ. Esther Murray aka @EM_Healthpsych is a psychologist working in London.
Her recent paper on whether the experiences of medical students might precipitate moral injury during their pre-hospital experiences gives an insight into how we all cope with and respond to the clinical work we do. Some of the work we do is traumatic, painful and morally difficult to rationalise. We are witness to the very worst aspects of some of our patient’s lives and there may be a price to pay.
I was delighted to explore some of the concepts around moral injury in this podcast and would really recommend that you read the paper 1 and consider whether this is something that can affect ourselves and our colleagues. The paper is open access at the moment so there is no excuse not to 😉
Although the paper is based on a small number of participants from only one aspect of the healthcare system it does recognise this limitation and alludes to future work with different groups of clinician.
What is Moral Injury? Esther describes ‘moral injury’ as a concept emerging from work with military veterans. It is used to describe the psychological sequelae of ‘bearing witness to the aftermath of violence and human carnage
A quick round up of the best from the blog in July 29.
Infinite Game theory and Emergency Medicine with Craig Ferguson
http://stemlynsblog.org/only-a-game-infinite-game-theory-in-emergency-medicine/
Epinephrine in Cardiac Arrest: Journal Club post (and a really important one)
http://stemlynsblog.org/jc-does-epinephrine-work-in-cardiac-arrest-st-emlyns/
Keep on Walking: PTSD and me with Rusty Carroll
http://stemlynsblog.org/keep-walking-ptsd-and-me-part-2-st-emlyns/
Tamulosin in Renal Colic: Journal Club post
http://stemlynsblog.org/jc-tamsulosin-and-renal-colic-st-emlyns/
Pointing the Finger: Paronychia in the ED from Natalie May
http://stemlynsblog.org/paronychia/
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Steve Playfor is an paediatric intensive care consultant at the Royal Manchester Children's Hospital here in the 'real' Virchester.
He is an expert in the management of fluid balance in children and has been instrumental in many of the changes to our attitudes, beliefs and practice around IV fluid management.
In this episode Simon and Steve discuss the somewhat crazy story of IV fluid management in kids, the pseudo-science, the custom and practice and finally the potential future of IV management.
I can guarantee that you will learn something here folks.
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Nat and Simon discuss the recent #badEMfest18 conference.
You can read more about the conference on our posts on the stemlynsblog website.
Day 1
Day 2
Day 3
Day 4... it's coming
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This month we have a podcast on how we approach patients with mental health needs in the ED. It outlines the rationale and delivery of a change in how we manage some of the most vulnerable patients in the ED. We hope you find it interesting and I suspect you will also find it quite challenging. We are aiming to improve the care of patients with Mental Health needs, but in doing so we must face our own prejudices and practices, which are not always healthy.
Editorial note on language – as you listen to the podcast you might be surprised to hear us use words like ‘insane’ in relation to decisions and systems. In some ways it seems incongruous to use such terms in a podcast that promotes a better understanding of mental health issues. We considered taking them out, but after consideration we left them in an attempt to illustrate the false dichotomy between medical and psychiatric needs that is embedded in much of our work. Perhaps the use of language reflects this and makes the point that we can do better.
Why do we need to rethink our approach to Psychiatric emergencies in the ED?
There are a group of life threatening conditions that present to your ED that you don’t deal with, or at least you don’t deal with very well. This group of conditions has a significant mortality and an incredibly high morbidity, but if you are a typical emergency physician you probably don’t think you own the problem. This group of conditions is at least as common as chest pain and yet it’s unlikely that you feel the same level of ownership of the problem.
The issue is of course that of psychiatric illness. In Virchester it accounts for about 1 in 20 patients through the door, and that number is much, much higher if we were to include substance abuse and its related outcomes.
In general, the approach in many UK units is to divide the patient up on arrival into physical and mental health needs. We feel responsible for the physical problem and then we try and offload any psychiatric problems onto the psychiatrists and mental health teams. At the centre of this is the patient who really does not see or feel this dichotomy and we really need to challenge our approach to this.
Such dichotomies are embedded in our systems. I’m sure that many readers will be familiar with the request to ‘medically clear’ a patient in order that they can then be assessed by the mental health team. Bizareer customs and practice take place around these assessments, for example in Virchester the rule that a patient with a heart rate of more than 100 cannot be medically fit for assessment is sometimes used to decline psychiatric assessment. Such informal rules (none are actually written down or appear in any agreed protocol) result in delayed assessments, patient distress and long waits in the ED. I could go on, and whilst there is good and practice amongst all teams and specialities (we are just as bad at the mental health teams in promoting this dichotomy), the point is that we really don’t act in the patient’s best interests by dividing mental and physical health.
This clear difficulty was one of the starting points for the APEX course, which aims to bring psychiatry and emergency medicine together for the benefit of patients, services and staff.
The interview on the podcast is recorded with Prof. Kevin Mackway-Jones who many of you will know through his work with the Advanced Life Support Group. He was the instigator of APLS at a time when there was a clear need for emergency physicians to improve their approach and knowledge of paediatric emergencies. APEx feels the same. A common condition in our EDs for which we are not currently doing the best that we can for our patients and where a joint teaching and learning approach is needed between the ‘tribes’ of medicine.
This could be a game changer to how we manage a very common and very vulnerable group of patients in the ED.
So what’s on the course?
I can’t give you the whole courses here but there are a few principles that underpin the content and approach.
Key points.
- It’s co-written and developed between psychiatry and emergency medicine
- It’s a symptom based approach (just like APLS) and so it deals with how we deal with the presenting complaint first and not the underlying diagnosis (as you may not know what this is when you are dealing with the patient).
- The approach will be familiar to many Eps.
- Primary Survey
- Resuscitation
- Secondary Survey
- Definitive management
- There is a unified approach. The patient needs an ABC approach for physical health, but in addition and concurrently they also need the AEIOU approach.
- A – Assessment of Aggression and Agitation
- E – The Environment in which you are assessing the patient
- I – The Intent of the patient
- O – The Objects the patient has to carry out the intent
- U – The Unified assessment (as you will also be carrying out an ABC assessment alongside AEIOU)
- Rapid tranquilisation is a key conern for EPs and so there is lots on this that does not automatically default to restraint, a needle and syringe and a significant risk.
- Oral tranquilisation works
- Ketamine is not the answer to every patient
- It’s a risk based approach as every intervention (including no intervention) has a risk
Find out more
You can find out more on the ALSG website here.
What has APEx got to do with St Emlyn’s?
At St Emlyn’s we are letting you know about the course for several reasons. Many of us teach and support the work of the ALSG charity (for free and because we believe in it), but also that we all believe that the care of patients with mental health needs can be improved. They are a vulnerable group who generally get a bad deal when they present in crisis to emergency departments. We know we can do better and we believe that this course will help us achieve our goal to do the best that we can for our patients.
APEX Course information.
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@EMManchester
- Subscribe to the blog (look top right for the link)
- Subscribe to our PODCAST on iTunes
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- PLEASE Like us on Facebook
- Find out more about the St.Emlyn’s team
- Come join us at our conference in October 2018
Simon and Iain talk through what the team has been up to in April. All the blogs should be on the website and of course you can subscribe to the podcast via iTunes or via PodBean.
Key publications in April.
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Our e-book on health and wellbeing for the resuscitationist. http://stemlynsblog.org/the-resuscitationists-guide-to-health-and-wellbeing-a-st-emlyns-e-book/
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Police drop offs for penetrating trauma in the US. http://stemlynsblog.org/to-protect-and-serveand-drop-off-st-emlyns/
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The latest blogs on the amazing #badEMfest18 conference in South Africa http://stemlynsblog.org/bademfest18-day-3-st-emlyns/
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The top 10 trauma papers of the year http://stemlynsblog.org/top-10-trauma-papers-2017-2018-for-traumacareuk-conference-st-emlyns/
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Complications of anticoagulation http://stemlynsblog.org/complications-of-anticoagulation-and-how-to-manage-them-st-emlyns/
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Trauma CT in kids http://stemlynsblog.org/jc-trauma-paediatric-wbct/
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The folly of dichotomous diagnosis http://stemlynsblog.org/50-shades-black-white-folly-dichotomy/
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Bonded in Blood with Ashley Liebig and Noah Gallagher http://stemlynsblog.org/bonded-in-blood/
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How to coach your team and the Austrian EM conference http://stemlynsblog.org/how-to-coach-feedback-team-st-emlyns/
Gosh, when you write it down and think about all the work the rest of the team puts in to teach and learn it makes me kind of proud. Don't forget to join us later this year for the live version at #stemlyneLIVE in Manchester.
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- Subscribe to the blog (look top right for the link)
- Subscribe to our PODCAST on iTunes
- Follow us on twitter @stemlyns
- PLEASE Like us on Facebook
- Find out more about the St.Emlyn’s team
- Come join us at our conference in October 2018
Iain and Simon catch up on what happend on the St Emlyn's blog and podcast in March 2018.
Visit http://www.stemlynsblog.org for more info and links to the articles mentioned in the podcast.
This month we cover IV fluids and the never-ending debate around balanced crystalloids vs. saline, we look at working in Africa on secondment or as a placement and we round off with a discussion of the utility of pupillary signs in the prognosis of patients post cardiac arrest.
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The Physician Response Unit (PRU) is an innovative service in East London that takes the emergency department to the patient. The PRU is led by Tony Joy, consultant in emergency medicine and prehospital care and is a fairly unique service to the UK.
In this podcast our very own Richard Carden interviews Tony for an in depth understanding of how the service is supporting the entire emergency care system in London.
You can read more about the PRU here https://londonsairambulance.co.uk/our-service/news/2017/10/remodelled-pru-to-be-a-seven-day-service-for-the-first-time and look out for a blog post on the St Emlyn's blog site very soon.
Iain and Simon round up the blog posts from January 2018. You can listen to the podcast below. Links to all the blog posts mentioned are listed below.
As 2017 ends and we look forward to 2018 it’s time to reflect on a year with the St.Emlyn’s team. Despite our chronological and geographical dispersal it’s really felt like a team effort in 2017. We have travelled, learned, listened,… Read more
JC: Devastating Brain Injury. Complex decisions in the resus room. St.Emlyn’s Simon Carley January 4, 2018 3 Comments Social media can sometimes give the impression that all is rosy in the world of resuscitation. We hear of the amazing saves, the wonders of ECMO, helicopters and heroic acts with great outcomes, but the reality is of course very… Read more
[caption id="attachment_31228" align="alignleft" width="300"] northern emergency medicine conference[/caption]
St.Emlyn’s goes further north – NEM Conference #NEMC18 Chris Gray January 9, 2018 0 Comments It’s the second time I’ve been to the Northern Emergency Medicine conference, this year held in the sunny city of Durham. I say sunny… I needed my jacket. Last year’s programme was great and included some fantastic speakers, including our… Read more
JC: Can I safely discharge dizzy patients from the ED? Janos Baombe January 12, 2018 4 Comments Last month, I came across a clinical review published in the Annals of Emergency Medicine1 that got me really excited! It got me excited (in a geeky professional sense of course…) as it covered a topic that causes significant… Read more
On Reflection Natalie May January 16, 2018 3 Comments On Reflection I’ve been reflecting on reflection for some time now, at least since I started formally collecting my lessons from Sydney HEMS and probably even before that, because this sort of meta nonsense is something medical education enthusiasts like… Read more
CRYOSTAT-2 with Ross Davenport Richard Carden January 21, 2018 2 Comments You might be aware that an exciting new trial has started called Cryostat-2. This is exciting as it has the potential to improve patient outcomes, but also because it will involve all the Major Trauma Centres in England and 8… Read more
The End of the ‘Roid? JC: ADRENAL Dan Horner January 22, 2018 4 Comments So another year, another Critical Care Reviews meeting. Rob is doing an absolutely fantastic job with these, inviting lead authors from major critical care trials to present and defend their work. In fact, this is going so well that this… Read more
Belgian EM at BeSEDiM 2018. Simon Carley January 28, 2018 0 Comments Last weekend, the BeSEDiM (Belgian Society of Emergency and Disaster Medicine) organised their annual symposium. It is the scientific organization of the Belgian emergency physicians with Said Idrissi as chairman. 13 years ago, Belgian Emergency medicine was born as a… Read more
Is there anything else I need to know? Working in Africa. Simon Carley January 29, 2018 0 Comments This is a guest post from our good friend Stevan Bruijns aka @codingbrown Stevan has been an advocate of international emergency medicine for many years and he, like us feels that there is much that high income countries can do… Read more
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@EMManchester
Before you go please don’t forget to…
- Subscribe to the blog (look top right for the link)
- Subscribe to our PODCAST on iTunes
- Follow us on twitter @stemlyns
- See our best pics and photos on Instagram
- PLEASE Like us on Facebook
- Find out more about the St.Emlyn’s team
Simon and Iain belatedly reflect on a tough winter and the posts in January.
Check out stemlynsconference.com if you want to know more about #StEmlynsLIVE
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In this episode, the fabulous Liz Crowe (@LizCrowe2) discusses how to approach debriefing after critical (and non critical) incidents in healthcare. We focus on the debriefing that takes place 5-7 days after an incident. For more on a "hot" debrief listen to this podcast by Ashley Liebig and Rob Orman
Rick and Simon talk about critical appraisal and diagnostic studies. How does a PICTR question work and how can you use it to assess the quality of a published study, and how can it be used in research design.
In this podcast Simon talks to Dan Harvey (ITU) and Mark Wilson (Neurosurgeon) on the management of complex patients with a perceived devastating brain injury.
This podcast is linked to the blog on the St.Emlyn's website.
http://stemlynsblog.org/jc-devastating-brain-injury-complex-decisions-in-the-resus-room-st-emlyns/
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December round up of St.Emlyn's
Dates for your diary.
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Cape Town Teaching Course
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Manchester Teaching Course
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BadEMFest18
Blog posts.
1.Dan does part of State of the Art #ICSSOA2017. St.Emlyn’s
2.Management of paracetamol therapeutic excess in the ED. St.Emlyn’s.
3.The ED Spa. Wellness and Support in #Virchester. St.Emlyn’s. (NOTE - We forgot to mention the incredible contribution of Kirsten Ballantyne on this project - it's more than just Laura)
4.JC : Paracetamol, NSAID’s or both in MSK trauma. St.Emlyn’s
- 104 Reflections from Sydney HEMS – the eBook. St.Emlyn’s
6.MARSIPAN – Not just for (Christmas) Cakes. St.Emlyn’s
7.How to ask a question at a conference. The origin of ‘that’ algorithm. St.Emlyn’s
8.Review of 2017. St.Emlyn’s
If anyone wants to know more about any of the conferences we talk about please get in touch with the team stemlyns@gmail.com
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Natalie and Simon discuss reflections, e-books and life at Sydney HEMS. This week we have added Lorikeets in the background (Nat recorded at Coogee Bay in NSW). We think they sound cute so we've kept them in (or rather we could not edit them out).
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A quick summary on how you can use group messaging systems in a major incident. A vast improvement on telephone cascades BUT you have to set this up in advance. If you make it up on the day it will be a disaster. Here's the tips and tricks from the Virchester team. You can read more here http://stemlynsblog.org/tag/whatsapp/
Simon (@EMManchester) and Iain (@docib) review some of the articles from the St Emlyns blog site (http://stemlynsblog.org/) from recent weeks and chat about the current state of Emergency Medicine in the UK.
1:00 - How to declare a Major Incident - http://stemlynsblog.org/how-to-declare-a-major-incident-st-emlyns/
3:10 - RCEM ASC 2017 – Update on the TiLLI study - http://stemlynsblog.org/rcem-asc-2017-update-on-the-tilli-study/
6:03 - The rise and SURPRISE of the DOACs - http://stemlynsblog.org/the-rise-and-surprise-of-the-doacs/
8:08 - Life as an EM Trainee in South Africa - https://itunes.apple.com/gb/podcast/the-st-emlyns-virtual-hospital-podcast/id547326956?mt=2&i=1000393179333
9:26 - Rheum for Improvement? The physical challenge of EM training - http://stemlynsblog.org/rheum-for-improvement-st-emlyns/ Harriet's website is here - https://www.rheumforimprovement.com/
10:47 - JC: Oxygen in ACS. A fuss about nothing? The DETO2X Trial - http://stemlynsblog.org/oxygen-in-acs-a-fuss-about-nothing/. Paper is here - http://www.nejm.org/doi/full/10.1056/NEJMoa1706222
11:57 - Is cMyC the new troponin? - http://stemlynsblog.org/cmyc-new-troponin/
13:00 - Who gets a Tetanus? You get a Tetanus! - http://stemlynsblog.org/tetanus-in-the-ed/
14:22 - Mass Casualty Incidents: Lessons from AAST - http://stemlynsblog.org/mass-casualty-incidents-lessons-aast-st-emlyns/
15:00 - The Annual Scientific Conference and the State of EM
I recently met up with some amazing UK docs working in South Africa at the EMSSA conference. This conference was held in Sun City near Johannesburg and brought together emergency physicians from across the contient.
It was great to catch up some UK docs who were on postgraduate electives working in hospitals like Khayelitsha which you may remember from this amazing blog by Robert Lloyd.
So please listen, learn and get in touch if it's something that you want to do.
On the podcast we have
Simon Carley (@EMManchester), Jennifer Hulse (@coffeeheadaches), Chris Wearmouth (@CCWearmouth), Jacob Smith (@DrJacobSmith), Emma Gold (@EmmaRGold) and Chloe Sanderson.
There are also Marina Queisser & Eveline Baerends in the photo.
A podcast on foreskin problems in the paediatric emergency department with Ross Fisher and Simon Carley.
This podcast links to the blog post which you can find here. Foreskins a PED primer.
It's that time of year again, where we get new colleagues in the Emergency Department (and across lots of other areas of the hospital too).
These are some of the top tips for new starters (and life in the ED in general) gathered from the senior medical and nursing team at Virchester (South).
More induction guidance and education available at http://stemlynsblog.org/induction/
Oh. And one tip we left out - always wear sunscreen.
With thanks (and apologies) to Baz Luhrmann.
This podcast links to a previous blog on St.Emlyns which you can find here.
Thinking the unthinkable.
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Iain (@docib) and Liz (@LizCrowe2) discuss one of the hottest topics in medicine - Burnout. What is it, who gets it and what can we do about it? Liz brings her huge knowledge and experience to a topic that is often discussed, but not always understood. Essential listening.
Our last podcast from the teaching course in Copenhagen #dasTTC. George Wills, Simon Carley, Natalie May, Jesse Spurr and Salim Rezzaie give the faculty perspective.
The short version is we think and hope that the delegates learned something, but as a faculty we once again learned loads and met some amazing people.
Roll on the next course. (hint they are in San Fransisco and Melbourne).
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Chris Nickson, Natalie May and Simon Carley discuss simulation and educational theory on day 2 of the teaching course.
Nat, Simon and Ash discuss day one of The Teaching Course in Copenhagen.
EMZen, wellness, icebreakers and feedback.
A critical appraisal nuggest on simple ways to understand the true effect of an intervention. Also see this more in depth podcast done with Iain Beardsell
http://ebem.podbean.com/2011/11/03/statistics-2/
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Iain and Simon chat through our top ten trauma papers for 2016. Lots here for anyone who is interested in trauma including whole body CT, traumatic cardiac arrest, neurosurgery in severe head injury and much more. As ever we'd suggest you read the original papers, references for which along with a blogpost can all be found here http://stemlynsblog.org/top-10-trauma-papers-2016-st-emlyns/
In a new podcast format Simon (@EMManchester) and Iain (@docib) discuss the month's offerings from the St Emlyn's blog and podcast (www.stemlynsblog.org).
It's been a month full of interesting posts on subjects as diverse as Thrombolysis in Stroke (Alan Grayson), The Future of Emergency Medicine in the Social Age (Simon), Cardiac Arrest Centres (Simon), Love in Critical Care (Liz Crowe), Transfers (Nat and Simon), Thrombolysis in PE (a guest post from FOAMed legend Anand Swarminathan) and Benzos in Back Pain (Janos). Head to the website for the articles themselves and all the references and links you need.
We're aiminig to make this a regular monthly podcast - let us know if it's useful and enjoyable and how we could make it even more educational.
Nat and Simon discuss the complexities of transferring a patient from the resus room to CT and back again. Look out for the blog post soon on stemlynsblog.org
This podcast accompanies the St.Emlyn's blog post on top tips for chest drainage.
http://stemlynsblog.org/chest-drain-excellence-microskills/
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Another Critical Appraisal Nugget on why analysis by intention to treat is so important.
A quick round up of events from the excellent Teaching Course in New York (https://flippingmeded.com/) with guests Ross Fisher (@ffoliet), Ashley Leibig (@ashleyliebig), Sandra Viggers (@StarSkaterDK) and Camilla Sorenson (@Camillabirgitte).
For brilliant summaries of each day, with details from every talk, visit http://scanfoam.org/teaching-course-nyc-day-1-ttcnyc16/ (Day 1) and http://scanfoam.org/teaching-course-nyc-day-2-ttcnyc16/ (Day 2)
Here's the podcast on BRUE and ALTE's in the emergency department. Check the associated blog too http://stemlynsblog.org/alte-brue/
Nat and Simon talk through the key points.
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The fabulous Liz Crowe (@LizCrowe2) returns to the St Emlyn's podcast to chat with Iain about how we can communicate more effectively with children in critical care. This podcast explores topics that are important not just for clinicians, but anyone who works with or has children.
Simon and Iain chat about the first few days at EuSEM in Vienna. Some of the clinical and social highlights. We also have a bonus podcast at the end recorded with a volunteer at Iain's "Podcasting for Beginners'" talk. For more from EuSEM (The European Society for Emergency Medicine) congress follow the #eusem16 hashtag on Twitter.
Prof Rick Body and Niall Morris, Clinical Research Fellow, discuss selection bias and how it can affect clinical research.
This podcast is the third in the St Emlyn's series "Clinical Appraisal Nuggets".
As part of our induction series we look at the management of upper GI bleeds in the ED.
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Rick and Simon talk blinding (and masking) for your critical appraisal delight.
See more at http://stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/
Liz and Iain review the communication workshop at SMACC Dublin. This is relevant to everyone who works in clinical care.
More great stuff from Liz (and Iain ;-) ).
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Our series on critical appraisal nuggets in 5-10 mins. This week it's Randomisation. Great if you are revising for an exam in critical appraisal (e.g. FRCEM).
Part 2 of our podcasts on major trauma handovers. This follows on from the discussion at SMACC and is intended to operationalise the concepts we talked about then. This is aimed at a UK audience but should apply pretty much anywhere. So hands off, eyes open and listen in, here we go.
Whilst we were in Dublin at the SMACC conference we took the opportunity to get some great minds together on the subject of ED handover at the point between prehospital and hospital teams for the critically ill or injured patient in the resus room.
This is an area of some difficulty in many areas (prob shouldn't be, but it is) and we thought it would be fun and useful to get perspectives from both sides.
As ever, we are not here to be definitive and your service may have a fantastic model that works well. This podcast is to help you think about what you're doing and to consider whether it can be improved.
Doug Lynch is a retrieval doctor from Australia
Ashley Voss-Liebig is a flight nurse from Texas
Natalie May is a retrieval doctor from Sydney (Virchester Alumnus)
Rusty Carroll is a senior paramedic from Virchester and a great supporter of the ATACC group.
We don't have all the answers, but we do have the ideas.
In Virchester it can certainly be improved.....
Tell us what you think and keep an eye out for the blog post on the same subject coming soon.
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If you want to be the best clinician for your patients then it's important to look after yourself.
In this podcast Liz and Iain talk about making a plan to fell better, be better and be well.
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Robert Lloyd aka @ponderingEM from the Pondering EM blog joins Simon to talk about his experiences in a South African ED. This is an amazing tribute to the work our South African colleagues and how an Englishman found a way to adapt to the challenges (and there are many) of SA EM practice.
You can find his references for the talk here.
Iain and Liz discuss boundaries and medicine. What do you do when your personal life impacts on your clinical practice.
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Ross Fisher, consultant paediatric surgeon and lead for TARNlet joins Simon Carley at the London Trauma Conference to discuss the challenges in managing paediatric trauma in the UK.
Sandra Viggers and Vic Brazil grace St.Emlyn's with a conference report from Sand Diego and the
International Meeting for Simulation in Healthcare (IMSH) #IMSH2016.
Iain Beardsell joins Tim Coats, chair of the UK Trauma Audit Network, to discuss the role of trauma units within major trauma networks.
Simon and Ross Fisher from Sheffield discuss the emerging role of paediatric surgeons in trauma. This podcast was recorded at the London Trauma Conference (so sorry for a bit of background noise at times).
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Iain and Liz discuss how we can manage bad outcomes at Christmas. It's especially tough for patients and their families when tragedy occurs at times when we are all suposed to be festive. It's also tricky for staff and their families. Liz and Iain talk through why we feel like we do and how we can manage ourselves and others better.
Our summary of Day 2 of the excellent London Trauma Conference. A unique threesome from Nat, Simon and Iain.....
Greetings from the London Trauma Conference!As has become our pre-Christmas custom, Iain and I have been hanging out at the fabulous London Trauma Conference, hearing about advances and controversies in trauma care and tracking down some of the speakers to find out exactly what they really think (and recording it, for podcasts we'll release in due course).
The conference extends over four days, incorporating the Air Ambulance and Prehospital Day and the Cardiac Arrest Symposium; unfortunately we can't stick around for those but our colleagues over at the RCEM FOAM network will be podcasting from those days too, so keep an eye on their site and podcast feed too.
We are truly honored to listen and learn from Dr Youri Yordanov from Paris. Youri was the senior emergency physician on duty on the 13/11/15 during the brutal and terrifying terrorist attacks in Paris. Here he joins St.Emlyn's to discuss how they managed a mass casualty incident with lessons for us all.
There is no doubt that without the skills, preparation and response of Youri, his ED team, the wider hospital and the emergency service in general the death rate would have been much worse.
Thanks Youri for your wisdom and reflections.
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My talk from the RCEM conference in Manchester 2015.
Linked blog post here. http://stemlynsblog.org/making-good-decisions-in-the-ed-rcem15/
Slides are here http://www.slideshare.net/simoncarley7/making-good-decisions-rcem-2015-manchester-wednesday
Have fun and enjoy your emergency medicine.
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Simon and Nat talk about how to have that tricky conversation when you have to tell a colleague that they may have made a mistake.
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How to make a referral from the ED to an in patient team. Iain and Simon give you tips on making it great.
Liz Crowe joins Iain Beardsell to discuss really difficult conversations in the ED. How do we communicate terrible news in the ED and critical care.
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Iain and Simon discuss the core skills that all EM clinicians need to manage pain in the ED.
These are the basics, but don't be put off. The basics are more important than the fancy stuff that we will discuss in a later podcast.
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A podcast mini to round up and look forward to the next few months on the podcast.
We also have a special recording of Danny Boy from the Irish Youth Choir and conducted by Greg Beardsell. This performance was dedicated to Dr John Hinds in Dublin following his untimely death in a motorcycle accident.
Please listen and take a moment to remember him and all that he has done to inspire everyone involved in the care of the injured.
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Day 2 and 3 at #smaccUS. Iain and Simon round up the highlights and look forward to #smaccDUB.
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Liz Crowe has delivered some great talks at SMACC, and her talents do not stop there. In her real job she is a social worker on PICUs in Australia. She has a wealth of experience at helping people through difficult times and she shares that with us here on the podcast.
In truth this is something we planned to do when we were all in Chicago but the podcast has added poignancy following the tragic death of John Hinds. Although planned as a stand alone subject we cannot help but contextualise the topic in light of recent tragic events.
We hope it helps now and in the future.
RIP John Hinds Crack the Chest talk at SMACCUS
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The first day of #smacc15 was amazing. An incredible introduction and an amazing program. Have a listen to what the St.Emlyn's team got up to on day one. S
Iain and Simon discuss Iain's SMACC talk and how we deal with difficult cases in the ED.
Recorded in Chicago at the SMACC US Conference, Nat, Rick, Simon and Iain discuss the day of workshops and look forward to the main conference.
Another induction podcast on a common condition in the ED. Back pain in the ED - it's not all musculoskeletal and there are some really risky diagnoses out there that you need to think about. Back pain is a multi system disorder....., until you can prove otherwise.
Don't forget to listen to Iain's talk on chronic pain link here. https://vimeo.com/97811644
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Red flag symptoms and analgesia advice below.
Barbra Backus joins Rick Body to discuss the origin, development and future of risk scores for ED patients with possible acute coronary syndromes. Two researchers at the top of their game, and authors of the HEART and MACS scores.
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Iain and Simon discuss the initial management of severe and life threatening asthma in the resus room.
Another podcast in the induction series aimed at new starters in Emergency Medicine.
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A first podcast with Simon Laing from the RCEMFOAMed team. We look back at influential trauma related papers from 2014-2015. This talk was presented at the Trauma Care Conference in Telford 2015. It's a great conference and I'd encourage you to attend. If you want to know more visit www.stemlynsblog.org for more discussion and links to all the papers discussed. vb S
Iain interviews the wonderful Tim Draycott on the management of the Obstetric patient with trauma.Tim is a consultant Obstetrician from Bristol and is a great speaker on this rather terrifying topic!
A short podcast updating the UK Advanced Paediatric Life Support (APLS) course guidelines for the management of trauma in children.
Don't forget to read the blog post here. APLS Updates: New kids on the block,
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I recently met Ross in the flesh. What a super chap. A great clinician who really wants to improve care for injured children in the UK and around the world.
In this podcast he gives us a paediatric perspective on how we should approach the seriously injured child.
Great stuff, controversial in places, challenging to adult dogma and always excellent.
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PS. If you ever get to hear him speak.... then do, he's awesome. Check this out.
Tom Evens is a doctor, rowing coach, prehospitalist and awesome resuscitationist. In this podcast he talks about aspiring to be excellent and whether we can draw parallels with sport. Great stuff. Check out the marginal gains post which is referenced in the podcast here http://stemlynsblog.org/ed-need-matt-parker-st-emlyns/ More on Tom here http://londonsairambulance.co.uk/our-service/news/2014/05/high-performance-sport-high-performance-medicine-with-dr-tom-evans S
Simon and Iain debate how the management of opiate OD has changed in the ED.
Surely you're not still giving massive doses of naloxone IV and IM are you? Really? Maybe this will make you think again.
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Do you think you're awesome at assessing shock?
Think again!
The stupendous Prof Tim Harris (who St.Emlyn's loves) tells us that all is not quite as it seems.....
Listen, learn, be awesome.
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Karim Brohi joins the St.Emlyn's team at the London Trauma Conference to talk on vascular injury and arterial dissection. A whole range of diagnoses that you should not miss, but which is easy to miss.
Tricky!
Check out the blog post that accompanies this podcast here.
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Live from the London Trauma Conference 2014. Iain Beardsell interviews Mark Wilson on the need for rapid response, digital technology and the GoodSAM app.
Rick Body and Kerstin de Wit discuss the role of NOACs in clinical management. Part 1 addresses the basics, stuff you should know if you are prescribing these drugs.
Part 1 tells us the good stuff, don't forget to listen to 2 and 3 in the next few weeks as not everything is perfect ;-)
Check out the BLOG POST HERE
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The number of patients seen in each ED with problems relating to early pregnancy in the UK is very variable - some hospitals have rapid referral pathways for patients who know they are pregnant. It's still worth thinking about early pregnancy problems though as all EDs see young women and many of these may not yet know that they are pregnant.
Our induction podcast covers our approach to women presenting to the ED
Nat and Iain :-)
First of our podcasts from the London Trauma Conference.
A fantastic episode with Iain talking to Gareth Davies (from London HEMS) talking about Impact Brain Apnoea.
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A Christmas review of the world of EM, CC and resuscitation #FOAMed.
This review is no way exclusive and focuses on sites that people may not be familiar with. Take it as read that EMCRIT, LITFL, PHARM, ICN, SGEM, EMLitofNote, ALiEM, Resus.me, KI docs, etc. are already known to be awesome. Check them out and follow the many excellent #FOAMed sites around the world.
Check out the big hitters here http://www.aliem.com/social-media-index/
There are also so many other sites that we have not mentioned, but which we regularly visit and listen to.
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It's prehospital and helicopter day at #LTC2014! Iain and guest podcaster Caroline Leech chat through the key points of the day. Download the GoodSAM app! https://www.goodsamapp.org BW Nat
Old, young, pregnant, social, airways, cricoid and dogmalysis. There is loads to catch up on from #LTC2014.
Iain and Nat take you through the day.
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Whilst I remain in Virchester healing the sick and injured, Nat and Iain are sharing the #FOAMed love at the London Trauma Conference. This is the first round up from day 1 with many highlights and a few tasters for some more podcasts to come.
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Next week Iain and Nat will be in London for the best trauma conference in the world. Join them in person, online, on the podcast and on twitter.
Check out the program here, it's amazing.
http://www.londontraumaconference.com/
Have fun :-)
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Iain and Simon discuss the dilemmas of dealing with the patient presenting with chest pain to the ED.
Blog post link here
Iain Beardsell and Natalie May talk you through a wise and safe approach to the child with moderate shortness of breath. Listen and learn from the St.Emlyn's team.
The Challenge and Value of Research in Emergency Medicine: at DGINA 2014
Rick Body's talk from DGINA on the need for research in EM.
Check out the associated blog post at http://stemlynsblog.org
Iain and Simon talk about the upcoming SMACC conference in Chicago and do their very best to persuade you to come to the best conference in the world Visit the site for the full program here. http://www.smacc.net.au/
S DOI - Both Iain and myself are being funded to attend.
Simon and Nat with a linked podcast to the blog post on the ingestion of button batteries by children.
http://stemlynsblog.org/button-batteries/
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Simon and Iain discuss what might appear to be a rather dull subject, but it's not. Coding is a key to developing your department and also to secure the functions of UK emergency departments.
A great primer for everyone coming up to FCEM and to anyone interested in how Emergency Departments are funded in the UK.
Follow this link to the associated blog post http://stemlynsblog.org/show-money/
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Rick and Iain explore how the latest guidance about the use of high sensitivity troponin was developed and how far we can be assured that it is evidence based.
The NICE guidance is available here. http://www.nice.org.uk/guidance/dg15
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Iain and Simon talk through the practicalities of in situ sim in the ED. How do we make it happen in a way that works and helps individuals, teams and departments learn together. Much of the work in this podcast should be attributed to John Gatward from Sydney Australia who inspired us to start and to Kirten Walthall our new Sim Fellow who introduced records and departmental learning processes to our systems. There are a couple of errors on the podcast. Firstly it's roughly 18 months that we have been doing in situ sim, time must fly so much that I said 9 months! Secondly, on reflection we average 2-4 sim sessions per week, but that includes some sessions that are not in situ, held in a separate area when training other groups of docs in the hospital. The ED in situ frequency is 2-3 sessions per week. As ever we stand on the shoulders of these giants who support what we all hope to achieve. vb S
Vic Brazil of #FOAMed and #SMACC fame came to talk to the St.Emlyn's team in Virchester.
Listen in for top tips on looking great and sounding super.
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John Hell is a Neurointensivist at University Hospital Southampton and very kindly gave up an afternoon to record his thoughts and share his considerable wisdom about Diffuse Axonal Injury.
I also managed to get him to discuss some other topics including the choice of induction agents and intravenous fluids in patients with head injury.
Please listen, enjoy and comment. We'd love to hear from you, and don't forget to visit the blog site for additional information, slides and content.
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Iain Beardsell
This podcast is part of our induction series for new docs starting in UK emergency departments.
You can check out the full post and supporting materials over at the main St.Emlyn's website.
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Recently we published part one of our series on cardiac troponins. If you haven't checked it out yet, you can find it here. In the second part, we're going to take a look at high sensitivity troponins and some of the more advanced areas around understanding cardiac troponin and its use in practice. We'll give you a quick run down on the troponin lingo - the language you need to be able to speak in order to fully understand how to use high sensitivity troponin in your practice, including terms like the limit of blank, limit of detection, co-efficient of variation and 99th percentile.
We'll also ask whether Joe Lex had a point when he stirred up controversy around these assays with this legendary tweet:
What if we called it "low specificity troponin" instead of "high sensitivity troponin?" Would that knock some sense into people?
— Joe Lex (@JoeLex5) October 9, 2012
So, check out the associated BLOG POST here and listen to the podcast. There is more on diagnostics and troponin to come very soon.
Hope you enjoy! Please keep the feedback, questions and comments coming. As always, we'd love to hear from you.
Rick
DOI: Much of my research work involves HsT. To help with this I have received reagents from companies who make HsT assays, but I not received any other financial benefit or gifts in kind as part of my work and have no financial ties to any companies.
Adam Reuben is a super chap. A rugby playing, friendly, engaging, hard working, researching, teaching emergency physician from Exeter in the lovely county of Devon.
In addition to being generally awesome he is also the convener of this year's College of Emergency Medicine conference in Exeter from the 9th to the 11th of September 2014. There is still time to come and the program looks really good and features some fantastic presenters.
AWESOME ALERT - CLIFF REID WILL BE THERE - YOU HAVE TO BE TOO!!!!
I'll be there with many others from St.Emlyn's so if you see me say hi.
You can see the program here
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Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about:
- Pneumonia
- Asthma/COPD
- Pulmonary Embolism
- Acute left ventricular failure
- Pneumothorax
Breathless Patients PodcastIn this podcast Iain and Simon discuss their approach to breathless patients in the ED which we hope will provide you with a good starting point.
For those of you who are more visual learners here is the video recorded a few years ago for SEMEP featuring our very own Iain Beardsell.
http://vimeo.com/35310564
Take Home Points* Oxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia kills * Always rule out life threatening causes first * These patients are sick - do not be afraid to ask advice from a senior colleague early * Look for clues - you don't have to wait until the penultimate page of the story to solve the mystery.
What have you learned about breathless patients? Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute setting - and can save lives. So yes, when you first approach a patient who is short of breath, get that oxygen on while you make your assessment then think about the finer points of respiratory failure afterwards.
Where do I begin? A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs (especially respiratory rate), looking for clues as to the underlying cause of their breathlessness, remembering the five common causes.
What treatments might be useful?
A small fluid bolus might help and carries relatively little risk; think about the need for nebulised bronchodilators for patients with asthma or COPD, and remember that antibiotics given early to patients with sepsis save lives. If the patient has pain we should definitely treat that too.
Which investigations might help me find out more?
- A chest x-ray is often useful in patients who are short of breath; your ED seniors might be able to use bedside ultrasound to further ascertain the underlying pathology, so get help early!
- ECGs are often useful in these patients
- Blood gases can also provide lots of useful information - think carefully about whether you need arterial gases and if so, please use local anaesthetic.
- If nothing makes sense - get a blood sugar, remembering that metabolic disease may cause an acidosis, presenting with an increased respiratory rate (although not often true dyspnoea).
- And GET SENIOR HELP (including getting your seniors to assess you for those all-important workplace-based assessments; definitely start those early)
Other resourcesChest RadiographsOne of the key investigations in patients with shortness of breath is the humble chest radiograph. There are some phenomenal FOAM resources for interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).
Chest X-Ray Anatomy - Chest X-Ray Abnormalities - Chest X-Ray Systematic Approach
Blood GasesThink! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...
Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links).
Natalie May
We've all had headaches, but not often severe enough to prompt us to seek help in an Emergency Department.
In our practice 10% of patients who do present to the ED with a primary presentation of headache will have serious pathology and our job as Emergency Physicians is to work out who these are. Key to this is actively ruling out the life-threatening and life-changing diagnoses:
- Subarachnoid Haemorrhage
- Meningitis
- Tumours and Space Occupying Lesions
- Temporal Arteritis
Listen to Simon and Iain discuss how to approach these patients here
Further ResourcesHeadaches at Life in the Fast Lane - a great summary from the LiTFL crew
NICE Guidelines (NCG150) - diagnosis and management of headaches; there's a flowchart and some red flags although you could read the St Emlyn's summary here!
Headache from the Flipped EM Classroom
Do you remember when it took three days to 'rule in' or 'rule out' an acute myocardial infarction (AMI)? When I was a medical student doing my first clinical attachments, I remember doing ward rounds on the CCU seeing patients with suspected AMI. The way they were managed is a million miles from what we do now. Back then, patients would have serial ECGs and then be admitted for cardiac enzyme evaluation over the course of the next 3 days. We'd measure CK, AST and LDH. 'CK' was the so-called 'early marker', which would rise early after the start of an AMI. Today we use CK as a marker of skeletal muscle damage (e.g. rhabdomyolysis). AST and LDH (today we think of these as liver function tests, I know) were the 'late markers' - and by late I really mean late - we might see a rise on days 2 and 3.
Could you imagine for a second, in today's world, ruling out AMI because their CK and LFTs were normal? It's completely unthinkable. That's how much cardiac troponin has changed our practice. We rely on it so completely to diagnose AMI. And yet, it's one of the most misunderstood tests in medicine. Given how much we use it, I guess we feel that we all should know lots about this test. But doctors still have so many questions. Here are just a few:
- What is cardiac troponin?
- Why is it a marker of AMI?
- What else causes a raised troponin and how?
- Should we be doing troponins at 3 hours, 6 hours, 12 hours? What's the difference and what's the evidence?
- What is a 'delta troponin'?
- What do you need to 'rule in' AMI?
- How do you use cardiac troponin in patients with renal failure?
This is just a brief list. With the research I do in this area and my experience developing protocols/guidelines, people get in touch to ask questions like this quite a lot. There are loads of questions that people ask - but there are lots of themes in common. We thought it was about time we produced a handy run down in the true spirit of #FOAMed.
Take a listen to Part 1 of our troponin podcast. While Simon and Iain have been prolifically churning out spectacular stuff for some time now, this is my debut on the St. Emlyn's podcast. I really enjoyed talking about troponin with Iain - and I hope we covered some useful stuff.
We'll cover more in part 2, when we'll move on to discussing high sensitivity troponins, what they are, how to use them and how to speak the troponin lingo. Please get in touch if there's anything we haven't covered that you'd like us to, or if there's anything you'd like us to elaborate on some more!
Rick
If you're starting out in EM then it can be a scary time. Iain and Simon talk through some of the initial anxieties and ask what you need to know to be safe, sensible and super.
Remember our top ten tips...
- Respect those around you and value their opinion
- The History is everything
- There are 4 key treatments we give in the ED – think whether every patient you see needs any of these and you will save lives and relieve pain
- Oxygen
- Fluids
- Analgesia
- Antibiotics
- Think ‘What difference have I made to this patient?’. Always try to make a difference, however small (it may “just” be getting them an extra blanket)
- No patient (almost) wants to be in the ED. They really don’t. It wasn’t what they planned for their day.
- Spend twice as long with patients you don’t like or don’t get on with.
- Look the part. Be smart. Behave in the way you would expect anyone to behave towards you.
- Be on time. Always. Ansd leave on time if at all possible.
- Take your breaks – eat when you can and drink water when you can’t.
- Enjoy yourself…
It is a little known fact that to be successful as an emergency physician in the UK it is vital to take a three month rotation in Archery. Archery is a key skill for us all dating back to Medieval times when we introduced the longbow into warfare. This devastating tool could cause panic in opposing forces, scattering them into many wide and ineffective directions. In short they were an effective tool to cause and disruption inthe opposition ranks whilst the noble English armies of old strode forward with their visions of the future. Soldiers trained using targets to hone their skills and to focus on the aim - meeting the target.
Of course these days we do not have real bows and arrows in the emergency department, but archery remains alive and well. In the modern NHS we still train our troops in archery, or at least in the principle aim of archery - to meet the target.
With our long history of target setting and target hitting it is therefore no suprise that we are world leaders in standards/targets/indicators....., whichever term you prefer in fact and it has to be said that a target culture in the NHS has been criticised widely, even being blamed for the exodus of trainees to Southern climes, but there is arguably more to it than that.
In last weeks episode we touched on new targets around trauma care in the UK and that raised many questions and opened a debate on twitter. This week we want to take those thoughts further and ask what we, as the archiest of arch archers across the entire NHS can do with these externally set targets.
What we forgot to say in the podcast is the absolute need to work alongside a short stay admissions unit under the ED umbrella. Without that you would really struggle to deliver safe and efficient care. We both work in units with short stay admission units that allow us to deliver safe diagnostic and therapeutic interventions to our patients.
So, with some trepidation Iain and I ask whether all targets are a bad thing....
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Iain and Simon discuss the challenges of getting our trauma patients to the CT scanner within 30 minutes of arrival.
The 30 minute target is a UK standard, and we did not set it! All UK trauma centres are judged against the target and (rightly or wrongly) it has become a real issue for many centres.
We would be really be interested in what our International colleagues think about the target and the resultant strategies outlined by the team. There's more on this at the St.Emlyn's website.
As always, we'd love to hear your comments.
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Iain and Simon chat about how we can start to translate research findings in to natural frequency summaries that help clinicians and patients alike understand the value of therapeutic interventions.
The NNT site we mention is just fantastic. Visit them here
Great revision page here by the amazing LITFL crew
The NNT for tranexamic acid is 67 not 50.
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Hopefully you will have already seen and listened to my SMACC talk on 'What to believe and when to change'. If not then please whizz over to the site now and have a listen. I really enjoyed exploring the uncertainties that exist around when we decide to adopt or abandon therapies.
My belief is that it's really difficult to define the perfect moment and that it's only in retrospect that we can define it.
Since appearing on the ICN network and St.Emlyn's, Scott Weingart, one of the best and most innovative clinicians I know has come back and argued for early adoption. You can check out his rationale on his site and see what you think.
I actually agree with many of the things he tells us, although he has confined himself to one side of the argument. In terms of a defence of early adoption he makes a good case, but like all debates there needs to be another side to the story, so sit back and listen to why we must reflect hard on the decisions we make in deciding what we do, why we do it, and most importantly when.
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Iain and Simon tackle the effect of prevalence on diagnostic performance. Mrs Trellis of North Wales makes a return appearance to discuss the delicate issues of sensitivity and Rick Body joins us by mail to raise concerns about the difficulties of missing patients with myocardial disease.
Listen and enjoy, visit the blog site and keep in touch.
Don't forget to subscribe to the podcast via iTunes, to subscribe to the blog site and to like us on facebook.
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Dear all, It would appear that the organ member was correct and we cannot be certain about the organ pipes. Apparently there are doubts about whether they are safe or need replacing. We will once again turn to Dr Beardsell and Prof. Carley to see if there is anything more that we can do. As I am due to allocate funds for repairs to musical instruments this year then we must ensure that these are spent wisely. If there is a less than 2% chance of failure we will wait. If there is a greater than 50% chance of failure then we should spend the money. The situation is uncertain and we need help. I have the honour to be et. etc. etc. The Choirmaster at St.Emlyn's
A podcast discussing sensitivity and specificity of diagnostic tests and how we can use this in our everyday medical care of patients.
This article from the Centre for Evidence Based Medicine is also useful.
The St.Emlyn's choirmaster has asked Iain and Simon to deliver a sermon on the importance of attending the SMACC Chicago conference in May 2015. After their pilgrimages to Australia in 2013 and 2014 they came back enthused and at times rather annoying about how jolly marvellous it all was. We felt that it was important for them to share their thoughts and to ask if anyone wishes to join them on their planned trip to the Northern Americas next year. AS Choirmaster at St.Emlyn's I have reluctantly decided to give them some air time. I have the honour to be, as always, your most dutiful servants. Yours etc. The St.Emlyn's Choirmaster
Welcome to the St.Emlyn's podcast. After a few years messing around with the blog at stemlynsblog.org the Choirmaster at St.Emlyn's has decided that some audio contributions are necessary. We will therefore be relaunching the podcast in a uniquely British way.
Please, put the kettle on, make yourself a nice cup of tea (I recommend Lady Grey or Gunpowder), sit back, relax and listen. Congo will take place every couple of weeks so keep checking iTunes for this weeks order of service. We have the honour to be, always, your most faithful servants. Yours etc. The Choirmaster at St.Emlyn's If you are listening to this podcast whilst driving do not put the kettle on....