Podcasts about emergency medicine journal

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 podcast, Dr. Chris Solie, an emergency physician, along with Jason Hicks, Fred DeMeuse, Greta Sowels (physician assistants), working for Emergency Medicine Physicians and Consultants (EMPAC) who review journals and papers around emergency medicine. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice changing. Differentiate between using a HEAR score versus a HEART score when assessing patients coming into the ED with chest pain. Restate whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV) - associated lower respiratory tract illness in newborns and infants. Discuss the rate of wound infection from suturing with sterile gloves, dressings, drapes, etc. versus non-sterile gloves, dressings in emergency department. Discuss the risk-benefit of using tranexamic acid (TXA) in the treatment of gastrointestional bleeds. Identify interventions designed to reduce fatigue among emergency department physicians. Determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk pencillin allergy. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. RESOURCES Article 1: O'Rielly, C.M., Andruchow, J.E., McRae, A.D. et al. External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing. Can J Emerg Med 24, 68–74 (2022). https://doi.org/10.1007/s43678-021-00159-y Article 2: Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480 Article 3: Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022;39(9):650-654. doi:10.1136/emermed-2021-211540 Article 4: HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Article 5: Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171. doi:10.1111/acem.14606 Article 6: Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. 2023;183(9):944-952. doi:10.1001/jamainternmed.2023.2986   Thank-you for listening to the podcast. Thanks to Dr. Chris Solie, Jason Hicks, Fred DeMeuse and Greta Sowels for their expert knowledge and contribution to this podcast.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research interview Ian Pope. Associate Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the new evidence in e-cigarette research and interview Dr Ian Pope, an emergency medicine physician and honorary associate professor at Norwich Medical School, about his new trial, which he co leads with Professor Caitlin Notley from the University of East Anglia. The new trial is the COSTED trial, the Cessation of Smoking Trial in the Emergency Department and funded by the British National Institutes of Health Research. This is a multi-centre randomised controlled trial, based in 6 emergency departments around the UK. This study tested the real-world effectiveness of an emergency department based smoking cessation intervention that included provision of an e-cigarette starter kit compared to usual care. (ClinicalTrial.gov:NCT04854616). Adults who smoke tobacco and were attending one of six EDs across the UK were randomised to either control (in which case they were given written information about stop smoking services) or intervention (brief smoking cessation intervention, provision of an e-cigarette starter kit, and referral to stop smoking services). Both groups were followed up 1, 3 and 6 months after randomisation. Smoking abstinence was biochemically verified at 6 months. There were over a thousand participants and biochemically verified smoking cessation rate of 7.2% in the intervention group 4.1% in the control group. The study found that it was feasible to implement a smoking cessation intervention in EDs with dedicated staff time to deliver the intervention and that EDs may represent an excellent opportunity to engage hard to reach smokers. Pope I, Notley C, Boyle A, Results of the cessation of smoking trial in the emergency department (COSTED), Emergency Medicine Journal / 2023;40(12):873-874 This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. Our literature searches carried out on 1st March found the following 1 new study: Hoeppner BB, Eddie D, Schick M, Hoeppner SS, Kelly L, Kelly JF, Feasibility of and reactivity to ecological momentary assessment (EMA) during electronic cigarette use initiation in adults who smoke daily: MASKED FOR REVIEW, European Journal of Psychiatry / 2024;38(3):100247. 10.1016/j.ejpsy.2023.100247 3 papers linked to studies included in the review: Auer R, Schoeni A, Humair J-P, Jacot-Sadowski I, Berlin I, Stuber MJ, Haller ML, Tango RC, Frei A, Strassmann A, Bruggmann P, Baty F, Brutsche M, Tal K, Baggio S, Jakob J, Sambiagio N, Hopf NB, Feller M, Rodondi N, Berthet A, Electronic Nicotine-Delivery Systems for Smoking Cessation, The New England journal of medicine / 2024;390(7):601-610. 10.1056/NEJMoa2308815 Piper ME, Schlam TR, Donny EC, Kobinsky K, Matthews J, Piasecki TM, Jorenby DE, The Impact of Three Alternate Nicotine-Delivery Products on Combusted Cigarette Use: A Randomized Controlled Trial, Nicotine & Tobacco Research, 2024;, ntae014, 10.1093/ntr/ntae014 Correction to Yingst: Changes in Nicotine Dependence Among Smokers Using Electronic Cigarettes to Reduce Cigarette Smoking in a Randomized Controlled Trial, Nicotine & Tobacco Research, 2023;, ntad229, 10.1093/ntr/ntad229 For further details see our webpage under 'Monthly search findings': https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 For more information on the full Cochrane review updated in January 2024 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub8/full This podcast is supported by Cancer Research UK.

Jamie Hartmann-Boyce and Nicola Lindson discuss emerging evidence in e-cigarette research interview Cara Murphy, Brown University, USA. Associate Professor Jamie Hartmann-Boyce and Dr Nicola Lindson discuss the new evidence in e-cigarette research and interview Assistant Professor Cara Murphy, clinical psychologist at Brown University. Cara Murphy works at the Center for Alcohol and Addiction in the School of Public Health and the Center for Addiction and Disease Risk Exacerbation. Jamie Hartmann-Boyce interviews Cara Murphy about her new trial, Trial for Harm Reduction With Incentives & Vaping E-cigarettes (THRIVE) and funded by the National Institute of General Medical Sciences. This trial will assess the effect of e-cigarettes and incentives on combustible cigarette smoking in individuals with overweight/obesity who smoke cigarettes. A randomized group of participants will given e-cigarettes for 6 weeks. carbon monoxide will be monitored and participants will either receive fixed incentives for sample completion or receive varying incentives contingent on their carbon monoxide levels. Researchers will compare groups to understand the effect of each condition on smoking-related behaviour. Cara outlines how individuals with overweight/obesity who smoke cigarettes have greatly increased risks of metabolic, cardiac, and pulmonary diseases due to the synergistic effects of tobacco and obesity. Cara also discusses issues faced by people who smoke and are overweight. Switching to e-cigarettes may decrease the risk of negative health outcomes and be a promising approach. This podcast is a companion to the electronic cigarettes Cochrane living systematic review and shares the evidence from the monthly searches. Our literature searches carried out on 1st December and 1st January found the following . 1 new study by Xu et el 2023 (Xu Y, Goldenson NI, Prakash S Augustson EM, Shiffman S, Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes. Experimental and clinical psychopharmacology / 2023;(9419066)). 2 new ongoing studies: NCT06111053, Trial for Harm Reduction With Incentives & Vaping E-cigarettes (https://clinicaltrials.gov/study/NCT06111053) and NCT06118502, A Clinical Trial of Adaptive Treatment for Early Smoking Cessation Relapse (ADAPT) (https://clinicaltrials.gov/study/NCT06118502). 1 study by Pope et al 2023 linked to Notley 2023 (Pope I, Notley C, Boyle A, Results of the cessation of smoking trial in the emergency department (COSTED), Emergency Medicine Journal / 2023;40(12):873-874). For further details see our webpage under 'Monthly search findings': https://www.cebm.ox.ac.uk/research/electronic-cigarettes-for-smoking-cessation-cochrane-living-systematic-review-1 For more information on the full Cochrane review updated in November 2022 see: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full This podcast is supported by Cancer Research UK.

Hear a summary of some of the best papers published in the December 2023 issue of the Emergency Medicine Journal. The podcast this month covers a trio of ultrasound papers addressing its use in the treatment of distal radial fractures, and thoracic and abdominal stab wound injuries. Featured also is a paper investigating the effectiveness of a predictive system for COVID-19 triage by telephone. Read the highlights: https://emj.bmj.com/content/40/12/803    The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 

Hear a summary of some of the best papers published in the November 2023 issue of the Emergency Medicine Journal. This month's podcast discusses a wide array of topics like cauda equina syndrome, biases in blood alcohol testing services, bystander CPR effectiveness in cardiac arrest, and the healthcare impacts of e-scooter use.   Read the highlights: https://emj.bmj.com/content/40/11/741  The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

While the hospital is a place of science and medicine, this does not keep our human tendency to be superstitious at bay. In today's episode we will be exploring a few of the most common hospital superstitions, their origins, and if there is any scientific evidence to support them. If you are enjoying Don't Look Under the Med, please help us out and leave a five-star review! And make sure you follow the podcast on your favorite platform so you never miss an episode. Articles: ABC: Friday the 13th and Emergency Departments, by Oliva Willis for Sum of All Parts Fusion Medical Staffing: Top 5 ER Superstitions, by Megan Bebout Healthline: How Does a Full Moon Affect Our Physical and Mental Well-Being?, by Rebecca Joy Stanborough, MFA The Washington Post: Friday the 13th: Things You Should Know, by Valerie Strauss CNN: Why is Friday the 13th Unlucky? The Cultural Origins of An Enduring Superstition, by Christobel Hastings Academic Articles:  Wu YW, Lai WS, Chen YC. [Superstitious Beliefs Among Healthcare Providers: A Concept Analysis]. Hu Li Za Zhi. 2023 Jun;70(3):85-93. Chinese. doi: 10.6224/JN.202306_70(3).11. PMID: 37259654. Johnson G. The Q**** Study – basic randomised evaluation of attendance at a children's emergency department. Emergency Medicine Journal 2010;27:A11. Zargar M, Khaji A, Kaviani A, Karbakhsh M, Yunesian M, Abdollahi M. The full moon and admission to emergency rooms. Indian J Med Sci. 2004 May;58(5):191-5. PMID: 15166467. Lo BM, Visintainer CM, Best HA, Beydoun HA. Answering the myth: use of emergency services on Friday the 13th. Am J Emerg Med. 2012 Jul;30(6):886-9. doi: 10.1016/j.ajem.2011.06.008. Epub 2011 Aug 19. PMID: 21855260.Podcast Art By: Irit Mogilevsky --- Support this podcast: https://podcasters.spotify.com/pod/show/dontlookunderthemed/support

And we just live in it. All about the hallucinogenic honey from the mountains of Turkey and Nepal.   Foot notes: UK article on Psilocybin therapy cost effectiveness: McCrone P, et al. Cost effectiveness of psilocybin assisted therapy for severe depression: exploratory findings from a decision analytic model. Psychological Medicine. 2 June 2023. https://www.cambridge.org/core/journals/psychological-medicine/article/costeffectiveness-of-psilocybinassisted-therapy-for-severe-depression-exploratory-findings-from-a-decision-analytic-model/8594CAC2F8D60F8C7B9A1CE3C3195B74 MDMA Assisted Therapy for Social Anxiety Disorder—Phase II trial being conducted at Portland (OR) Psychotherapy, link here for those interested in finding out more information or enrolling: https://portlandmdmatherapy.com/participate/ Krane, K. HHS Call to reschedule marijuana is a big deal: here's why. Forbes. 31 Aug 2023. https://www.forbes.com/sites/kriskrane/2023/08/31/hhs-call-to-reschedule-marijuana-is-a-big-deal-heres-why/?sh=af122092a4a7     Beasley M, et al. Poisoning due to tutin in honey—a report of an outbreak in New Zealand. The New Zealand Medical Journal. 2018; 131(1473): 59-71. https://pubmed.ncbi.nlm.nih.gov/29649198/ Bryce E. The Strange History of Mad Honey. Modern Farmer. 2014. https://modernfarmer.com/2014/09/strange-history-hallucinogenic-mad-honey/ Honey. Natural Medicines comprehensive database. Last updated 12 June 2023. Accessed 15 Oct 2023. How eating “Mad Honey” cost Pompey the Great 1000 soldiers. Texas A&M Research. 3 Nov 2014. https://research.tamu.edu/2014/11/03/how-eating-mad-honey-cost-pompey-the-great-1000-soldiers/ Jansen S, et al. Grayanotoxin poisoning: mad honey disease and beyond. Cardiovascular Toxicology. 2012; 12(3): 208-215. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404272/ Johnson S. “Mad Honey: the rare hallucinogen from the mountains of Nepal. Big Think. 26 Dec 2022. https://bigthink.com/health/mad-honey/ Ozhan H, et al. Cardiac emergencies caused by honey ingestion: a single centre experience. Emergency Medicine Journal. 2004; 21(6:) 742-744. https://pubmed.ncbi.nlm.nih.gov/15496712/ Ullah S, et al. Mad Honey: uses, intoxicating/poisoning effects, diagnosis, and treatment. RSC Advances. 2018; 8(33): 18635-18646.

Hear a summary of some of the best papers published in the October 2023 issue of the Emergency Medicine Journal. This month's podcast covers a variety of topics from litigation issues in the ED, young people's experiences in the Paediatric ED, parental anxiety in the PED, and all about 'Silver trauma'.    Read the highlights: https://emj.bmj.com/content/40/10/687. The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

Insulin EM Pulse PodcastThis is the next episode of our Push Dose Pearls miniseries with ED Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode again focuses on insulin. Should everyone with hyperglycemia get regular insulin? Is IV better than subcu? We'll answer these questions and more as we discuss the latest recommendations for managing hyperglycemia and DKA in the ED.  Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Hardern RD, Quinn ND Emergency management of diabetic ketoacidosis in adults Emergency Medicine Journal 2003;20:210-213 Schwartz X, Porter B, Gilbert MP, Sullivan A, Long B, Lentz S. Emergency Department Management of Uncomplicated Hyperglycemia in Patients without History of Diabetes. J Emerg Med. 2023 Aug;65(2):e81-e92. doi: 10.1016/j.jemermed.2023.04.018. Epub 2023 Apr 26. PMID: 37474343. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

This is the summary of some of the best papers we published in the September 2023 issue of the Emergency Medicine Journal. Rick and Sarah discuss a trio of papers on health services, the use of isopropyl alcohol as an anti-emetic, and they talk to Dr Anna Collini, co-author of a paper that explores how new emergency medicine consultants experience uncertainty (https://emj.bmj.com/content/40/9/624). Read the highlights: https://emj.bmj.com/content/40/9/621. The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

A summary of some of the best paper we published in the August 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics touching on the assessment of scaphoid and ankle injuries, patient involvement in research, frequent attendees to the ED, and deciding which patients to escalate during a pandemic. Read the highlights: https://emj.bmj.com/content/40/8/539 The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

Panel: Pramod Chandru and Shreyas Iyer.Case Summary: 61-year-old male presenting with 2 distinct episodes of shortness of breath, chest pain, and associated presyncope.   Asymptomatic by the time of arrival to the emergency department.   ECG and observations at triage were unremarkable.  No recent travel or recent major surgeries.  Initial troponin and serial troponin were 80ng/L.   D-dimer was ordered given static troponin and the nature of symptoms: 0.58.  Although this D-dimer was negative when age-adjusted, a V/Q scan was pursued as the patient was not felt to fit a ‘low risk' pre-test probability for PE (IV contrast shortage dictated V/Q over CTPA).  Bilateral segmental pulmonary PE identified on V/Q scan with mild right heart strain evident on subsequent CTPA and TTE.   Key Discussion Points: If a case does not follow the usual ‘pattern' of your initial diagnosis, consider alternate aetiologies.  There are many tools available for risk-stratifying PE including PERC, age-adjusted D-dimer, and the YEARS diagnostic pathway. However, the way in which to appropriately utilize these tools is nuanced.   A paper published in JAMA in December 2021 demonstrates some ways in which these tools can be used together (see first reference below).   The PESI score (even prior to definitive diagnosis) can be useful to risk stratify patients with possible PE and help determine their disposition.   Take-Home Points: Pre-test probability is incredibly important, particularly in entities such as PE where only highly invasive imaging modalities are diagnostic.  Having a structured approach to protect yourself from your own mistakes is extremely important (such as a hypothesis and hypothesis testing approach).  References & Background Reading:  Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2021 Dec 7;326(21):2141-2149. doi: 10.1001/jama.2021.20750.  Thiruganasambandamoorthy, V., Stiell, I.G., Sivilotti, M.L. et al. Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study. BMC Emerg Med 14, 8 (2014). https://doi.org/10.1186/1471-227X-14-8. Crane SD, Risk stratification of patients with syncope in an accident and emergency department Emergency Medicine Journal 2002;19:23-27. Almulhim KN. The Characteristics of Syncope-Related Emergency Department Visits: Resource Utilization and Admission Rate Patterns in Emergency Departments. Cureus. 2022 Feb 8;14(2):e22039. doi: 10.7759/cureus.22039. PMID: 35340474; PMCID: PMC8913182.  Iwuji K, Almekdash H, Nugent KM, Islam E, Hyde B, Kopel J, Opiegbe A, Appiah D. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis. J Prim Care Community Health. 2021 Jan-Dec;12:21501327211054996. doi: 10.1177/21501327211054996. PMID: 34814782; PMCID: PMC8640977.  Schouten HJ, Geersing GJ, Koek HL, et al. Diagnostic accuracy of conventional or age-adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133492/. Franco-Moreno AI, Bustamante-Fermosel A, Ruiz-Giardin JM, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D. Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review. Rev Clin Esp (Barc). 2023 Jan;223(1):40-49. doi: 10.1016/j.rceng.2022.07.004. Epub 2022 Sep 22. PMID: 36241500; PMCID: PMC9492501.  Christ M, Geier F, Popp S, Singler K, Smolarsky A, Bertsch T, Müller C, Greve Y. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope. Am J Med. 2015 Feb;128(2):161-170.e1. doi: 10.1016/j.amjmed.2014.09.021. Epub 2014 Oct 15. PMID: 25447619.  Lindner G, Pfortmueller CA, Funk GC, Leichtle AB, Fiedler GM, Exadaktylos AK. High-Sensitive Troponin Measurement in Emergency Department Patients Presenting with Syncope: A Retrospective Analysis. PLoS One. 2013 Jun 18;8(6):e66470. doi: 10.1371/journal.pone.0066470. PMID: 23823330; PMCID: PMC3688899.  Music/Sound Effects: ENGINE by Alex-Productions | https://onsound.eu/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Feel It by MBB feat. JV Saxx | https://soundcloud.com/mbbofficial, https://www.instagram.com/JVSAXX/, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Lakeside by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.  Ocean Love by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US. Nostalgic Marshmallows by Arthur Vyncke | https://soundcloud.com/arthurvost, Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0), https://creativecommons.org/licenses/by-sa/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Promotional Video (Soundtrack):Pina Colada by Scandinavianz | https://soundcloud.com/scandinavianz,Music promoted by https://www.free-stock-music.com, Creative Commons / Attribution 3.0 Unported License (CC BY 3.0), https://creativecommons.org/licenses/by/3.0/deed.en_US.Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

A summary of some of the best paper we published in the July 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics on Pre Hospital assessment of chest pain, management of pain in the emergency department and some thoughts on improving the experience for the waiting patient. Read the highlights: https://emj.bmj.com/content/40/7/471 The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

A summary of some of the best paper we published in the June 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics including home pulse oximetry, out of hospital cardiac arrest, the perils of correctly calculating respiratory rate in the ED and even cross-cultural adaptation of patient communication material. Read the highlights: https://emj.bmj.com/content/40/6/393 You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).  Thank you for listening!

A summary of some of the best paper we published in the June 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics including home pulse oximetry, out of hospital cardiac arrest, the perils of correctly calculating respiratory rate in the ED and even cross-cultural adaptation of patient communication material. Read the highlights: https://emj.bmj.com/content/40/6/393 You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). Thank you for listening!

A summary of some of the best paper we published in the April 2023 issue of the Emergency Medicine Journal. Rick and Sarah talk through topics including the impact of emergency physician gender on the outcomes of patients with early pregnancy loss; major trauma centre care for patients with low velocity trauma; the development of a new checklist for emergency paediatric intubation; the effect of head-up position on intubation success in the Emergency Department; and spiking by injection in the ED. One great feature of this month's papers is that there is so much that's immediately relevant to our clinical practice. Read the highlights: https://emj.bmj.com/content/40/4/239 You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). Thank you for listening!

A summary of some of the best papers we published in the March 2023 issue of the Emergency Medicine Journal. EMJ's deputy editor Rick Body and social media editor Sarah Edwards talk through topics including biomarkers of traumatic brain injury, the limping child, hypothermia and sepsis in infants and the importance of avoiding secondary insults in patients intubated for traumatic brain injury in the prehospital environment. Read the highlights: https://emj.bmj.com/content/40/3/157 You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). Thank you for listening!

This podcast, Dr. Lucas Dingman and Dr. Cady Welch, emergency medicine physicians with EMPAC and Ridgeview, discuss six articles on various topics related to emergency medicine, as part of this first ED journal review. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice-changing Describe how to rule out a pulmonary embolism (PE) in the emergency department using the YEARS criteria and age adjusted d-dimer. Differentiate when antibiotics for treating diverticulitis is warranted. Describe the benefits of using a small percutaneous catheter chest tube for treating a traumatic hemothorax. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  Study #1: Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study) A Multicentre, Randomised, Open-label, Noninferiority Trial - DINAMO study & diverticulitis - Multicenter, randomized, open label, non-inferiority trial (Nov.2016 - Jan.2020) - 480 randomized participants  and put into two groups - Results: admission to hospitals, ED revisits, no complications, no major significant findings - Nonantibiotic outpatient treatment of mild acute diverticulitis is safe and effective and is not inferior to current standard treatment. Study #2: Anterior–Lateral Versus Anterior–Posterior Electrode Position for Cardioverting Atrial Fibrillation - EPIC Atrial Fibrilation ( EPIC AF) - Two positions for pad placement for cardioverting patients - Multicenter, randomized, open label trial - 467 randomized patients, scheduled for elective cardioversion - Results: 50% successful conversion to normal sinus rhythm after one biphasic shock, many patients needed multiple shocks to cardioconvert (4-5 shocks). - AHA Guidelines: pad placement for AF and VF, treatment recommendations - Anterior-lateral electrode positioning was more effective than anterior-posterior electrode positioning for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome. Study #3: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial - Poiseuille's law and chest tubes - and involves components of rate of flow, radius of the tube, change in pressure and viscosity. - 120 participants - 8 years and older, traumatic hemothorax or pneumothorax, hemodynamically stable patient only - Treatment arm: 14 Fr cook catheter used (seldinger techique, anterior axillary or midaxillary line) - Control arm: 28-32 Fr. chest tube placed (standard way - 4th-5th intercostal, midaxillary line) - Results: Failure rate of the tube, repeat hemothorax requiring intervention, drainage outputs at different designated times, total chest tube days, insertion complications, ventilator days, ICU length of days, hospital length of stay - Patients had better experience with percutaneous catheter - Hemlich valve - Study discussed looks specifically at hemothoraces which require drainage of blood and chest tubes connected to traditional pleuro vac chamber - Small caliber 14 Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated. Study #4: Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial - ScienceDirect - Single center, placebo controlled, blinded, randomized trial - Sample: 120 healthy adults, median age 40 years old presenting to ED with chief complaint of nausea/vomiting -  Change in nausea score at 30 min. (drop in mm on VAS) - Mean nausea baseline = 50 - Limitations: fairly young healthy participants, difficult to blind (can smell difference) - Among ED patients with acute nausea and not requiring immediate IV access, aromatherapy with or without ondansetron provides greater nausea relief than oral ondansetron alone. Study #5: Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial - YEARS criteria with age adjusted vs only age adjusted - Cluster, randomized, crossover, non-inferiority trial to determine if YEARS plus age-adjusted could be used to rule out PE, age 18 or older, not pregnant - Sample size: 1414 patients within 18 EDs, PERC positive - Outcome: PE diagnosed in 100 patients, no missed PEs with patients with YEARS score of "0", - Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a concential diagnostic strategy, did not result in an inferior rate of thromboembolic events. Study #6: Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial - Randomized, single masked study (providers were masked), controlled clinical trial, non-inferiority study design, single center study - Participants: children - aged 8 weeks to 3 years, moderately dehydrated (dehydration score greater than 3, but less than 7) - Outcomes: Successful rehydration at 4 hours, hospitalization rate, time to initiation of treatment, repeat ED visits within 72 hrs -Results: no difference between the groups with succesful rehydration at 4 hours - Limitations: small sample size - Oral rehydration therapy (ORT) is as good as intravenous fluid therapy (IVF) in rehydration of moderately dehydration children due to gastroenteritis. In addition, the study found that less time was required to intiate ORT when compared with IVF in the ED. Patients treated with ORT had fewerer hospitalizations. Results of the study suggested that ORT be the initial treatment of choice for moderately dehydrated children less than three years old with gastroeneritis. Thanks to Dr. Lucas Dingman and Dr. Cady Welch for their knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

The best of our October 2022 issue, covering a superb qualitative study exploring the experience of older adults in the Emergency Medicine Journal with a wonderful accompanying editorial; a look at variation in practice for treating pre-orbital and orbital cellulitis in children; the association between anticoagulation and mortality in major trauma; point of care testing for tetanus immunity and more. Read the highlights: https://emj.bmj.com/content/39/10/723 You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). Thank you for listening!

Sarah Edwards, Social Media Editor of EMJ, and Rick Body, Deputy Editor of EMJ, give an overview of the best of the September issue of the Emergency Medicine Journal. They cover a plethora of clinically relevant papers. There's a terrific non-inferiority trial looking at the use of non-sterile gloves to repair traumatic wounds in the Emergency Department, two great papers that look at whether we might avoid x-ray for patients with suspected shoulder dislocation (one involving ultrasound), a fascinating paper involving the pre-hospital use of echocardiography and point of care troponin testing for patients with chest pain and more. Read the highlights: https://emj.bmj.com/content/39/9/647, and the complete issue: https://emj.bmj.com/content/39/9. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).

Sarah Edwards, Social Media Editor of EMJ, and Rick Body, Deputy Editor of EMJ, take you through the best of the Emergency Medicine Journal in August 2022, covering topics from COVID-19 to triage to community Emergency Medicine to complications of emergency intubation in children and survival rates for out of hospital cardiac arrest. Read the highlights: https://emj.bmj.com/content/39/8/567, and the complete issue: https://emj.bmj.com/content/39/8. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).

Sarah Edwards, Social Media Editor of EMJ, and Rick Body, Deputy Editor of EMJ, take you through the best of the Emergency Medicine Journal in July 2022. They cover some important topics including ED crowding, telephone triage, unrecognised endobroncheal intubation, acute coronary syndromes and pre-hospital trauma. Read the highlights: https://emj.bmj.com/content/39/7/491 If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).

Rick Body, Deputy Editor of EMJ, and Sarah Edwards, Social Media Editor of EMJ, talk through the very best of the Emergency Medicine Journal with most of the papers we published in April 2022. We cover everything from sepsis and qSOFA scoring to how to manage traumatic pneumothoraces and how to recognise cervical spine injuries. We even look at the problem we have with convenience sampling in Emergency Medicine clinical research studies. Do we need to make big changes? Have a listen and find out! Read the highlights: https://emj.bmj.com/content/39/4/269 If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244).

Top 3 points: Seek feedback Use feedback Give feedback   About Caitlin: Caitlin Wilson (Twitter: @999_Caitlin) is a paramedic for North West Ambulance Service NHS Trust and is currently undertaking a PhD on prehospital feedback at the University of Leeds funded by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre. Her final PhD study is an online diary study exploring predictors and effects of prehospital feedback for patient-facing ambulance staff in the UK. The study is open to recruitment until end of August 2022 and more details can be found at http://bit.ly/prefeed-diary   Relevant publications:   Wilson, C., Howell, AM., Janes, G and Benn, J. (2022) The role of feedback in emergency ambulance services: a qualitative interview study. BMC Health Services Research, 296 (2022).https://doi.org/10.1186/s12913-022-07676-1   Wilson, C., Janes, G., Lawton, R. and Benn, J. (2021) The types and effects of feedback received by emergency ambulance staff: a systematic mixed studies review with narrative synthesis. British Paramedic Journal, Vol. 5 No. 4, pp. 68-69. https://doi.org/10.29045/14784726.2021.3.5.4.68   Wilson, C., Janes, G., Lawton, R. and Benn, J. (2021) The types and effects of feedback received by emergency ambulance staff: protocol for a systematic mixed studies review with narrative synthesis. International Journal of Emergency Services, Vol. 10 No. 2, pp. 247-265. https://doi.org/10.1108/IJES-09-2020-0057   Wilson C, Janes G, Lawton R and Benn, J. (2021) PP24 Prehospital feedback in the United Kingdom: protocol for a review of current practice using a realist approach. Emergency Medicine Journal 2021;38:A10-A11.   Caitlin Wilson  PhD Student & Paramedic University of Leeds / North West Ambulance Service NHS Trust Email: hc15c2w@leeds.ac.uk Twitter: @999_Caitlin   Recent Publications Wilson, C., Howell, AM., Janes, G. et al. The role of feedback in emergency ambulance services: a qualitative interview study. BMC Health Serv Res 22, 296 (2022). https://doi.org/10.1186/s12913-022-07676-1

Caitlin Chats us through hyperventilation syndrome, classically referred to as “panic attack” and how we can spot it and treat the syndrome     Top 3 tips:  Keep an open mind – Hyperventilation Syndrome (HVS) is a diagnosis of exclusion!  Use your diagnostic tools & clinical judgement - Don't guess what findings might be!  Be cautious when diagnosing HVS in older patients or when you're uncertain in HVS being the sole diagnosis + safety net the patient when considering non-conveyance!    Biography:  Caitlin Wilson is a paramedic for North West Ambulance Service NHS Trust and conducted a research study on Hyperventilation Syndrome (HVS) as part of her MSc Clinical Research Methods in 2015/16. Caitlin went on to publish findings from her research and was involved in updating the JRCALC guidelines for HVS. Currently, Caitlin is undertaking a PhD in prehospital feedback at the University of Leeds funded by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre.  Links and resources:  Wilson, C., Harley, C., & Steels, S. (2020). How accurate is the prehospital diagnosis of hyperventilation syndrome?. Journal of Paramedic Practice, 12(11). doi:10.12968/jpar.2020.12.11.445  Wilson, C. (2018). Hyperventilation syndrome: diagnosis and reassurance. Journal of Paramedic Practice, 10(9), 370-375. doi:10.12968/jpar.2018.10.9.370  Wilson, C., Harley, C., & Steels, S. (2018). Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies. Emergency Medicine Journal, 35(12), 757-764. doi:10.1136/emermed-2018-207588     

Rick Body, Deputy Editor of EMJ, and Sarah Edwards, Social Media Editor of EMJ, talk through the highlights of the February edition of the Emergency Medicine Journal. Read the highlights: https://emj.bmj.com/content/39/2/85. You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). Thank you for listening!

Rick Body, Deputy Editor of EMJ, and Sarah Edwards, Social Media Editor of EMJ, talk through the highlights of the January 2022 edition of the Emergency Medicine Journal. Read the highlights: https://emj.bmj.com/content/39/1/1 Details of the papers mentioned in the podcast: Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data: https://emj.bmj.com/content/39/1/3 Heterogeneity of reasons for attendance in frequent attenders of emergency departments and its relationship to future attendance: https://emj.bmj.com/content/39/1/10 Non-urgent emergency department attendances in children: a retrospective observational analysis: https://emj.bmj.com/content/39/1/17 How much time do doctors spend providing care to each child in the ED? A time and motion study: https://emj.bmj.com/content/39/1/23 Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis: https://emj.bmj.com/content/39/1/30 Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial: https://emj.bmj.com/content/39/1/37 Effects of sleepiness on clinical decision making among paramedic students: a simulated night shift study: https://emj.bmj.com/content/39/1/45 Incidence and impact of incivility in paramedicine: a qualitative study: https://emj.bmj.com/content/39/1/52 COVID-19 rapid diagnostics: practice review: https://emj.bmj.com/content/39/1/70

Simon Carley, Associate Editor of EMJ, talks through the highlights of the December 2021 edition of the Emergency Medicine Journal. Read the highlights: https://emj.bmj.com/content/38/12/867 Details of the papers mentioned in this podcast can be found below: Evaluation of a state law on opioid-prescribing behaviour and the void affecting codeine-containing antitussive syrup - https://emj.bmj.com/content/38/12/889 We Need to Talk About Codeine: an Implementation Study to reduce the number of Emergency Department patients discharged on high-strength co-codamol using the Behaviour Change Wheel - https://emj.bmj.com/content/38/12/895 Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study - https://emj.bmj.com/content/38/12/919 Evaluating the utility of Rapid Response EEG in emergency care - https://emj.bmj.com/content/38/12/923 Early warning scores to assess the probability of critical illness in patients with COVID-19 - https://emj.bmj.com/content/38/12/901 Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage - https://emj.bmj.com/content/38/12/868 Association of advanced age with intubation-related adverse events in the emergency department: a multicentre prospective observational study - https://emj.bmj.com/content/38/12/874 Improving outcomes for older people in the emergency department: a review of reviews - https://emj.bmj.com/content/38/12/882 Identifying opportunities for health promotion and intervention in the ED - https://emj.bmj.com/content/38/12/927

Simon Carley, Associate Editor of EMJ, talks through the highlights of the August 2021 edition of the Emergency Medicine Journal. A systematic mixed studies review of patient experiences in the ED https://emj.bmj.com/content/early/2021/03/03/emermed-2020-210634 To prescribe or not to prescribe for paediatric sore throat: A retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary Paediatric Emergency Department and a national review of practice. https://emj.bmj.com/content/early/2021/04/14/emermed-2020-210786 Early Prediction of Serious Infections in Febrile Infants Incorporating Heart Rate Variability in an Emergency Department: A Pilot Study https://emj.bmj.com/content/early/2021/04/16/emermed-2020-210675 Toddler's Fracture Immobilisation (ToFI) Study - A Randomised Controlled Trial Comparing Immobilisation in Above Knee Plaster of Paris to Controlled Ankle Motion Boots in Undisplaced Paediatric Spiral Tibial Fractures https://emj.bmj.com/content/early/2021/06/21/emermed-2020-210299.long Clinical benefits of prone positioning in the treatment of non-intubated patients with acute hypoxic respiratory failure: A rapid systematic review https://emj.bmj.com/content/early/2021/06/22/emermed-2020-210586.long Prognostic accuracy of emergency department triage tools for adults with suspected COVID-19: The PRIEST observational cohort study https://emj.bmj.com/content/early/2021/06/03/emermed-2020-210783 Implementation of the ‘TAKE STOCK' Hot Debrief Tool in the Emergency Department: A Quality Improvement Project. https://emj.bmj.com/content/early/2021/01/13/emermed-2019-208830.info The Cardiac Arrest Nurse Leadership (CANLEAD) Trial: A simulation based Randomised Controlled Trial implementation of a new cardiac arrest role to facilitate cognitive offload for medical team leaders. https://emj.bmj.com/content/early/2021/01/26/emermed-2019-209

Simon Carley, Associate Editor of EMJ, talks through the highlights of the June 2021 edition of the Emergency Medicine Journal. Read the primary survey here: https://emj.bmj.com/content/38/6/407 Emergency medicine electronic health record usability: where to from here? (16 March, 2021) FREE Katie Walker, Tim Dwyer, Heather A Heaton: https://emj.bmj.com/content/38/6/408 Usability of electronic health record systems in UK EDs Editor's Choice (3 March, 2021) Benjamin Michael Bloom, Jason Pott, Stephen Thomas, David Ramon Gaunt, Thomas C Hughes: https://emj.bmj.com/content/38/6/410 Hypochloraemia is associated with 28-day mortality in patients with septic shock: a retrospective analysis of a multicentre prospective registry: https://emj.bmj.com/content/38/6/423 Emergency department attendances during the COVID-19 pandemic: a retrospective analysis of attendances following Irish governmental pandemic measures: https://emj.bmj.com/content/38/6/439 Incidence of emergency calls and out-of-hospital cardiac arrest deaths during the COVID-19 pandemic: findings from a cross-sectional study in a UK ambulance service: https://emj.bmj.com/content/38/6/446 Sex-related differences in opioid administration in the emergency department: a population-based study: https://emj.bmj.com/content/38/6/467

Theme: Retrieval Medicine. Participants: Dr Ruby Hsu, Dr Ruth Parsell, Dr Pramod Chandru, Shannon Townsend, Yelise Foon, Shreyas Iyer and Samoda Wilegoda Mudalige.Discussion 1:Benoit, J., Stolz, U., McMullan, J., & Wang, H. (2021). Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation, 160, 59-65. https://doi.org/10.1016/j.resuscitation.2021.01.009.Presenter - Yelise Foon - ED senior resident medical officer. Summary: This study was a retrospective cohort study that looked at adult, non-traumatic OOHCA patients with an advanced airway (supraglottic or endotracheal). The timing of airway placement (intra-arrest versus post-ROSC) and patient outcomes (with respect to the cerebral performance category, or CPC) were analyzed.  They observed a higher CPC in the group that had the advanced airway placed post-ROSC (i.e. 21.7% in post-arrest group versus 7.5% in intra-arrest group). They concluded that the timing of the airway placement was not associated with poor neurological outcomes.  Discussion 2:Aziz, S., Foster, E., Lockey, D., & Christian, M. (2021). Emergency scalpel cricothyroidotomy use in a prehospital trauma service: a 20-year review. Emergency Medicine Journal, 38(5), 349-354. https://doi.org/10.1136/emermed-2020-210305.Presenter - Shannon Townsend, ED advanced trainee at Orange Health Service.Summary & Take-Home Points: This was a retrospective observational study conducted from 2000 to 2019 using clinical records and aimed to (1) ascertain the rate of scalpel cricothyroidotomy and (2) understand indications for and factors associated with this procedure. They observed that the main indication for scalpel cricothyroidotomy was as a rescue airway (for failed laryngoscopy due to a large volume of blood in the airway). They noted high levels of procedural success, but the overall mortality in patients receiving this procedure was high (due to a number of factors).  The rate of scalpel cricothyroidotomy has decreased over the years due to factors such as the introduction of supraglottic airways and longer-acting muscle relaxants (rocuronium versus suxamethonium).  It is important to remember that, if we optimize our intubation conditions (e.g. improving patient position, carefully choosing drugs and equipment according to patient's clinical situation), we are likely to increase our first pass success with laryngoscopy.  It is important to (1) recognize the indications for scalpel cricothyroidotomy, (2) be familiar with the procedure itself, (3) overcome the mental barriers against performing it, and (4) perform it confidently and competently. Discussion 3:Sperry, J., Guyette, F., Brown, J., Yazer, M., Triulzi, D., & Early-Young, B. et al. (2018). Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. New England Journal Of Medicine, 379(4), 315-326. https://doi.org/10.1056/nejmoa1802345.Presenter - Dr Ruth Parsell. Summary: In this pragmatic, multi-center, cluster-randomized, phase 3 superiority trial, the efficacy of administering thawed plasma to patients at risk of haemorrhagic shock was studied.  The comparative arm was standard-care resuscitation (with crystalloid fluids). The primary outcome was mortality at the 30-day mark.  They concluded that administration of thawed plasma to patients at risk of haemorrhagic shock resulted in (1) lower 30-day mortality and (2) lower median prothrombin-time ratio.  Interlude Segment 1:Presenter - Dr Ruth Parsell. Interlude Segment 2:Presenter - Dr Ruby Hsu.Credits:The discussions were mediated by retrieval specialists and ED consultants, Dr Ruby Hsu and Dr Ruth Parsell and ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Beach Volley by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Lose My Mind by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sol by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Sunrise by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. The Leap by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thinking Of You by Ron Gelinas Chillout Lounge | https://soundcloud.com/atmospheric-music-portal, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Theme: Paediatrics. Participants: Dr Surbhi Rikhi, Dr Kerf Tan, Dr Pramod Chandru, Johann De Alwis (PEM trainee) Omal Fernando (PEM trainee), Min Park (EM trainee), Shreyas Iyer, Kit Rowe, Caroline Tyers and Samoda Wilegoda Mudalige.Discussion 1:Kuppermann, N., Dayan, P., Levine, D., Vitale, M., Tzimenatos, L., & Tunik, M. et al. (2019). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatrics, 173(4), 342. https://doi.org/10.1001/jamapediatrics.2018.5501. Presenter - Johann De Alwis.Summary: Serious bacterial infections (SBIs); which include UTI, meningitis, and bacteraemia, lead to dangerous complications in infants. This was a prospective observational study between 2011 and 2013, looking at previously healthy febrile infants aged 60 days or younger, who were evaluated for SBIs. The clinical rule considered the urinalysis, absolute neutrophil count (ANC), and serum procalcitonin, and had a sensitivity of 97.7%, with a specificity of 60%, and a negative predictive value of 99.6%. One infant with bacteraemia and two with UTI who were misclassified.  This tool decreased the number of lumbar punctures performed, antibiotics administered, and infants admitted to the hospital.  Take-Home Points: Remember that these infants are the most at-risk population; do more rather than less. Safety net: no matter what you do or what investigations reveal, always have a safety net!  Discussion 2:Pan, P. (2020). Validation of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) Score in the Diagnosis of Testicular Torsion in Children With Acute Scrotum. Indian Pediatrics, 57(10), 926-928. https://doi.org/10.1007/s13312-020-1992-6.Presenter - Omal Fernando.Summary: The TWIST score includes - testicular swelling (2), hard testicle (2), absent cremasteric reflex (1), nausea or vomiting (1), a high-riding testicle (1).  Low risk was a score of 0-2, intermediate risk was a score of 3-4 and high risk was a score 5-7. Of those with testicular torsion, the mean TWIST score was 5.7 (none in low-risk category, 13 in intermediate-risk group, and 55 in high-risk group).  Of those without testicular torsion, the mean TWIST score was 1.46 (21 in low-risk group, 7 in the intermediate-risk group, and 0 in the high-risk group). All patients with a high-riding testis or absent cremasteric reflex were found to have testicular torsion. Take-Home Points: This score reminds us what we should be looking for when assessing a patient with acute testicular pain and thus help to build clinical gestalt, however, there is not enough evidence at present to rely on this tool alone (although this may change in the years to come).  It is important to involve the urologist/general surgeon if there is any suspicion of torsion. Given the time-critical nature of this presentation, patients should be taken to the theatre (rather than further investigated with ultrasound) if testicular torsion is suspected. Discussion 3:Iramain, R., Castro‐Rodriguez, J., Jara, A., Cardozo, L., Bogado, N., Morinigo, R., & De Jesús, R. (2019). Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial. Pediatric Pulmonology, 54(4), 372-377. https://doi.org/10.1002/ppul.24244.Presenter - Min Park. Take-Home Points: 103 children between the age of 2 and 14 years with severe asthma exacerbations (pulmonary score 7) were randomly allocated to a nebulizer or metred dose inhaler (MDI) and spacer with nasal prong oxygen. The primary outcome was the rate of hospitalization with the secondary outcome being oxygen saturations at 60 and 90 minutes. Children in the MDI group had significantly improved oxygen saturation from 60 minutes compared with the nebulizer group, with significantly lower rates of admission to hospital (5.8% vs. 27.5%).  Summary: MDIs may be at least equally effective if not more effective than nebulizers. MDIs are also cheaper and provide an opportunity to educate patients regarding their use. It is important to re-assess your patients following initial treatment. There may be variability in the way you approach each patient to meet their individual needs.  Always refer to your local guidelines.  Interlude Segment 1:Presenter - Dr Surbhi Rikhi.Interlude Segment 2:Presenter - Dr Kerf Tan.Resources (to support doctor well-being) -  Applications: Shift (Black Dog Institute app for healthcare workers), Calm, Headspace, Feeling Good, Smiling Minds, Insight Timer.   JMO support line (NSW): 1300 566 321. Access EAP (free confidential service for all NSW Health employees). Doctors for doctors: www.drs4drs.com.au. Beyond Blue: 1300 224 636. Lifeline: 13 11 14.  Suicide call-back service: 1300 659 467.  Other References:“Step by step” approach to the febrile infant -  Mintegi, S., Bressan, S., Gomez, B., Da Dalt, L., Blázquez, D., & Olaciregui, I. et al. (2013). Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emergency Medicine Journal, 31(e1), e19-e24. https://doi.org/10.1136/emermed-2013-202449.Original study validating the TWIST score - Barbosa, J., Tiseo, B., Barayan, G., Rosman, B., Torricelli, F., & Passerotti, C. et al. (2013). Development and Initial Validation of a Scoring System to Diagnose Testicular Torsion in Children. Journal Of Urology, 189(5), 1859-1864. https://doi.org/10.1016/j.juro.2012.10.056.Starship Hospital (NZ) study examining nebuliser vs. MDI delivery for asthma - Klassen, T. (2001). Spacers were better and less expensive than nebulisers for giving albuterol to children with moderate to severe acute asthma. Evidence-Based Medicine, 6(1), 31-31. https://doi.org/10.1136/ebm.6.1.31.Further evidence regarding female ACS presentations (as covered in our previous episode) -van Oosterhout, R., de Boer, A., Maas, A., Rutten, F., Bots, M., & Peters, S. (2020). Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. Journal Of The American Heart Association, 9(9). https://doi.org/10.1161/jaha.119.014733.Sederholm Lawesson, S., Isaksson, R., Thylén, I., Ericsson, M., Ängerud, K., & Swahn, E. (2018). Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal Of Cardiology, 264, 7-11. https://doi.org/10.1016/j.ijcard.2018.03.084.Credits:The discussions were mediated by PEM consultant Dr Surbhi Rikhi, ED consultant Dr Kerf Tan and, ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Fable by Free Music | https://soundcloud.com/fm_freemusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Moments by Sarah Jansen Music | https://soundcloud.com/sarahjansenmusic, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  New Days by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sound effects from https://www.free-stock-music.com. Sunset Beach by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.   Warm Duck Shuffle by arnebhus | https://soundcloud.com/arnebhus, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the April 2021 edition of the Emergency Medicine Journal. Read the primary survey here: https://emj.bmj.com/content/38/4/249 Environmentally sustainable emergency medicine: https://emj.bmj.com/content/38/4/315 When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China: https://emj.bmj.com/content/38/4/252 S100B protein level for the detection of clinically significant intracranial haemorrhage in patients with mild traumatic brain injury: a subanalysis of a prospective cohort study: https://emj.bmj.com/content/38/4/285 Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: a pre-planned substudy in a sample of CRASH-3 trial patients: https://emj.bmj.com/content/38/4/270 Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study: https://emj.bmj.com/content/38/4/290 Handheld electronic device use in patient care: the emergency department patient perspective—a cross-sectional survey: https://emj.bmj.com/content/38/4/258 Read the full Aprilissue here: https://emj.bmj.com/content/38/4

Simon Carley, Associate Editor of EMJ, talks through his highlights of the February 2021 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/38/2/87 Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study https://emj.bmj.com/content/38/2/88 Diagnostic accuracy of point-of-care lung ultrasound in COVID-19 https://emj.bmj.com/content/38/2/94 Rise and fall of the aerosol box; and what we must learn from the adoption of untested equipment https://emj.bmj.com/content/38/2/109 COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study https://emj.bmj.com/content/38/2/111 Evaluation of a novel approach to recognising community-acquired paediatric sepsis at ED triage by combining an electronic screening algorithm with clinician assessment https://emj.bmj.com/content/38/2/132 Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study https://emj.bmj.com/content/38/2/139 Emergency Medicine Journal COVID-19 monthly top five https://emj.bmj.com/content/38/2/158 Read the full February issue here: https://emj.bmj.com/content/38/2

Simon Carley, Associate Editor of EMJ, talks through his highlights of the November 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/11/657 Details of the papers mentioned in this podcast can be found below: Risk of significant traumatic brain injury in adults with minor head injury taking direct oral anticoagulants: a cohort study and updated meta-analysis - https://emj.bmj.com/content/37/11/666 Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital - https://emj.bmj.com/content/37/11/680 Identification of very low-risk acute chest pain patients without troponin testing - https://emj.bmj.com/content/37/11/690 National trends in chest pain visits in US emergency departments (2006–2016 - https://emj.bmj.com/content/37/11/696 Community frailty response service: the ED at your front door - https://emj.bmj.com/content/37/11/714 SONO case series: soft tissue infections, abscesses, pyomyositis and necrotising fasciitis - https://emj.bmj.com/content/37/11/722 Read the full November issue here: https://emj.bmj.com/content/37/11

Simon Carley, Associate Editor of EMJ, talks through his highlights of the October 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/10/593 Details of the papers mentioned in this podcast can be found below: Are we preaching to the choir? Where should studies on frequent users of EDs be published? - https://emj.bmj.com/content/37/10/595 Frequent attendances at emergency departments in England - https://emj.bmj.com/content/37/10/597 A data linkage study of suspected seizures in the urgent and emergency care system in the UK - https://emj.bmj.com/content/37/10/605 Perspectives of emergency department attendees on outcomes of resuscitation efforts: origins and impact on cardiopulmonary resuscitation preference - https://emj.bmj.com/content/37/10/611 Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case - study https://emj.bmj.com/content/37/10/617 Insufficient quality of public automated external defibrillator recordings in the greater Paris area, a descriptive study - https://emj.bmj.com/content/37/10/623 Close air support: enhancing emergency care in the COVID-19 pandemic - https://emj.bmj.com/content/37/10/642 Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle? - https://emj.bmj.com/content/37/10/644 Beirut: a wounded city explodes- https://emj.bmj.com/content/37/10/656 Read the full October issue here - https://emj.bmj.com/content/37/10

Simon Carley, Associate Editor of EMJ, talks through his highlights of the August 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/7/395 Details of the papers mentioned in this podcast can be found below: Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review - https://emj.bmj.com/content/37/8/508 I-FiBH trial: intravenous fluids in benign headaches—a randomised, single-blinded clinical trial - https://emj.bmj.com/content/37/8/469 Colles’ type distal radial fractures undergoing manipulation in the ED: a multicentre observational cohort study - https://emj.bmj.com/content/37/8/498 Read the full August issue here - https://emj.bmj.com/content/37/8

Simon Carley, Associate Editor of EMJ, talks through his highlights of the July 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/7/395 Details of the papers mentioned in this podcast can be found below: Updated framework on quality and safety in emergency medicine - https://emj.bmj.com/content/37/7/437 Evaluating the sustained effectiveness of a multimodal intervention aimed at influencing PIVC insertion practices in the emergency department - https://emj.bmj.com/content/37/7/444 Endotracheal intubation with barrier protection - https://emj.bmj.com/content/37/7/398 Aerosol containment box to the rescue: extra protection for the front line - https://emj.bmj.com/content/37/7/400 Accuracy of PE rule-out strategies in pregnancy: secondary analysis of the DiPEP study prospective cohort - https://emj.bmj.com/content/37/7/423 Oral nitroglycerin solution for oesophageal food impaction: a prospective single-arm pilot study - https://emj.bmj.com/content/37/7/434 Use of prehospital emergency medical services according to income of residential area - https://emj.bmj.com/content/37/7/429 Using emergency physicians’ abilities to predict patient admission to decrease admission delay time - https://emj.bmj.com/content/37/7/417 Read the full July issue here - https://emj.bmj.com/content/37/7.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the June 2020 edition of the Emergency Medicine Journal. Read the highlights: https://emj.bmj.com/content/37/6/321 Other links: Suffocating in the eye of the storm: attempting to breathe at the epicentre of New York’s COVID-19 pandemic - https://emj.bmj.com/content/37/6/330 Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED - https://emj.bmj.com/content/37/6/335 Implications for COVID-19 triage from the ICNARC report of 2204 COVID-19 cases managed in UK adult intensive care units - https://emj.bmj.com/content/37/6/332 Early versus delayed emergency department presentation following mild Traumatic Brain Injury and the presence of symptom at 1, 4 and 12 weeks in children - https://emj.bmj.com/content/37/6/338 The CRASH3 study: prehospital TXA for every injured patient? - https://emj.bmj.com/content/37/6/392 Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications - https://emj.bmj.com/content/37/6/345 Burns and Scalds Assessment Template: standardising clinical assessment of childhood burns in the emergency department - https://emj.bmj.com/content/37/6/351 Moderate to severe hyperphosphataemia as an independent prognostic factor for 28-day mortality in adult patients with sepsis - https://emj.bmj.com/content/37/6/355 Prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources - https://emj.bmj.com/content/37/6/363 Evolution of methodology and reporting of emergency medicine quantitative research over a 20-year period - https://emj.bmj.com/content/37/6/324 Academic emergency medicine in the UK - https://emj.bmj.com/content/37/6/322 Whole blood transfusion versus component therapy in adult trauma patients with acute major haemorrhage - https://emj.bmj.com/content/37/6/370 Successful endotracheal intubation following a failed first attempt during aeromedical retrieval - https://emj.bmj.com/content/37/5/314.

A bit later than usual, but here we are again! Simon Carley, Associate Editor of EMJ, talks with Professor Richard Body about the highlights of the May 2020 edition of the Emergency Medicine Journal. Read the primary survey here - emj.bmj.com/content/37/5/249 Details of the papers mentioned in this podcast can be found below: SARS: experience from the emergency department, Tan Tock Seng Hospital, Singapore - emj.bmj.com/content/20/6/501 Views and experiences of nurses in providing end-of-life care to patients in an ED context: a qualitative systematic review - emj.bmj.com/content/37/5/265 End of life care in the emergency department - emj.bmj.com/content/37/5/273 That was a game changer: clinical impact of an emergency department-based palliative care communication skills training workshop - emj.bmj.com/content/37/5/262 Inter-rater reliability in a bespoke scoring tool: the Paediatric Observation Priority Score - emj.bmj.com/content/37/5/293 Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores? - emj.bmj.com/content/37/5/279 Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study - emj.bmj.com/content/37/5/286 Emergency medicine registrar training in Africa: overview of programmes, faculty and sustainability - emj.bmj.com/content/37/5/300 Read the full May issue here - emj.bmj.com/content/37/5

Simon Carley, Associate Editor of EMJ, talks through his highlights of the April 2020 edition of the Emergency Medicine Journal. Our regular monthly round up of the best and the brightest in the April edition of the EMJ. Read the primary survey here - https://emj.bmj.com/content/37/4/177 Impact of emergency care centralisation on mortality and efficiency: a retrospective service evaluation - https://emj.bmj.com/content/37/4/180 Three into one does go - https://emj.bmj.com/content/37/4/178 Emergency department visits during the 4/20 cannabis celebration - https://emj.bmj.com/content/37/4/187 Routine alcohol screening in the ED: unscreened patients have an increased risk for hazardous alcohol use - https://emj.bmj.com/content/37/4/206 Inadvertent tissue adhesive tarsorrhaphy of the eyelid: a review and exploratory trial of removal methods of Histoacryl - https://emj.bmj.com/content/37/4/212 Performance of the MEDS score in predicting mortality among emergency department patients with a suspected infection: a meta-analysis - https://emj.bmj.com/content/37/4/232. Read the full April issue here: - https://emj.bmj.com/content/37/4

Simon Carley, Associate Editor of EMJ, talks through his highlights of the March 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/3/117. Predicting abusive head trauma in children https://emj.bmj.com/content/37/3/118 Validation of the PredAHT-2 prediction tool for abusive head trauma https://emj.bmj.com/content/37/3/119 Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury https://emj.bmj.com/content/37/3/127 Biological mechanisms and individual variation in fibrinolysis after major trauma https://emj.bmj.com/content/37/3/135 Prehospital critical care is associated with increased survival in adult trauma patients in Scotland https://emj.bmj.com/content/37/3/141 Cranial burr holes in the emergency department: to drill or not to drill? https://emj.bmj.com/content/37/3/151 Cranial burr holes in the emergency department: to drill or not to drill? https://emj.bmj.com/content/37/3/154 Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK https://emj.bmj.com/content/37/3/155 Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review https://emj.bmj.com/content/37/3/162 Read the full March issue here - emj.bmj.com/content/37/3

In our COVID-19 Critical Care series we are hitting you with the fundamentals of critical care that you may need when caring for COVID-19 patients. In this episode we cover non-invasive positive pressure ventilation and continuous positive airway pressure ventilation. ReferencesKeenan, S. et.al. (2011). Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. Canadian Medical Association Journal. PMID: 21324867Nee, P. et.al. (2010). Critical care in the emergency department: acute respiratory failure. Emergency Medicine Journal. PMID: 21112972 Caples SM, Gay PC. Noninvasive positive pressure ventilation in the intensive care unit: a concise review. Crit Care Med. 2005;33(11):2651–2658.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the February 2020 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/37/2/55. Details of the papers mentioned in this podcast can be found below: ‘Stealth trauma’ in the young and the old: the next challenge for major trauma networks? - https://emj.bmj.com/content/37/2/56 Massive transfusion in The Netherlands - https://emj.bmj.com/content/37/2/65 Blunt chest trauma in the elderly: an expert practice review - https://emj.bmj.com/content/37/2/73 How can pain management in the emergency department be improved? Findings from multiple case study analysis of pain management in three UK emergency departments - https://emj.bmj.com/content/37/2/85 Read the full February issue here - emj.bmj.com/content/37/2

Simon Carley, Associate Editor of EMJ, talks through his highlights of the January 2020 edition of the Emergency Medicine Journal. Read the primary survey here - emj.bmj.com/content/37/1 Details of the papers mentioned in this podcast can be found below: Comparison of four decision aids for the early diagnosis of acute coronary syndromes in the emergency department https://emj.bmj.com/content/37/1/8 The incidence of airway haemorrhage in manual versus mechanical cardiopulmonary resuscitation https://emj.bmj.com/content/37/1/14 Epidemiology of adolescent trauma in England: a review of TARN data 2008–2017 - https://emj.bmj.com/content/37/1/25 Blood Glucose Reduction in Patients Treated with Insulin and Dextrose for Hyperkalemia - https://emj.bmj.com/content/37/1/31 No rest for the weary: A cross-sectional study comparing patients sleep in the emergency department to those on the ward https://emj.bmj.com/content/37/1/42 Thromboprophylaxis in Lower Limb Immobilisation after Injury (TiLLI) https://emj.bmj.com/content/37/1/36 Emergency Medicine: let’s feed the good wolf - https://emj.bmj.com/content/37/1/52 Read the full January issue here - https://emj.bmj.com/content/37/1

Simon Carley, Associate Editor of EMJ, talks through his highlights of the October 2019 edition of the Emergency Medicine Journal. Patients don’t have language barriers; the healthcare system does - https://emj.bmj.com/content/36/10/580 Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment - Editor's Choice - https://emj.bmj.com/content/36/10/582 Framing of clinical information affects physicians’ diagnostic accuracy - https://emj.bmj.com/content/36/10/589 Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation - https://emj.bmj.com/content/36/10/595 Diurnal, weekly and seasonal variations of chest pain in patients transported by emergency medical services - https://emj.bmj.com/content/36/10/601 Pulmonary embolism following complex trauma: UK MTC observational study - https://emj.bmj.com/content/36/10/608 Adapting the Canadian CT head rule age criteria for mild traumatic brain injury - https://emj.bmj.com/content/36/10/617 Read the full October issue here - emj.bmj.com/content/36/10.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the September 2019 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/36/9/517 Details of the papers mentioned in this podcast can be found below: The Panoramic Dental Radiograph for Emergency Physicians - https://emj.bmj.com/content/36/9/565 Exploring the characteristics, acuity and management of adult ED patients at night-time - https://emj.bmj.com/content/36/9/554 Evaluation of the criteria for trauma activation in the paediatric emergency department - https://emj.bmj.com/content/36/9/529 Why are people increasingly attending the emergency department? A study of the French healthcare system - https://emj.bmj.com/content/36/9/548 Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: Nationwide observational study - https://emj.bmj.com/content/36/9/541 Phenomenological study exploring ethics in prehospital research from the paramedic’s perspective: experiences from the Paramedic-2 trial in a UK ambulance service - https://emj.bmj.com/content/36/9/535 Process conformance is associated with successful first intubation attempt and lower odds of adverse events in a paediatric emergency setting - https://emj.bmj.com/content/36/9/520 Triaging the triage: reducing waiting time to triage in the emergency department at a tertiary care hospital in New Delhi, India - https://emj.bmj.com/content/36/9/558 Read the full September issue - https://emj.bmj.com/content/36/9

Simon Carley, Associate Editor of EMJ, talks through his highlights of the August 2019 edition of the Emergency Medicine Journal. Read the primary survey here - emj.bmj.com/content/36/8/451 Details of the papers mentioned in this podcast can be found below: First responder communication in CBRN environments: FIRCOM-CBRN study - https://emj.bmj.com/content/36/8/456 Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan - https://emj.bmj.com/content/36/8/485 Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest - https://emj.bmj.com/content/36/8/479 Potential added value of the new emergency care dataset to ED-based public health surveillance in England: an initial concept analysis - https://emj.bmj.com/content/36/8/459 Paracetamol versus other analgesia in adult patients with minor musculoskeletal injuries: a systematic review - https://emj.bmj.com/content/36/8/493 Recognising bias in studies of diagnostic tests part 2: interpreting and verifying the index test - https://emj.bmj.com/content/36/8/501 Man versus machine: comparison of naked-eye estimation and quantified capillary refill - https://emj.bmj.com/content/36/8/465 Read the full August issue - https://emj.bmj.com/content/36/8

Simon Carley, Associate Editor of EMJ, talks through his highlights of the July 2019 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/36/7/385 Details of the papers mentioned in this podcast can be found below: Epidemiology of traumatic injuries presenting to an ED in Central Haiti: a retrospective cohort study - https://emj.bmj.com/content/36/7/389 Prehospital tranexamic acid shortens the interval to administration by half in Major Trauma Networks: a service evaluation - https://emj.bmj.com/content/36/7/395 Confirmed cardiac output on emergency medical services arrival as confounding by indication: an observational study of prehospital airway management in patients with out-of-hospital cardiac arrest - https://emj.bmj.com/content/36/7/410 Driving stroke quality improvement at scale in EDs across a nationwide network of hospitals: strategies and interventions - https://emj.bmj.com/content/36/7/423 The association of paramedic rapid sequence intubation and survival in out-of-hospital stroke - https://emj.bmj.com/content/36/7/416 Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions - https://emj.bmj.com/content/36/7/435 Read the full July issue here - emj.bmj.com/content/36/7.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the June 2019 edition of the Emergency Medicine Journal. Read the primary survey here - https://emj.bmj.com/content/36/6/324 Details of the papers mentioned in this podcast can be found below: Measurement and improvement of emergency department performance through inspection and rating: an observational study of emergency departments in acute hospitals in England - https://emj.bmj.com/content/early/2019/04/10/emermed-2018-207941 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest - https://emj.bmj.com/content/early/2019/05/02/emermed-2018-208165 Ageing population has changed the nature of major thoracic injury - https://emj.bmj.com/content/early/2019/04/02/emermed-2018-207943.abstract 'They don't are how much you know until they know how much you care': A qualitative meta-synthesis of patient experience in the Emergency Department - https://emj.bmj.com/content/early/2019/04/19/emermed-2018-208156 Anatomy of resuscitative care unit: expanding the borders of traditional intensive care units - emj.bmj.com/content/early/2019/04/16/emermed-2019-208455.abstract Plight of the pelvic exam - https://emj.bmj.com/content/early/2019/04/16/emermed-2019-208474 Read the full June issue - https://emj.bmj.com/content/36/6

Simon Carley, Associate Editor of EMJ, talks through his highlights of the May 2019 edition of the Emergency Medicine Journal. Read the primary survey here - emj.bmj.com/content/36/5/257 Details of the papers mentioned in this podcast can be found below: Could this be Measles? - https://emj.bmj.com/content/36/5/310 Randomised controlled trial of simulation-based education for mechanical cardiopulmonary resuscitation training - https://emj.bmj.com/content/36/5/266 Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians - emj.bmj.com/content/36/5/273 Immune checkpoint blockade toxicity among patients with cancer presenting to the emergency department - emj.bmj.com/content/36/5/306 Major incident triage and the evaluation of the Triage Sort as a secondary triage method - https://emj.bmj.com/content/36/5/281 Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out - https://emj.bmj.com/content/36/5/287 A mixed methods study of the impact of consultant overnight working in an English Emergency Department - https://emj.bmj.com/content/36/5/298 Read the full May issue here - emj.bmj.com/content/36/5.

Simon Carley, Associate Editor of EMJ, talks through his highlights of the February 2019 edition of the Emergency Medicine Journal. Read the primary survey here - emj.bmj.com/content/36/2/63 Details of the papers mentioned in this podcast can be found below: A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department - emj.bmj.com/content/36/2/66 A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze? - emj.bmj.com/content/36/2/97 From ED overcrowding to jail overcrowding: a cautionary tale of a Serial Inebriate Programme (SIP) - emj.bmj.com/content/36/2/92 UK’s initial operational response and specialist operational response to CBRN and HazMat incidents: a primer on decontamination protocols for healthcare professionals - emj.bmj.com/content/36/2/117 Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study - emj.bmj.com/content/36/2/78 Emergency medical services oxygen equipment: a fomite for transmission of MRSA? - emj.bmj.com/content/36/2/89 Factors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study- emj.bmj.com/content/36/2/72 Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission - emj.bmj.com/content/36/2/82 Approach to syncope in the emergency department - emj.bmj.com/content/36/2/108 Read the full February issue here - emj.bmj.com/content/36/2.

Simon Carley, Associate Editor of EMJ, talks through the highlights of the January 2019 edition of the Emergency Medicine Journal, this month, chosen by Editor-in-Chief Ellen Weber. Read the primary survey here: emj.bmj.com/content/36/1/1. Details of the papers mentioned in this podcast can be found below: The view from here: on the other side of the curtain - emj.bmj.com/content/36/1/52 Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study - emj.bmj.com/content/36/1/4 Side effects of decision rules, or the law of unintended consequences - emj.bmj.com/content/36/1/2 Analgesia in the emergency department: why is it not administered? - emj.bmj.com/content/36/1/12 Urgent care axis for the older adult: where is best to target interventions? - emj.bmj.com/content/36/1/22 Exploring parents’ reasons for attending the emergency department for children with minor illnesses: a mixed methods systematic review - emj.bmj.com/content/36/1/39 Read the full January issue here: emj.bmj.com/content/36/1

Simon Carley is Professor of Emergency Medicine in Manchester, England. He is an active clinician at Manchester Royal Infirmary and the Royal Manchester Children’s Hospital. He has published over 100 papers in clinical journals with research interests in disaster medicine, diagnostics, evidence base medicine and medical education. He has additional roles as associate editor of the Emergency Medicine Journal. As a co-founder and developer of the BestBets and St.Emlyn’s websites he has integrated web based learning into all levels of EM education. He developed the StEmlyns Blog to share learning across the globe in the true spirit of #FOAM.

Simon Carley, Associate Editor of EMJ, talks through the highlights of the December 2018 edition of the Emergency Medicine Journal, this month, chosen by Associate Editor Mary Dawood. Read the primary survey here: emj.bmj.com/content/35/12/719 Details of the papers mentioned in this podcast can be found below: Evaluation of the provision of helicopter emergency medical services in Europe - emj.bmj.com/content/35/12/720 Heart failure and palliative care in the emergency department - emj.bmj.com/content/35/12/726 Performing sit down medicine in a stand-up place: is it time for palliative care in the emergency department? - emj.bmj.com/content/35/12/730 Predrawn prehospital medications are microbiologically safe for up to 48 hours - emj.bmj.com/content/35/12/743 Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies - emj.bmj.com/content/35/12/757 Read the full December 2018 issue of EMJ here: emj.bmj.com/content/35/12

Simon Carley, Associate Editor of EMJ, talks through the highlights of the November 2018 edition of the Emergency Medicine Journal, this month chosen by Associate Editor Professor Rick Body. Read the primary survey here: emj.bmj.com/content/35/11/651 Details of the papers mentioned in this podcast can be found below: Managing accidental hypothermia: a UK-wide survey of prehospital and search and rescue providers - emj.bmj.com/content/35/11/652 Managing accidental hypothermia: progress but still some way to go - emj.bmj.com/content/35/11/657 Characteristics and outcomes of accidental hypothermia in Japan: the J-Point registry - emj.bmj.com/content/35/11/659 Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century - emj.bmj.com/content/35/11/667 Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation - emj.bmj.com/content/35/11/669 Defining significant childhood illness and injury in the Emergency Department: a consensus of UK and Ireland expert opinion - emj.bmj.com/content/35/11/685 Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies - emj.bmj.com/content/35/11/692 Read the full November 2018 issue of EMJ here: emj.bmj.com/content/35/11

We were delighted to be back to cover the joint Faculty of Prehospital Care and BASICS conference, day 2,  held at the Royal College of Surgeons of Edinburgh. Again we were absolutely spoilt for choice when it came to content for the podcasts but we managed to catch up with: • Dr Anne Weaver – a consultant in Emergency Medicine and Prehospital Care working for the Royal London Hospital and London HEMS. She talked to us about chemical burns and a novel treatment for managing these injuries. • Dr Virginia Beckett – an Obstetrics and Gynaecology consultant who is a member of the mMOET working group and has recently published on the topic of cardiac arrest in pregnancy. She was talking on the topic of resuscitative hysterotomy. • Sam Cooper – a Critical Care Paramedic from Derbyshire, Leicestershire and Rutland Air Ambulance who discussed a case of prehospital amputation and the learning points that arose from it. • Dr Rob Lloyd – an Emergency Medicine trainee, blogger and fellow podcaster who has an interest in performance psychology. He talked about Mental Toughness, framed by his experiences working in a hospital deep in a South African township. Once again, our thanks to Caroline Leech for being instrumental in the organisation of today and inviting us up. We’re already looking forward to next year…. Enjoy! Simon, Rob & James References PonderMed Diphoterine A video showing a similar demonstration to the one at the conference showing why Diphoterine works and the limitations of water Pre-hospital Obstetric Emergency Training; POET VA Beckett, M Knight, P Sharpe, 2017, 'The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 124, no. 9, pp. 1374-1381 Realtime simulation of peri-mortem c-section; Bradford Teaching Hospital K. M. Porter, 2010, 'Prehospital amputation', Emergency Medicine Journal, vol. 27, no. 12, pp. 940-942 Caroline Leech, Keith Porter, 2016, 'Man or machine? An experimental study of prehospital emergency amputation', Emergency Medicine Journal, vol. 33, no. 9, pp. 641-644  

Simon Carley, Associate Editor of EMJ, talks through the highlights of the August 2018 edition of the Emergency Medicine Journal. Read the primary survey here: emj.bmj.com/content/35/8/461 Details of the papers mentioned in this podcast can be found below: Fluid therapy in the emergency department: an expert practice review - emj.bmj.com/content/35/8/511 Intravenous cefazolin plus oral probenecid versus oral cephalexin for the treatment of skin and soft tissue infections: a double-blind, non-inferiority, randomised controlled trial - emj.bmj.com/content/35/8/492 Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain - emj.bmj.com/content/35/8/499 Application of outpatient cardiac testing among emergency department patients with syncope - emj.bmj.com/content/35/8/486 Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the emergency department: the PATCH-ED study - emj.bmj.com/content/35/8/477 Prehospital neurological deterioration in stroke - emj.bmj.com/content/35/8/507 Development and validation of an admission prediction tool for emergency departments in the Netherlands - emj.bmj.com/content/35/8/464 Read the full August 2018 issue of EMJ here: https://emj.bmj.com/content/35/8

Simon Carley, Associate Editor of EMJ, talks through the highlights of the July 2018 edition of the Emergency Medicine Journal, this month, chosen by Deputy Editor, Ian K Maconochie. Read the primary survey here: emj.bmj.com/content/35/7/403 Details of the papers mentioned in this podcast can be found below: Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey - emj.bmj.com/content/35/7/406 Effects of hallway/corridor and companions on clinical encounters: a possible explanation - emj.bmj.com/content/35/7/404 Essential medicines for emergency care in Africa - emj.bmj.com/content/35/7/412 End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study - emj.bmj.com/content/35/7/428 Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events - emj.bmj.com/content/35/7/420 Read the full July issue of EMJ here: emj.bmj.com/content/35/7

Simon Carley, Associate Editor of EMJ, talks through the highlights of the June 2018 edition of the Emergency Medicine Journal, this month, chosen by Associate Editor, Edward Carlton. Read the primary survey here: emj.bmj.com/content/35/6/341 Details of the papers mentioned in this podcast can be found below: Editor's choice: Comparison of qSOFA with current emergency department tools for screening of patients with sepsis for critical illness - emj.bmj.com/content/35/6/350 Editor's choice: qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis - emj.bmj.com/content/35/6/345 Editor's choice: Sepsis-3 and simple rules - emj.bmj.com/content/35/6/343 MRSA nares swab is a more accurate predictor of MRSA wound infection compared with clinical risk factors in emergency department patients with skin and soft tissue infections - emj.bmj.com/content/35/6/357 Outpatient management of children at low risk for bacterial meningitis - emj.bmj.com/content/35/6/361 Gender and survival from out-of-hospital cardiac arrest: a New Zealand registry study - emj.bmj.com/content/35/6/367 Inter-rater and intrarater reliability of the South African Triage Scale in low-resource settings of Haiti and Afghanistan - emj.bmj.com/content/35/6/379 Validity of the Japan Acuity and Triage Scale in adults: a cohort study - emj.bmj.com/content/35/6/384 Marauding terrorist attack (MTA): prehospital considerations -emj.bmj.com/content/35/6/389 Read the full June issue of EMJ here: emj.bmj.com/content/35/6

Simon Carley, Associate Editor of EMJ, talks through the highlights of the May 2018 edition of the Emergency Medicine Journal, this month, chosen by our Associate Editor, Caroline Leech. Read the primary survey here: emj.bmj.com/content/35/5/279 Details of the papers mentioned in this podcast can be found below: Editor's choice: Lack of efficacy in a randomised trial of a brief intervention to reduce drug use and increase drug treatment services utilisation among adult emergency department patients over a 12-month period - emj.bmj.com/content/35/5/282 Absence of a quick fix does not mean ‘do nothing:’ time to address drug use in the ED - emj.bmj.com/content/35/5/280 New decision formulas for predicting endotracheal tube depth in children: analysis of neck CT images - emj.bmj.com/content/35/5/303 What is positionality and should it be expressed in quantitative studies? - emj.bmj.com/content/35/5/323 Modelling attending physician productivity in the emergency department: a multicentre study - emj.bmj.com/content/35/5/317 Impact of emergency department surge and end of shift on patient workup and treatment prior to referral to internal medicine: a health records review - emj.bmj.com/content/35/5/309 Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients - emj.bmj.com/content/35/5/289 Image challenge: acute chest pain after tooth extraction - emj.bmj.com/content/35/5/332 Read the full May issue of EMJ here: https://emj.bmj.com/content/35/5

Managing external haemorrhage is easy right?! Then why does haemorrhage remain a major cause of death from trauma worldwide? Ok, some of that is from internal sources, but…. No one should die from compressible external haemorrhage With the right treatment applied in a timely fashion, the vast majority of these bleeds can be stopped. But with new advances like haemostatic agents, changing advice surrounding tourniquet use and practice changing evidence coming out of conflict zones can mean it’s difficult to remain current with the latest best practice. So what options are available to us, how do we use them and what’s the evidence. Here’s the line-up for this months’ podcast: Haemorrhage control ladder Evidence based guidelines on haemorrhage control Direct pressure Enhanced pressure dressings Haemostatic agents and wound packing Tourniquets Case studies As always we welcome feedback via the website or on Twitter and we look forward to your engagement. Enjoy! Simon, Rob & James   References & Further Reading Bennett, B. L & Littlejohn, L. (2014) Review of new topical hemostatic dressings for combat casualty care. Military Medicine. Volume 179, number 5, pp497-514. Lee, C., Porter, K. M & Hodgetts, T. J. (2007) Tourniquet use in the civilian prehospital setting. Emergency Medicine Journal. Volume 24, pp584-7.  Nutbeam, T & Boylan, M. (2013) ABC of prehospital emergency medicine. Wiley Blackwell. London. Shokrollahi, K., Sharma, H & Gakhar, H. (2008) A technique for temporary control of haemorrhage. The Journal of Emergency Medicine. Volume 34, number 3, pp319-20. Trauma! Extremity Arterial Hemorrhage; LITFL  The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Rolf Rossaint. Critical Care 2016. NICE 2016. Major Trauma; Assessment and Initial Management FPHC 2017; Position statement on the application of Tourniquets    

Simon Carley, Associate Editor of EMJ, talks through the highlights of the February 2018 edition of the Emergency Medicine Journal, this month, picked by Simon himself. Read the primary survey here: http://emj.bmj.com/content/35/2/73 Details of the papers mentioned in this podcast can be found below: Understanding cardiac troponin part 1: avoiding troponinitis - http://emj.bmj.com/content/35/2/120 Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine’s Sentinel Site Survey data - http://emj.bmj.com/content/35/2/114 Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards - http://emj.bmj.com/content/35/2/108 Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial - http://emj.bmj.com/content/35/2/103 Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis - http://emj.bmj.com/content/35/2/96 Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests - http://emj.bmj.com/content/35/2/89 A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces? - http://emj.bmj.com/content/35/2/83 Managing alcohol-related attendances in emergency care: can diversion to bespoke services lessen the burden? - http://emj.bmj.com/content/35/2/79 Alcohol identification and intervention in English emergency departments - http://emj.bmj.com/content/35/2/75 Taking control of alcohol-related emergency department visits - http://emj.bmj.com/content/35/2/74 Read the full February issue of EMJ here: emj.bmj.com/content/35/2

Simon Carley, Associate Editor of EMJ, talks through the highlights of the January 2018 edition of the Emergency Medicine Journal, this month, picked by Ellen Webber (Editor-in-Chief, University of California, San Francisco, USA). Read the primary survey here: http://emj.bmj.com/content/35/1/1. Details of the papers mentioned in this podcast can be found below: Impact of Physician Navigators on productivity indicators in the ED - http://emj.bmj.com/content/35/1/5 Tackling the demand for emergency department services: there are no silver bullets - http://emj.bmj.com/content/35/1/3 Emergency consultants value medical scribes and most prefer to work with them, a few would rather not: a qualitative Australian study - http://emj.bmj.com/content/35/1/12 Can an observational pain assessment tool improve time to analgesia for cognitively impaired older persons? A cluster randomised controlled trial - http://emj.bmj.com/content/35/1/33 Failure of falls risk screening tools to predict outcome: a prospective cohort study - http://emj.bmj.com/content/35/1/28 PREDICT prioritisation study: establishing the research priorities of paediatric emergency medicine physicians in Australia and New Zealand - http://emj.bmj.com/content/35/1/39 Profile and outcomes of critically ill children in a lower middle-income country - http://emj.bmj.com/content/35/1/52 Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department - http://emj.bmj.com/content/35/1/46 Waveform capnography: an alternative to physician gestalt in determining optimal intubating conditions after administration of paralytic agents - http://emj.bmj.com/content/35/1/62 Read the full January issue of EMJ here: http://emj.bmj.com/content/35/1

Simon Carley, Associate Editor of EMJ, talks through the highlights of the October 2017 edition of the Emergency Medicine Journal, this month, picked by Richard Body (Emergency Department, Manchester Royal Infirmary, Manchester, UK). Read the primary survey: http://emj.bmj.com/content/34/10/633. Details of the papers mentioned in this podcast can be found below: The use of whole-body computed tomography in major trauma: variations in practice in UK trauma hospitals - http://emj.bmj.com/content/34/10/647 Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission - emj.bmj.com/content/34/10/643 Whole body computed tomography for trauma: friend or foe? - http://emj.bmj.com/content/34/10/635 Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions http://emj.bmj.com/content/34/10/680 Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial - http://emj.bmj.com/content/34/10/637 Gender, race and the presentation of acute coronary syndrome and serious cardiopulmonary diagnoses in ED patients with chest pain - http://emj.bmj.com/content/34/10/653 Primary care services co-located with Emergency Departments across a UK region: early views on their development - http://emj.bmj.com/content/34/10/672 Read the full October issue of EMJ: http://emj.bmj.com/content/34/10.

Simon Carley, Associate Editor of EMJ, talks through the highlights of the August 2017 edition of the Emergency Medicine Journal. Read the primary survey here: emj.bmj.com/content/34/8/491 Details of the papers mentioned on this podcast can be found below: Clinical relevance of pharmacist intervention in an emergency department - emj.bmj.com/content/34/8/495 Developing a decision rule to optimise clinical pharmacist resources for medication reconciliation in the emergency department - emj.bmj.com/content/34/8/502 Emergency medicine pharmacists on an international scale - emj.bmj.com/content/34/8/492 ‘Major trauma’: now two separate diseases? - emj.bmj.com/content/34/8/494 Traumatic brain injuries in older adults—6 years of data for one UK trauma centre: retrospective analysis of prospectively collected data - emj.bmj.com/content/34/8/509 Validating the Manchester Acute Coronary Syndromes (MACS) and Troponin-only Manchester Acute Coronary Syndromes (T-MACS) rules for the prediction of acute myocardial infarction in patients presenting to the emergency department with chest pain - emj.bmj.com/content/34/8/517 A practical approach to Events Medicine provision - emj.bmj.com/content/34/8/538 BET 1: Lidocaine with propofol to reduce pain on injection - http://emj.bmj.com/content/34/8/551.2 BET 2: Poor evidence on whether teaching cognitive debiasing, or cognitive forcing strategies, lead to a reduction in errors attributable to cognition in emergency medicine students or doctors - http://emj.bmj.com/content/34/8/553 Read the full August issue here: emj.bmj.com/content/34/8

Simon Carley, Associate Editor of EMJ, talks through the highlights of the July 2017 edition of the Emergency Medicine Journal. Read the primary survey here: http://emj.bmj.com/content/34/7/427 Details of the papers mentioned on this podcast can be found below: The key to resilient individuals is to build resilient and adaptive systems - http://emj.bmj.com/content/34/7/428 Emergency medicine: what keeps me, what might lose me? A narrative study of consultant views in Wales - http://emj.bmj.com/content/34/7/436 The psychological health and well-being of emergency medicine consultants in the UK - http://emj.bmj.com/content/34/7/430 Satisfaction, burnout and intention to stay of emergency nurses in Shanghai - http://emj.bmj.com/content/34/7/448 Occupational stress in the ED: a systematic literature review - http://emj.bmj.com/content/34/7/441 Can a partnership between general practitioners and ambulance services reduce conveyance to emergency care? - http://emj.bmj.com/content/34/7/459 Relationship between oxygen concentration and temperature in an exothermic warming device - http://emj.bmj.com/content/34/7/472 The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign - http://emj.bmj.com/content/34/7/466 Read the full July issue here: http://emj.bmj.com/content/34/7?current-issue=y

Simon Carley, Associate Editor of EMJ, talks through the highlights of the June 2017 edition of the Emergency Medicine Journal, starting with T-MACS, ROC curves, the demand for mental health care in emergency medicine, pain scales for children and more. Read the primary survey here: http://emj.bmj.com/content/34/6/347 Details of the papers mentioned on this podcast can be found below: Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts - http://emj.bmj.com/content/34/6/349 What is an ROC curve? - http://emj.bmj.com/content/34/6/357 A systematic review of management strategies for children’s mental health care in the emergency department: update on evidence and recommendations for clinical practice and research - http://emj.bmj.com/content/34/6/376 The Royal College of Emergency Medicine composite pain scale for children: level of inter-rater agreement - http://emj.bmj.com/content/34/6/360 Emergency department syndromic surveillance to investigate the health impact and factors associated with alcohol intoxication in Reunion Island - http://emj.bmj.com/content/34/6/386 Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events - http://emj.bmj.com/content/34/6/364 Read the full June issue here: http://emj.bmj.com/content/34/6?current-issue=y

Simon Carley, Associate Editor of EMJ, talks through the highlights of the May 2017 edition of the Emergency Medicine Journal, starting with pregnancy problems: the management of severely injured or ill pregnant patients. Read the primary survey here: http://emj.bmj.com/content/34/5/271. Details of the papers mentioned on this podcast can be found below: Management of pregnancy and obstetric complications in prehospital trauma care: faculty of prehospital care consensus guidelines - http://emj.bmj.com/content/34/5/318; Management of pregnancy and obstetric complications in prehospital trauma care: prehospital resuscitative hysterotomy/perimortem caesarean section - http://emj.bmj.com/content/34/5/326; Does end-tidal capnography confirm tracheal intubation in fresh-frozen cadavers? - http://emj.bmj.com/content/34/5/315; Remifentanil for procedural sedation: a systematic review of the literature - http://emj.bmj.com/content/34/5/294; The role of reduced heart rate volatility in predicting disposition from the emergency department - http://emj.bmj.com/content/34/5/289; Extracorporeal cardiopulmonary resuscitation probably good, but adoption should not be too fast and furious! - http://emj.bmj.com/content/34/5/275; Emergency extracorporeal life support and ongoing resuscitation: a retrospective comparison for refractory out-of-hospital cardiac arrest - http://emj.bmj.com/content/34/5/277; Progressive prediction of hospitalisation in the emergency department: uncovering hidden patterns to improve patient flow - http://emj.bmj.com/content/34/5/308.

Simon Carley, Associate Editor of EMJ, talks through the highlights of the April edition of the Emergency Medicine Journal, with a special focus on organ donation. Read the primary survey here: http://emj.bmj.com/content/34/4/201. Details of the papers mentioned on this podcast can be found below. Critical care in the Emergency Department: organ donation: http://emj.bmj.com/content/34/4/256. Withdrawal of life-sustaining therapy: the case for delay: http://emj.bmj.com/content/34/4/203. A randomised experiment comparing low-cost ultrasound gel alternative with commercial gel: http://emj.bmj.com/content/34/4/227. Validity of the Manchester Triage System in patients with sepsis presenting at the ED: a first assessment: http://emj.bmj.com/content/34/4/212. Mid-arm circumference can be used to estimate weight of adult and adolescent patients: http://emj.bmj.com/content/34/4/231.

Conversation with Dr. Ellen Weber (Editor in Chief of Emergency Medicine Journal) and Dr. Michael Callaham (Editor in Chief of Annals of Emergency Medicine)about their journal career path, the inner workings of journal peer review, and tips for educator-scholars. A unique insight with two of our Emergency Medicine's leaders in scientific publishing. Facilitated by Dr. Michael Gottlieb, COO of ALiEM Faculty Incubator. https://www.aliem.com/faculty-incubator/ The 2016-17 Faculty Incubator was sponsored by the Council of EM Residency Directors.

The truths and myths about the so-called "weekend effect" in the UK hospitals is discussed in this podcast. Chris Moulton, Vice President of the Royal College of Emergency Medicine and a senior consultant at the Royal Bolton Hospital, and Ellen Weber, Editor-in-Chief of the EMJ, compare two very different realities between the USA and the UK emergency medicines, in terms of resources, mind-sets and politics. Why does data show there is a disparity in mortality rate for patients admitted to hospital at the weekend compared to those admitted on a weekday? Both related article and commentary published by the Emergency Medicine Journal are available here: http://emj.bmj.com/content/early/2016/10/27/emermed-2016-206049; http://emj.bmj.com/content/early/2016/10/27/emermed-2016-206226.