Podcasts about st emlyn

In this episode of the St Emlyn's Podcast, Iain Beardsell and Simon Carley revisit January's  blog posts and podcasts, covering several seminal studies relevant to emergency and pre-hospital care. Topics include the Sub 30 Feasibility Study on pre-hospital ECMO, comparisons of pre-hospital versus in-hospital emergency anaesthesia, variations in maintenance of pre-hospital anaesthesia in trauma patients, and the effectiveness of physician-led pre-hospital teams. They also discuss the economic implications of advanced pre-hospital interventions and highlight reviews from the London Trauma Conference. 00:00 Introduction and January Recap 01:58 Pre-Hospital ECPR Study: The Sub 30 Study 07:09 Emergency Anaesthesia: Pre-Hospital vs. Emergency Department 13:55 Maintenance of Pre-Hospital Anaesthesia: Variations in Practice 16:57 Physician-Led Pre-Hospital Teams: Do They Improve Outcomes? 22:12 Additional Insights and Upcoming Content

In this special edition of the St Emlyn's podcast, Iain Beardsell and Simon Carley review the top medical papers of 2024, originating from Simon's talk at The Big Sick conference in Zermatt. The discussion includes a comparison of non-invasive versus arterial pressure monitoring, the association of intra-arrest arterial blood pressure with ROSC, the efficacy of serratus anterior plane blocks for rib fracture management, and the evaluation of a micro axial flow pump in cardiogenic shock. They also delve into double sequential external defibrillation in refractory out-of-hospital cardiac arrest and provide a rapid-fire review of additional critical papers discussed at the conference. Notable mentions include the HEMOTION trial, PRE OXI trial, BLING III, and PARAMEDIC-3, among others. A must-listen for those passionate about evidence-based medicine in emergency and pre-hospital care. You can read more about all the trials, including links to all the papers here (part 1) and here (part 2) 00:00 Introduction and Conference Highlights 01:51 Non-Invasive vs. Arterial Pressure Monitoring 03:28 Intra-Arrest Blood Pressure and ROSC 05:34 Serratus Anterior Plane Blocks for Rib Fractures 08:38 Micro Axial Flow Pump in Cardiogenic Shock 10:49 Double Sequential Defibrillation in Cardiac Arrest 13:17 HEMOTION Trial 15:01 PRE OXI and BLING III Trials 17:08 Fluid Management in Septic Shock 18:37 Expedited Transfer vs. On-Scene Resuscitation 20:39 Intraosseous vs. Intravenous Access 21:48 Conclusion and Final Thoughts

Join hosts Iain Beardsell and Natalie May at the London Trauma Conference as they welcome Peter Brindley back to the St Emlyn's podcast. In this engaging episode, they delve into the nuances of social media, digital footprints, and the burgeoning influence of artificial intelligence in medicine. Brindley discusses the importance of maintaining an authentic digital presence and addresses the impact of misinformation and disinformation in the digital age. They explore the challenges and opportunities presented by AI in clinical decision-making and share insights on navigating this evolving landscape as healthcare professionals. Tune in for a thought-provoking conversation on staying relevant and responsible in a digitally-driven world. 00:00 Introduction and Welcome 01:40 Understanding Digital Footprint 03:53 Navigating Information and Misinformation 05:41 The Role of AI in Information Search 08:45 AI in Clinical Decision Making 15:28 The Kardashian Index and Social Media Influence 17:39 Conclusion and Final Thoughts

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley reflect on their experiences at recent conferences, including the IncrEMentuM 2025 and The Big Sick. They discuss the exceptional quality and innovative formats of presentations at IncrEMentuM, emphasizing the enthusiasm and positive atmosphere. The discussion also covers key emergency medicine topics from February's blog posts, including the maintenance of clinical skills, the importance of diastolic blood pressure in resuscitation, and a systematic review on resuscitative hysterotomy. Additionally, they explore new guidance on the diagnosis of death, particularly in intensive care settings. Special thanks to Galen Pharmaceuticals and PM Cardio for their support. 00:00 Introduction and Recent Conferences 00:42 Highlights from IncrEMentuM 2025 04:47 Emergency Medicine Blog Posts Overview 05:10 Maintaining Competency in Rare Procedures 11:23 Diastolic Blood Pressure in Resuscitation 15:37 Resuscitative Hysterotomy Insights 20:43 Understanding Death Criteria 24:48 Conclusion and Acknowledgements

In this episode of the St Emlyn's Podcast, Iain Beardsell and Natalie May speak with Richard Lyon, an emergency doctor and deputy medical director of the air ambulance service at Kent, Surrey, and Sussex. Recorded at the London Trauma Conference 2024 in Kensington, Richard shares experiences and lessons from his talk on five critical cases that shaped him as a clinician and human being.   Discussion topics include the importance of case debriefing, the impact of video recording in clinical practice, overcoming the challenges of self-reflection, and the evolving culture of pre-hospital emergency medicine. Richard emphasizes the significance of supportive and structured debriefing processes and offers insights on integrating video reviews into emergency practices for improved education and reflection.   00:00 Introduction and Guest Welcome 00:37 Richard Lyon's Background and Talk Overview 01:00 The Importance of Case Learning and Debriefing 02:12 Challenges and Strategies in Case Learning 04:24 The Power of Video Recording in Clinical Practice 07:30 Implementing Video Recording: Practical Steps 08:24 Addressing Concerns and Building Trust 12:56 Senior Clinicians and Vulnerability 17:33 Supporting Pre-Hospital Clinicians 20:35 Conclusion and Final Thoughts   The Guest - Richard Lyon   Professor Lyon is an active UK NHS Consultant in Emergency Medicine and Pre-hospital Care in Edinburgh and Deputy Medical Director for Air Ambulance, Kent Surrey & Sussex. A globally recognised leader in pre-hospital and emergency medical care, Prof Lyon works for multiple world class organisations, helping to develop current and future state-of-the art medical devices, systems and concepts aiming to save lives across the globe. A respected clinical leader and senior medical advisor to both governments and global corporations, with a track record of delivering high quality output and success across clinical, academic, research and innovation. Prof Lyon was made a Member of the Most Excellent Order of the British Empire (MBE) by HM The Queen in the 2017 Honours, for Services to Emergency Healthcare, after he established a programme of work on out-of-hospital cardiac arrest for Scotland. Prof Lyon holds a personal Chair of Pre-hospital Emergency Care at the University of Surrey and has an established research portfolio in pre-hospital resuscitation and trauma care, with an extensive publication record. Prof Lyon is a current member of the Faculty of Pre-hospital Care and author of several international guidelines. Prof Lyon is a Physician with the UK International Search & Rescue Team.

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome Dan Dworkis, an ER doctor from Los Angeles and host of the Emergency Mind podcast. Dan shares his expertise on optimizing team and individual performance in high-stress medical environments. The discussion delves into the concept of excellence beyond merely avoiding negative outcomes, using a rosebush metaphor to illustrate the need for proactive growth. They explore how teams can benchmark and improve performance, the importance of creating a culture of continuous improvement, and strategies to maintain positivity and energy even in challenging conditions. Dan also highlights the Mission Critical Team Institute and its role in supporting teams in life-or-death situations. This episode is essential listening for medical professionals committed to pushing the boundaries of excellence in their practice.   00:00 Introduction and Guest Welcome 01:06 Defining Excellence in Medicine 02:29 Measuring and Achieving Team Performance 06:13 Small Changes for Big Impact 10:03 Maintaining Positivity and Energy 15:30 Mission Critical Team Institute 16:33 Conclusion and Farewell   The Guest - Dan Dworkis Dan Dworkis, MD, PhD, FACEP is the Chief Medical Officer at the Mission Critical Team Institute, the founder of The Emergency Mind Project, a board-certified emergency medicine physician, and an assistant professor at the Keck School of Medicine at USC. His work focuses on the optimal development of mission critical teams in and out of emergency departments. He completed the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital / Brigham Health, and also earned an MD and PhD in molecular medicine from Boston University School of Medicine. Dr. Dworkis is the author of The Emergency Mind:  Wiring Your Brain for Performance Under Pressure.      

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome back Caroline Leech, a emergency medicine consultant with extensive pre-hospital care experience. Caroline discusses the concept of moral injury, delving into its distinction from moral distress. She introduces three mechanisms of moral injury: acts of commission, acts of omission, and betrayal. Caroline provides insightful examples from emergency medicine to illustrate these concepts, emphasizing the importance of identifying and addressing moral injury to support healthcare professionals. The discussion highlights the emotional and cognitive distress faced by emergency responders and the necessity for professional psychological support when moral distress accumulates into moral injury.   00:00 Introduction and Welcome   00:23 Introducing Caroline Leech   01:10 Defining Moral Injury and Distress   03:42 Acts of Commission   07:12 Acts of Omission   12:30 Betrayal in Healthcare   15:00 Conclusion and Final Thoughts   The Guest - Caroline Leech Caroline Leech is Deputy Clinical Lead of The Air Ambulance Service and has 25 years of prehospital clinical experience.  She is a Consultant in Emergency Medicine at University Hospital Coventry, the West Midlands Trauma Network Director, and the Trauma Lead for the Institute for Applied & Translational Technologies in Surgery (IATTS). Caroline is currently undertaking a NIHR funded Clinical Research Scholarship with Warwick University. Her research interests include maternal out-of-hospital cardiac arrest, calcium in traumatic haemorrhage, and frailty in major trauma. She is committed to improving equality and diversity in PHEM, and promoting strategies for supporting the wellbeing and psychosocial care of prehospital responders.  

St Emlyn's Podcast: Season 11 Finale and Highlights in Emergency Medicine In this season-ending episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley come together in Zermatt, Switzerland, to discuss recent studies and updates. They highlight a randomized control trial on early exercise in blunt chest wall trauma, revealing its limited impact on recovery outcomes. Additionally, they explore the long-term safety of intraosseous access based on new evidence from Denmark. The episode also provides insights into updated imaging guidelines for pediatric trauma and broad considerations on the growing role of AI in healthcare, especially in emergency settings. There are closing remarks on recent blog posts about toxic alcohol poisoning and the Difficult Airway Society meeting, while looking forward to upcoming conferences in Spain and Vienna. 00:00 Welcome to St Emlyn's Podcast 00:31 Exploring the Big Sick Conference in Zermatt 01:25 Evidence-Based Medicine: Early Exercise in Blunt Chest Wall Trauma 04:30 Intraosseous Access: Long-Term Complications 06:37 Imaging Decisions in Pediatric Trauma 09:17 The Promise and Perils of Artificial Intelligence in Healthcare 13:10 Toxic Alcohol Poisoning: A Critical Review 16:17 Conference Highlights and Future Events 19:19 Season 11 Finale and Looking Ahead to Season 12

Vill du, liksom Hilda, vara förberedd på den minimala risken att uppleva stormastma eller vill du hellre känna igen din realistiska arbetsvardag hemma i soffan när du ser årets bästa serie? Arin har lyssnat på St Emlyn's podd och tänkt en del på ”compassionate resuscitation” och vilket mindset man kan ha vid hjärtstopp. I detta avsnittet tar vi upp några kända och andra mindre kända nyheter relaterade till medicinska (sär)intressen.

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe talk with Nathalie Pattyn at TacTrauma24 in Sweden about the phenomenon of skills fade amongst emergency physicians. Nathalie discusses her extensive background in medicine, psychology, and neuroscience, and shares insights from her research on how skills can deteriorate during low workload deployments, such as her 15-month clinical stint in Antarctica. They delve into the lack of systemic measures to address returning to practice after long absences, how cognitive and psychomotor skills are affected by skill fade, and the contrast between teaching technical skills and ensuring they become automatic and stress-resilient. The conversation highlights the need for evidence-based guidelines to ensure healthcare professionals maintain their proficiency, which ultimately benefits patient care and the healthcare system. 00:00 Introduction and Guest Introduction 00:13 Natalie's Background and Expertise 00:38 Skills Fade in Emergency Medicine 01:01 Personal Experience with Skills Fade 02:14 Regulations and Policies on Skills Maintenance 04:19 Imposter Syndrome vs. De-skilling 06:42 Aviation vs. Medical Field: Skills Certification 08:27 Aging and Cognitive Decline in Medical Skills 09:57 Teaching vs. Training in Medical Education 12:42 Future Directions and Systemic Solutions 14:31 Conclusion and Contact Information The Guest Nathalie Pattyn, MD, MPsy, PhD, received a degree in medicine from the Université Libre de Bruxelles (magna cum laude, 2001), a Master in Clinical Psychology from the Vrije Universiteit Brussel (cum laude, 2004), a PhD in Psychological Sciences from the Vrije Universiteit Brussel (2007) and a PhD in Social and Military Sciences from the Royal Military Academy (2007). She also holds a postgraduate degree in Aerospace Medicine; a postgraduate degree in Emergency Medicine; a postgraduate degree in General Practice ; a postgraduate degree in Disaster Medicine ;and a Master in Global and Remote Healthcare. She completed her Junior Officer Course with the Belgian Defense College in 2005, and her Staff Officer Course in 2008. She has a mixed clinical, research and operational background, having been deployed as a medical officer in various Middle Eastern and African countries, and having completed missions in Antarctica for a total duration of more than two years. Her longest deployment was 15 months to the Halley VI Research Station in Antarctica, where she worked as the station physician while setting up a new biomedical research laboratory for the European Space Agency. She is currently still working as an emergency physician and a flight surgeon. Her research interests include the psychophysiological measures of performance in elite populations; and Human Factors approach to isolated and confined environments, ranging from space to submarines. In 2010, she founded a research unit within the Royal Military Academy, dedicated to the multidisciplinary study of human performance in operational environments. This led her to be the project manager for designing a tailored Human Performance Program for the tier one unit of the SOF community in Belgium. She is currently an Associate Professor in Physiopathology at the Vrije Universiteit Brussel and in Human Performance at the Royal Military Academy. You can read Nathalie's excellent book "Handbook of Mental Performace" for free here.

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe speak with Sean Brayford Harris, a paramedic and interoperability development officer with the London Ambulance Service, about the development of the 10 second triage tool—a new, streamlined method for triaging casualties in high-stress environments like major incidents. They discuss its creation and implementation, including collaboration with the Metropolitan Police and other emergency services. Key points include the shortcomings of the previous 'sieve and sort' system, the challenges of developing a simplified tool, and the benefits of this new approach for non-medical first responders. The episode emphasizes the importance of cross-team collaboration in emergency scenarios and the potential impact of the tool on reducing distress and improving outcomes for both responders and patients. 00:00 Introduction 00:37 Background on Major Incident Triage 01:01 Challenges with Existing Triage Systems 01:15 Designing the 10 Second Triage Tool 05:16 Implementing the Triage Tool 06:50 How the 10 Second Triage Tool Works 13:48 Real-World Applications and Benefits 18:54 Conclusion and Final Thoughts

During Winter's Challenges, Iain Beardsell and Simon Carley reviewed the November 2024 blog posts for St Emlyn's podcast, marking the start of 2025. They discuss the busy state of emergency departments, critical incidents, and the importance of maintaining a learning culture. They highlight the upcoming Big Sick Conference in Zermatt and the IncrEMentuM in Spain, noting their potential benefits for networking and education. Simon emphasizes creating a psychologically safe environment and fostering curiosity, growth, and knowledge-sharing among emergency department staff. They also review a range of medical studies, including those on small bore vs. large bore chest tubes for haemothorax, intra-arrest arterial blood pressure monitoring, and the new GLP-1 receptor antagonists for obesity treatment. Lastly, they address the importance of handling bad behavior in the team and maintaining kindness and professionalism, even during high-stress periods. 00:00 Introduction and New Year Greetings 00:35 Current State of Emergency Departments 01:17 Upcoming Conferences: The Big Sick and IncrEMentuM 03:43 Building a Learning Culture in Emergency Medicine 12:24 Pre-Hospital ECPR and ECMO 13:58 Small Bore vs Large Bore Chest Tubes 17:37 Intra-Arrest Arterial Blood Pressure Monitoring 24:01 New Drugs and Toxicology 24:47 Care in the Hot Zone 27:12 Addressing Bad Behaviour in Emergency Departments 30:42 Conclusion and Future Plans for St Emlyn's

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley provide a comprehensive update for October 2024. They discuss key blog posts covering diverse medical topics, including highlights from the Royal College of Emergency Medicine's academic science conference focusing on toxicology, high-potency opioids, novel benzodiazepines, and the use of flumazenil. They also explore the Green ED project and the impact of climate change on healthcare. Additionally, they delve into recent research on ventricular fibrillation pad positions, the use of tranexamic acid (TXA) in trauma care, and the importance of maintaining a positive outlook amidst winter challenges by seeking small wins and engaging in enjoyable aspects of emergency medicine. The episode offers valuable insights and updates for emergency medicine professionals. 00:00 Welcome and Introduction 01:27 Highlights from the Royal College of Emergency Medicine Conference 01:50 Toxicology Insights: High Potency Opioids and Benzodiazepines 05:11 Climate Change and Healthcare: The Green ED Project 08:23 Medical Conferences: A Phoenix from the Ashes 10:38 Ventricular Fibrillation and Pad Position: New Insights 17:22 Tranexamic Acid (TXA) in Trauma Care 24:01 Maintaining Positivity in Challenging Times

In this episode of the St Emlyn's podcast, Iain Beardsell and Natalie May reflect on their experiences at the London Trauma Conference, a four-day event covering various aspects of trauma and pre-hospital care. They discuss key takeaways from sessions on cardiac arrest, including talks on perioperative cardiac arrest and the prognostication of cardiac arrest patients. The episode also delves into wellness in the medical field, featuring insights from senior emergency physician Rod McKenzie and pre-hospital expert Matt Hooper on practical psychosocial care. Additionally, the podcast highlights advancements in trauma care, defibrillation strategies, and the importance of correct pad placement and basic practices. The episode underscores the holistic approach to patient care and the significance of personal well-being for medical professionals. 00:00 Welcome to the St Emlyn's Podcast 00:52 Highlights from the London Trauma Conference 01:13 Cardiac Arrest Symposium Insights 03:53 Prognostication After Cardiac Arrest 06:44 Defibrillation Strategies and Basics 08:29 Wellness and Mental Health in Emergency Medicine 11:10 Palliative Care in Pre-Hospital Settings 12:32 Trauma Conference Highlights and Innovations 16:48 Poster Presentations and Stand-Up Science 17:58 Key Takeaways and Reflections 18:43 Closing Remarks

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe are joined by Chris Bishop, a clinical research fellow at the Centre for Trauma Sciences at Queen Mary University of London. Chris discusses his PhD research on veno-arterial ECMO support for cardiogenic shock following major trauma haemorrhage and explains the principles and applications of ECMO, particularly in trauma patients. The conversation covers the current practices, challenges, and future directions in the use of ECMO for trauma care, including multidisciplinary decision-making, patient selection criteria, and pioneering techniques like selective aortic arch perfusion and emergency preservation and resuscitation. 00:00 Introduction 01:12 Understanding ECMO and Its Applications 02:20 ECMO in Trauma Patients 04:17 Challenges and Resistance in ECMO Adoption 05:36 Current Research and Practices 11:31 Future Directions in Trauma Resuscitation 13:28 Conclusion

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley discuss various facets of emergency medicine. They highlight a study on patient experience in emergency departments, focusing on issues like loss of autonomy, unmet expectations, and vulnerability. Suggestions for improvement include better communication, effective signage, and patient comfort. The podcast also covers a 'dirty adrenaline drip' study from Australia, emphasizing remote inotrope management. Discussions include the use of arterial blood pressure monitoring in pre-hospital settings and the merits of CT scans beyond the traditional six-hour window for diagnosing subarachnoid haemorrhage. The episode wraps up with reflections on the positives of emergency medicine and the importance of maintaining enthusiasm and mastery in the field. 00:00 Introduction 01:08 Patient Experience in the Emergency Department 02:33 Improving Patient Experience: Practical Tips 04:05 Qualitative Studies in Healthcare 06:43 Dirty Adrenaline Drip: A Practical Insight 10:44 Emergency Endoscopy for Caustic Ingestions 14:15 Subarachnoid Hemorrhage Diagnosis: The S.H.E.D. Study 18:14 Arterial Blood Pressure Monitoring in Pre-Hospital Settings 24:18 Reflections on Emergency Medicine as a Career 27:41 Conclusion

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 St. Emlyn's podcast, Rick Body and Greg Yates, continue our exploration of diagnostic test accuracy, shifting our focus to positive predictive value (PPV) and negative predictive value (NPV). These concepts are vital for anyone preparing for exams or looking to enhance their application of diagnostic tests in clinical practice. While our last podcast discussion centred on sensitivity and specificity, PPV and NPV offer a different, arguably more clinically practical perspective on interpreting test results. Positive predictive value (PPV) and negative predictive value (NPV) are essential tools for understanding the effectiveness of diagnostic tests. PPV helps us determine the likelihood that a patient with a positive test result actually has the condition, whereas NPV helps us gauge the probability that a patient with a negative test result does not have the disease. These values are crucial for making informed clinical decisions, particularly when considering the prevalence of a condition in the population. Today, we'll delve into these concepts, their practical applications, and why it's important to consider both PPV and NPV alongside sensitivity and specificity.   You can find more about this on the St Emlyn's Blog and please don't forget to like and subscribe.

Welcome to the St Emlyn's Monthly Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Simon and Iain will bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development.  In this round-up of May 2024, we talk about a wide range of issues relating to emergency medicine, including highlights from the RCEM conference, including the future management of head injury, crowding, RATing and what it takes to be an awesome ED for training. There's also advice on how to be a epic Emergency Physician In Charge, as well as discussion about the use of ChatGPT for medical exams, serratus anterior blocks for rib fractures, whether first pass success matters and the return of measles. Thank you for joining us, please do like and subscribe wherever you get our podcasts.

The sudden death of anyone is a tragic event, but even more so a child, particularly when it comes completely unexpectedly. We've all seen stories in the papers or even been involved in caring for these young people. In this podcast Harshil Dhutia talks about the common causes fo sudden cardiac death, and gives a roadmap for the investigation of young people with worrying symptoms and ongoing care for their families. There are more details in the comprehensive post on the St Emlyn's blog site This podcast was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organising team for hosting us and allowing us to use the audio. The PIER and PREMIER websites are full of amazing resources for anyone working in Paediatric Emergency Medicine and we recommend them highly. The Speaker Harshil Dhutia is a consultant cardiologist at Glenfield Hospital, University Hospitals of Leicester the lead for inerited cardiac conditions service in the region, providing specialist care for patients with genetic heart diseases and their family members. He is a International Board of Heart Rhythm Examiners certified heart rhythm specialist for all aspects of cardiac device implantation and management including pacemakers, defibrillators and cardiac resynchronisation therapy. He is an expert in sports cardiology and has extensive clinical and research interests in the management of competitive and recreational athletes with cardiovascular disease. He is the medical lead for the Joe Humphries Memorial Trust, a Leicestershire based charity that raises awareness of sudden cardiac death in young people and provides cardiovascular resuscitation and AED training in schools, sports clubs and to members of the community.

Welcome to St Emlyn's Monthly Round Up Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Iain and Simon bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development.  You can find an in-depth set of shownotes on St Emlyn's. Please do also like and subscribe, wherever you get your podcasts. This month's content includes... Introduction 00:00 - 00:34 Do Bougies increase first pass success? 00:34 - 04:28 Cardiac arrest management - dual sequence defibrillation, personalised care and drones for AEDS. 04:28 -10:50 Trauma - Cardiac tamponade vs exsanguination 10:50 - 13:35 Sepsis - effect of the microcirculation 13:35 - 15:23 A history of race and medicine 16:54 - 18:36 Differential attainment 18:37 - 19:27 What can we do about addressing EDI issues? 19:28 - 22:20 Choosing with intention 20:21 - 26:55 The ARC-H Principle 26:56 - 28:32 Closing thoughts 28:33 - 30:10 Recommended Conferences Premier Conference - 11th-12th June 2024, Winchester Tactical Trauma 24 - 7th-9th October, Sundsvall, Sweden RCEM Annual Scientific Conference

It's episode one of season 11 and Simon and Iain chat through the blog content from St Emlyn's from January 2024. There's discussion about New Year resolutions and how to make them habits, intubating poisoned patients with a decreased conscious level and what we can possibly do to improve the working conditions in our Emergency Departments. As ever, we hope you enjoy the podcast. Please do like and subscribe, and if you'd like to contribute to St Emlyn's in any way please get in touch. 

It's the last episode of season 10 and Iain and Simon discuss December 2023's blog posts. In a packed podcast they discuss prehopsital blood transfusion decision making, E-scooter injury patterns, the potential for AI in medicine and selective aortic arch perfusion. Please do get in touch if you would like to contribute to St Emlyn's and as ever do like and suscribe and tell your friends (if you think the podcast is any good).  Mentioned in the podcast Gary Klein - Streetlights and Shadows Critical Appraisal Nugget - Semi Structured Interviews EMCrit - Shadowboxing EMCrit - Interview with Gary Klein A Skeptic's Guide to Emergency Medicine Life in the Fast Lane - What is AI and How Does it Work T-MACS scores Homo Deus: A Brief History of Tomorrow by Yuval Noah Harari  East Anglia Air Ambulance RAID Conference

In this bumper double edition Simon and Iain chat through all the recent content on the St Emlyn's blog site, including a review of CRYOSTAT-2 and the DAShED study, a review of the new ILCOR guidelines, flow in the ED and why silence might just be the tonic we all need.   All of us at St Emlyn's wish you all, wherever you are on the world a peaceful, happy and restful Christmas.    Please do like and subscribe and get in touch if you'd like to contribute to our ongoing work. 

An EBM-packed episode where Iain and Simon go over ten of the top papers from the last year discussing all manners of things Emergency Medicine, including TXA in trauma, use of video laryngoscopy, defibrillation strategies in refractory VF, and ten-second triage in major incidents. There's also a very pertinent discussion about whether the age of your Emergency Physician might affect your outcome... Thank you again for listening to the St Emlyn's podcast. Please do like and subscribe and get in touch if there is anything you'd like us to discuss or if you'd like to get involved. 

After a long, hot and relaxing summer (!) Simon and Iain return with all the content from the St Emlyn's blog in July and August. They discuss four papers in detail, including the ARREST trial about cardiac arrest centres, whether clinical examination can identify life threatening injuries in trauma, the TOP-ART study looking at a novel agent in trauma management and the use of REBOA.  Please do like and subscribe and get in touch if you would like to contribute to the blog site. 

Welcome to a bumper edition of the podcast discussing content from St Emlyn's for June 2023. In this episode, Simon and Iain talk about DL vs VL, the PATCH trial, drug pushers, packers and stuffers, the new head injury guidelines from NICE and the AMAX4 algorithm and much more. If you would like to submit something to St Emlyn's for consideration we'd love to hear from you. Times are tough in the NHS at the moment, but we hope at St Emlyn's we can remind you of all the best parts of the incredibly important and rewarding job we do. Take care.     

The clue to these is very much in the Title – BRUE is a diagnosis in itself. Children often do weird stuff, but they rarely do weird scary stuff. In this talk, Jilly goes talks through how we can define these events as high and low risk and gives us tools to manage these patients (and their parents) Along with colleagues, Jilly has written a guideline for BRUE, the full version of which you can find here Jilly also mentions a flowchart from Peds Cases, which you can find here   There is also this superb blog post from Natalie May on the St Emlyn's website which accompanies this podcast, which goes through some really useful cases. As a Wessex ST7 in Paediatric Emergency Medicine (RCPCH), Jilly Boden currently works in Queen Alexandra Hospital (Portsmouth).  Her specialist interests include acute stabilisation and transfer of the critically ill patient, having spent a year with the 'Southampton & Oxford Retrieval Team' (SORT) and hopes to find a way of combining this with her future PEM career. Jilly has a passion for education, particularly 'PEM to the non-paediatrician', including international teaching of the tri-service military GPs, and being on the national committee to write a new standardised paramedic paediatric curriculum. In her free time (you know, apart from the kids and all that) she works as part of the track medical team for the 'British Motorcycle Racing Club', providing pre-hospital care to high velocity polytrauma patients in the 'golden hour' following collisions often exceeding 120mph. 

This episode of the podcast is a live recording from the PREMIER Conference of John O Neil discussing penetrating injuries with learning points that are useful for clinicians who look after both adult and paediatric patients.  There are three main mechanisms – violence, impalement and self harm, although the first is by far the most common.  Penetrating injuries are rare but have significant morbidity and mortality. The key is early and accurate diagnosis, and many can be managed conservatively. The distribution of penetrating injuries across the UK differs widely, with most in the London area, although as seen in the news recently can happen anywhere. Remember how traumatic it is to be a trauma patient. We put you on a bed, cut off your clothes, stick needles in you and take your family away. Some will also just not engage with you (teenage boys particularly) making assessment difficult. Be kind. Don't get frustrated. Physiologically there may be a strong vagal response that can hide some of the signs we'd expect. Also, bear in mind the events prior to the injury – the child may have been running a considerable distance (before and after the incident) raising their lactate (but don't assume this is the cause). Children tend to ‘fall off a cliff' – they appear well, but can suddenly decompensate – keep the momentum to definitive management going and do not be falsely reassured. John mentioned a great friend of St Emlyn's Vic Brazil and we would heartily endorse you have a look at her work. You can find more information about the Reducing Knife Crime initiative here  

The monthly round up of all the blog posts at St Emlyn's, including a deep dive into HALO (high acuity, low occurrence) procedures and blood transfusion.  Thanks again for listening. Please do like and subscribe here. 

Our monthly podcast round up from St Emlyn's Blog. This month Simon and Iain discuss the prehospital use of troponin measurement in the assessment of patients with chest pain and the use of AI in medicine, as well as an update about St Emlyn's WILD. Please do like and subscribe

This is the first podcast in our new series from St Emlyn's Medical School. They are specifically aimed at healthcare students and focus on the Medical Licensing Assessment (UK) presentations in particular but will be useful wherever you listen in the world.  Each episode has a standard format with a case to set the scene, a set of learning objectives, a discussion, a summary and a case resolution.  There are comprehensive listening notes on the dedicated website, as well as a growing set of other resources.  We hope you enjoy listening. The rest of the podcasts can be found on Spotify, or wherever you get your podcasts.  The music for this series (just as it is for the St Emlyn's Podcast) is composed by Greg Beardsell

Our regular monthly round up and chat from the St Emlyn's blog. We talk about the use of artificial intelligence in research and the use of remifentanil instead of neuromuscular blockade in rapid sequence intubation. Plus more about the StEmlynsWILD conference and Simon's new role as Dean of RCEM and how you can get involved. 

Long term listeners to the St Emlyn's podcast may remember our series entitled ‘Critical Appraisal Nuggets' (CANs). We are absolutely delighted to reinvigorate this project under the leadership of Professor Rick Body, with the episode on semi structured interviews. In this easily digestible and succinct podcast Rick and Laura Howard go through the pros and cons of setting up semi structured interviews and how these can be used effectively in qualitative research. In the latest episode, we cover a qualitative research technique: semi-structured interviews. Qualitative research might be out of your comfort zone: we're generally more comfortable with quantitative measures – numbers and statistics. It's something they have experience with, having previously published a paper exploring the impact of events that happen at work on the wellbeing of emergency physicians. This was a labour of love for Laura. Laura wrote a powerful blog about it here. Semi-structured interviews are a great way to get the really rich data we need to understand something in greater depth. They allow us to ask ‘why?' as well as just ‘what?', ‘who?' and ‘when?'. But reading qualitative research papers can be difficult when it takes us out of our comfort zone. In this CAN podcast, Laura and Rick take us through what semi-structured interviews are, why we might use them, how you design and conduct them, and they also have some pearls of wisdom about how to make transcribing them a lot less painful. By the end, we hope that you'll feel confident with the basics of the technique. And if you want to practice your critical appraisal, why not put their study under the microscope?

Lots of chat about St Emlyn's WILD and just what you can expect if you join us in the Lake District in June, as well as discussion about ECMO in cardiac arrest and just how many of our patients with 'minor head injuries' will actually have ongoing symptoms weeks and even months later.    Click here to buy tickets for #StEmlynsWILD

In our new regular slot of the middle Monday of the month we're delighted to bring you the highlights from the St Emlyn's blog this month., Iain and Simon chat about batching in EDs, Ossilation in decision making and a whole lot more about trauma (chest drains, extrication, sex and TXA and rib fixation). Please do like and subscribe and keep an eye out for our new sister website St Emlyn's Medical School and it's podcast series coming soon. 

Join Iain and Simon for this month's round up of September's blog content from St Emlyn's. They discuss managing harm in the ED; management of traumatic brain injury; Head Up mechanical CPR and fentanyl in RSI. Lots to think about and discuss. Please do like and subscribe and get in touch if there is anything you'd like us to cover on the blog and podcast, or perhaps you'd even like to write something for publication. 

This is our round up of all that happened on the St Emlyn's blog in August 2022 (yes - we know it's a bit late, but there's been a lot going on!). Listen to Simon and Iain discuss the latest therapies in COVID, particularly Baricitinib, calcium in trauma and how we find balance in our work-life blend. Please do like and subscribe to the podcast and tell your friends and colleagues. We've lots of exciting stuff coming your way over the next few months.

Simon and Iain run through the latest highlights from the St Emlyn's blog and podcast.

Our monthly round up of all from the St Emlyn's blog. We discuss pathways into emergency care research, pad positioning in cardioversion of AF and possible gender differences in the presciption of TXA in trauma. We also chat about travel in Lithuania, memories of defibrillating with hand held paddles and Simon's recent forst infection with COVID. We mention a post on Lyme disease which you can read here (especially if you live near the New Forest...)  

After a brief hiatus we're back with more from the St Emlyn's Blog. We discuss a wide range of topics from crowding in Emergency Departments and the RePHILL trial to breastfeeding, genetic testing and diagnosing DVTs, as well as our highlights from the recent RCEM CPD Conference in Bournemouth. There really is something for everyone! 

We made it! A double century of podcasts. In this month's update Iain and Simon talk through myth busting in resuscitation, Rick Body's airway expertise (with a side mention for high sensitivity troponin), a paper about resuscitative thoracotomy, ACPs in EM and how we all could set future research priorties. Thank you again for listening to the St Emlyn's podcast. We really do hope that you enjoy it and have found our witterings over the last 200 episodes useful.  Hopefully we'll see some of you at the RCEM CPD Conference in Bournemouth next week.  Please do rate us on iTunes, like, subscribe, tweet and tell you friends about the podcast. 

Simon and Natalie discuss some of the complexities of feedback when it involved different specialities and patients. We also review our general rules of feedback.   See https://www.stemlynsblog.org/?s=feedback for more.

The first episode of our 9th Season with discussion about Calcium in cardiac arrest, a deep dive into the physiology of exsanguinating haemorrhage, a comparison of ketamine and etomidate for induction of anaesthesia and the ECG Thrust.  Please do like, subscribe and tell your friends about the St Emlyn's podcast. 

Welcome to Episode 13 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 13 of “The 2 View” – Nystagmus, SCAD, Sotromivab, Paxlovid, Molnupivarvir, and more. Nystagmus Mehar A. CanadiEM Frontline Primer - Vertigo workup. CanadiEM. Published April 25, 2020. Accessed January 11, 2022. https://canadiem.org/canadiem-frontline-primer-vertigo/ Nystagmus. NeurologyNeeds.com. Accessed January 11, 2022. https://www.neurologyneeds.com/neurological-examination-tips-tricks/nystagmus/ Nystagmus. The Proceduralist. Published January 10, 2022. Accessed January 11, 2022. https://www.youtube.com/watch?v=fW3sVsNgJ2k Talmud JD, Coffey R, Edemekong PF. Dix Hallpike Maneuver. NCBI. StatPearls Publishing. Last Update December 19, 2021. Accessed January 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459307/ SCAD Beardsell L. Preventing mid-life spontaneity becoming a crisis - SCAD as a serious cause of chest pain. St Emlyn's. St.Emlyn's Emergency Medicine. Published May 29, 2021. Accessed January 11, 2022. https://www.stemlynsblog.org/scad/ Durrani M. Spontaneous Coronary Artery Dissection (SCAD). REBEL EM - Emergency Medicine Blog. Published October 19, 2020. Accessed January 11, 2022. https://rebelem.com/spontaneous-coronary-artery-dissection-scad/ Hayes SN, Tweet MS, Adlam D, et al. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. Published August 2020. Accessed January 11, 2022. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.05.084 Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Raukar NP. 243 Spontaneous Coronary Artery Dissection in the Emergency Department: The Elusive Dissection. Ann Emerg Med. Published October 1, 2020. Accesseed January 11, 2022. https://www.annemergmed.com/article/S0196-0644(20)31003-9/fulltext#relatedArticles Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med. Published December 10, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMra2001524 Sotromivab, Paxlovid and Molnupivarvir Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. Published November 5, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/nejmoa2007764 Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. Published online December 16, 2021. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 PAXLOVIDTM (nirmatrelvir tablets; ritonavir tablets): Now Authorized for Emergency Use. For Patients. Pfizer. Covid19oralrx-patient.com. Accessed January 11, 2022. https://www.covid19oralrx-patient.com/ Sotrovimab. Sotrovimab.com. GSK. Accessed January 11, 2022. https://www.sotrovimab.com/ Guest Interview: JIM ROBERTS - IVERMECTIN Bryant A, Lawrie T, Dowswell T, et al. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics. Lww.com. Published July/August 2021. Accessed January 11, 2022. https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectinforpreventionandtreatment_of.7.aspx Em-news.com. Accessed January 11, 2022. http://www.em-news.com Kory P MD, Meduri GU MD, Iglesias J, et al. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. Published online 2020. Updated January 16, 2021. Accessed January 11, 2022. https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf Mike & Martha's Something Sweet: Safest Countries in the World in 2021 Safest Countries in the World 2021. Worldpopulationreview.com. Accessed January 11, 2022. https://worldpopulationreview.com/country-rankings/safest-countries-in-the-world Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in – this month we are giving away 20% off of our July Bootcamp Course and lunch with the faculty! Win and join us in Vegas this summer – come and share your ER experiences with us over a good meal.

The round up of the St Emlyn's blog posts in August 2021, featuring discussion about therapeutic anticoagulation in hospitalised COVID-19 patients, non invasive ventilation vs usual care for critically hypoxic COVID-19 patients and the recent EMTA (Emergency Medicine Trainees Association) survey. Oh, and Simon's mid-life crisis. 

A podcast with Iain and Simon summarising all the latest content from the St Emlyn's blog in April 2021. Topics discussed include Vaccine Induced Thrombocytopenic Thrombosis, how our own biases can effect our critical appraisal and whether we need to worry about grading the quality of FOAMed resources. Thanks for listening. Please check out the blogs themselevs at www.stemlynsblog.org and consider subscribing and rating us on iTunes.  If you'd like to see some more from Peter Brindley you can watch one of his SMACC talks here. 

A discussion about all the latest from the St Emlyn's blog, including a hot off the press article about vaccine induced thrombocytopenic thrombosis and the new FRCEM revision guide.  Simon and Iain also talk about the latest results from the RECOVERY trial, Major Trauma Triage tools, cricothyroidotomy, thromboprophylaxis in COVID19 and the new Medical Licensing Assessment for medical students and the new St Emlyn's Undergraduate Curriculum 

Our regular podcast round up from February 2021. Iain and Simon highlight the key learning points from this month on the St Emlyn's blog and podcast. Topics discussed this month include tocilizumab in COVID19, TIA risk scores, new Emergency Care standards (targets) and TXA use in epistaxis. We also pay tribute to Dr Cliff Mann, former President of RCEM who sadly died this month.  Please remember to subscribe to the podcast on iTunes/Google Play and please do leave us some reviews and ratings there.

Our regular round up of the best of the blog and podcast from January 2021 with Iain and Simon. The St Emlyn's blog posts from January 2021 are discussed, including plenty about Coronavirus as well as other topics relevant to anyone interested in Emergency Medicine and evidence based care. 

A vaccine update with Rick Body, Simon Carley, Pam Vallely, Paul Klapper and Charlie Reynard. Bringing RCEM, St Emlyn's and the University of Manchester together for the latest thoughts and wisdom on the vaccines that might get us out of this pandemic.   Moderna vaccine phase 3 trial - https://www.nejm.org/doi/full/10.1056/nejmoa2022483 Oxford vaccine phase 2/3 - https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)32466-1.pdf Pfizer vaccine trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2034577   #vaccines #COVID19 #coronavirus

A special festive edition of our round up podcast featuring six weeks of blog posts and plenty more besides. From all at St Emlyn's we hope you have a very happy festive season and we cannot wait to talk to you again in 2021. Take care, Simon and all the team

Welcome to our audio round up of everything on the blog during August.  As the world continues to be in the grips of the Coronavirus pandemic there have been more papers looking at all aspects of this disease. Simon reviewed the latest paper on Hydroxychloroquine and Charlie collated some of the top papers covering aspects from aerosol spread and use of CPAP to the effect on vulnerable groups and the effect on staff psychological health It's not all COVID though. Sepsis is a condition we all want to be able to treat more effectively. Sadly there doesn't seem to be any encouraging news about the use of Vitamin C, Steroids and Thiamine in this latest RCT. Many of the St Emlyn's group have special expertise in toxicology and Gareth wrote this incredibly informative post about the use of GBL. If you're not sure what "ChemSex" is then this post from a few years ago by Janos is worth a read. The anonymously written "Look at what they make you give" post really struck a chord with readers, with an astonishing number of views. There are messages here for us all. The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think.

Our own version of Buy One Get One Free* this month, where you get a round up of two months of blog content.   Coronavirus continues to dominate the medical (and non-medical) headlines, and we discuss the two major results from the RECOVERY trial published recently, one positive and one not so (depending on who you talk to....). Simon also catches up with Roberto Cosentini, who you'll remember from the very powerful podcast at the beginning of the pandemic.   COVID isn't the only EBM circus in town though: we've reviewed HALT-IT and Simon has given a talk about the "Ten Top Trauma Papers" of the last year and Laura reviewed a paper looking at haloperidol for headaches.   We're having to think even harder about how we communicate in the ED, both for clinical care and to deliver education. Two ideas to help learning have been featured this month: The St Emlyn's Lesson Plans and "Background Learning".    Good luck to all those starting in Emergency Medicine, and a huge thank you to all those who are moving to other areas of medicine or other departments. It's been a curious few months...   Take care,   Iain *It's actually Get One Free Get Another Free, but whose ever heard of that?    

We are delighted to introduce you to the "St Emlyn's Lesson Plans", which we hope will help structure some of your education sessions over coming months (and years). Each lesson plan starts with a descrete learning outcome, to set the scene, as well as details of the RCEM curriculum item(s) that will be covered. The first tasks are aimed at aquiring some background knowledge and can either be done as part of the session, or beforehand. These utilise the vast "FOAMed" resources (including, but not exclusively, those of St Emlyn's). Our experience is that time constraints often mean that "background reading" isn't achieved before the session, so would encourage allowing time within it to complete these. They are designed to take about 30 minutes and occupy the first half of the session. Everything you need for each lesson is included in the plan. We would recommend that each learner has an internet enabled device available (with headphones) to read and listen to the background material at their own pace. The second half of the session should be facilitated by an expert. This can happen in person, but also online, via any of the interfaces that are now so familiar. In many plans we have given some case examples, but it would be even better if learners can bring cases of their own for discussion. This element is very much within the control of the facilitator (who should been fully cogniscent of the contents of the knowledge section). The session finishes off with a summary, this should emphasise again the most important learning points. To really embed the knowledge and skills the particiapants should be encouraged to reflect on what they have learned, and to even talk to thse who were unable to attend about what they missed. For learners this also gives an opportunity to easily link teaching sessions to their portfolio. You may want to record the "face-to-face" elements, so that those who were not present are able to access them when they can (and those that did can rewatch to refresh their learning). Although these plans are designed for delivery in a single centre, there is absolutely no reason why regional (or even national) teaching could take place in this way. The recent COVID19 Journal Clubs have demonstrated beautifully how a group of learners can engage with an online panel. We would be very happy to receive lessons plans to add to the collection. This is very much a collaborative effort. Please let us know what you think of these lesson plans and if you are using them in your Department. We'd love to hear your ideas about how we can take medical education forward.

St Emlyn's three professors, Carley, Body and Horner* critically appraise the Press Release regarding Dexamethasone in the treatment of COVID-19. What does this mean for the future of Evidence Based Medicine? Can we really start using a medication when the trial hasn't been peer reviewed and the full dataset not released?  The blog post by Josh Farkas, that is mentioned in the podcast, is here. *Professor Simon Carley, Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in Adult and Paediatric Emergency Medicine at Manchester Foundation Trust, Professor Rick Body Professor of Emergency Medicine in Manchester and Honorary Consultant in Emergency Medicine at Manchester Foundation Trust. Professor Dan Horner, Professor of Emergency Medicine of the Royal College of Emergency Medicine and Consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust.

Lots to chat about on the podcast this month, and not just COVID! There's been blog posts about clots, troponin and even telly, as well as the Journal Club series.   Keep a look out for the new St Emlyn's Lesson Plans that we hope will help usher in a new era of medical education in a socially distanced world.    If you would like to donate to the fund in the memory Adel Aziz you can find the link here.   We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.    Take care   Iain Podcast edited by Izzy Carley PS You can find the Lesson Plans here. Still a work in progress, but as you've read these "shownotes" you deserve to have a sneak preview... 

Welcome to our seventh webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.   The live event took place on Tuesday 26th May. Today's panel will be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Ellie Hothershall (Consultant in Public Health), Prof Simon Carley and special guest Kelly Ann Janssens (Emergency Physician in Ireland) to discuss five papers about COVID-19 infection. This will be the last weekly journal club, but we will be back with more EBM goodness very soon. Do let us know what you like to be included at stemlyns@gmail.com References Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. N Engl J Med. Published online May 22, 2020. doi:10.1056/nejmoa2007764 Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 2020. doi:10.1016/s0140-6736(20)31180-6 Gray N, Calleja D, Wimbush A, et al. “No test is better than a bad test”: Impact of diagnostic uncertainty in mass testing on the spread of Covid-19. Published online April 22, 2020. doi:10.1101/2020.04.16.20067884 Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019. Annals of Emergency Medicine. Published online May 2020. doi:10.1016/j.annemergmed.2020.05.022 Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatr. Published online May 19, 2020. doi:10.1111/apa.15371 Podcast edited from a live webinar by Iazzy Carley  

Welcome to our fifth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's. The live event took place on Tuesday 12th May at 11.00am BST (10.00am GMT).  The COVID-19 Journal Club Panel Today's panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Dan Horner, Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Lauren Westafer (Attending in Emergency Medicine and Co-Creator of the Foamcast blog and podcast) and Ellie Hothershall (head of undergraduate medicine at the University of Dundee and an expert in Public Health) to discuss six papers about COVID-19 infection. 1. Lai S, Ruktanonchai NW, Zhou L, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature. May 2020. doi:10.1038/s41586-020-2293-x 2. Paranjpe I, Fuster V, Lala A, et al. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. Journal of the American College of Cardiology. May 2020. doi:10.1016/j.jacc.2020.05.001 3. Thanh L, Andreadakis Z, Kumar A, et al. The COVID-19 vaccine development landscape. Nat Rev Drug Discov. 2020;19(5):305-306. doi:10.1038/d41573-020-00073-5 4. Bryan A, Pepper G, Wener MH, et al. Performance Characteristics of the Abbott Architect SARS-CoV-2 IgG Assay and Seroprevalence in Boise, Idaho. J Clin Microbiol. May 2020. doi:10.1128/jcm.00941-20 5. Treibel TA, Manisty C, Burton M, et al. COVID-19: PCR screening of asymptomatic health-care workers at London hospital. The Lancet. May 2020. doi:10.1016/s0140-6736(20)31100-4 6. Altmann S, Milsom L, Zillessen H, et al. Acceptability of app-based contact tracing for COVID-19: Cross-country survey evidence. May 2020. doi:10.1101/2020.05.05.20091587   Podcast edited from a live webinar by Izzy Carley

Welcome to our fourth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.   The live event tool place on Tuesday 5th May at 11.30am BST (10.30am GMT).    The panel was again be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar (Academic Clinical Lecturer), Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Justin Morgenstern to discuss six papers about COVID-19 infection.   There will be another COVID 19 Journal Club next week (Tuesday 12th May at 11am).   References 1. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online April 15, 2020. doi:10.1038/s41591-020-0869-5   2. Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? The Journal of Infectious Diseases. Published online April 16, 2020. doi:10.1093/infdis/jiaa189.   3. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. Published online April 2020. doi:10.1016/s0140-6736(20)31022-9   4. Rajendran K, Narayanasamy K, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID‐19: Systematic review. J Med Virol. Published online May 2020. doi:10.1002/jmv.25961   5. Tedeschi S, Giannella M, Bartoletti M, et al. Clinical impact of renin-angiotensin system inhibitors on in-hospital mortality of patients with hypertension hospitalized for COVID-19. Clinical Infectious Diseases. Published online April 27, 2020. doi:10.1093/cid/ciaa492   6. Docherty AB, Harrison EM, Green CA, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. Published online April 28, 2020. doi:10.1101/2020.04.23.20076042   Podcast edited from a live webinar by Izzy Carley 

  It's been another busy month at St Emlyn's, with the publication of 15 blog posts and five podcasts, but there does seem to be an awful lot to talk about!   Of course there have been multiple posts and podcasts about COVID-19, and you can fiind all of these on our special St Emlyn's page. Highlights have included the three RCEM/St Emlyn's Webinars which we are delighted to host in podcast form.   It's not just been coronavirus though, we have also dipped out toes into exercise and nutrition, graphic design and horticulture!   Parts of the site have also undergone a bit of a redesign with the curriculum pages now easier to navigate to find that post to fioll an e-portfolio hole.     We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.   They'll be much more to come in May I am sure.   Take care   Iain Podcast edited by Izzy Carley  

Welcome to our third webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's. The live event took place on Tuesday 28th April at 11am BST (10am GMT). The panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Dan Horner (RCEM Professor), Prof Pam Vallely (Professor of Medical Virology), Salim Rezaie (Emergency Physician and Founder of REBEL EM) and Prof Simon Carley (you know him…) to discuss five papers about COVID-19 infection. There will be another COVID 19 Journal Club next week (Tuesday 5th May at 11am). Edited by Izzy Carley and Iain Beardsell References Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine. April 2020:1-21. https://www.esicm.org/wp-content/uploads/2020/04/863_author_proof.pdf. Caputo ND, Strayer RJ, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED's Experience during the COVID‐19 Pandemic. Acad Emerg Med. April 2020. doi:10.1111/acem.13994 Garcia FP, Perez Tanoira R, Romanyk Cabrera JP, Arroyo Serrano T, Gomez Herruz P, Cuadros Gonzalez J. Rapid diagnosis of SARS-CoV-2 infection by detecting IgG and IgM antibodies with an immunochromatographic device: a prospective single-center study. April 2020. doi:10.1101/2020.04.11.20062158 Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. April 2020. doi:10.1001/jama.2020.6775 Metzler B, Siostrzonek P, Binder R, Bauer A, Reinstadler S. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. April 2020. doi:10.1093/eurheartj/ehaa314

Welcome to our second webinar on recent research about COVID-19, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's. The panel was hosted by Rick Body. The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer), Dr Casey Parker and Prof Simon Carley (you know him…) to discuss six papers about COVID-19 infection. The live event took place on Tuesday 21st April 2020 References:  Paper 1 (00:00) Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. April 2020. doi:10.1101/2020.04.10.20060558 Paper 2 (12:09) Bendavid E, Mulaney B, Sood N, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. April 2020. doi:10.1101/2020.04.14.20062463   Paper 3 (16:40) Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. April 2020. doi:10.1038/s41586-020-2196-x   Paper 4 (23:33) Favas C. Guidance for the Prevention of COVID-19 Infections among High-Risk Individuals in Camps and Camp-like Settings. London School of Hygiene and Tropical Medicine; 2020:1-15. https://www.lshtm.ac.uk/sites/default/files/2020-04/Guidance%20for%20the%20prevention%20of%20COVID-19%20infections%20among%20high-risk%20individuals%20in%20camps%20and%20camp-like%20settings.pdf. Accessed April 21, 2020.   Paper 5 (30:30) Zeng J-H, Liu Y-X, Yuan J, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. April 2020. doi:10.1007/s15010-020-01424-5   Paper 6 (35:02) Caruso D, Zerunian M, Polici M, et al. Chest CT Features of COVID-19 in Rome, Italy. Radiology. April 2020:201237. doi:10.1148/radiol.2020201237   Podcast edited by Izzy Carley and Iain Beardsell

Dr Roberto Cosentini is an old friend of St Emlyn's who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid19 outbreak. He kindly found an hour to record a podcast with us on his experiences. There are so many essential lessons in this podcast. Please share with clinical and non-clinical colleagues, as we need to plan NOW. Roberto is quite clear that if we don't train and get plans into place before the wave of cases hit us then both ourselves and our patients will suffer. In the interest of speed I'm not going to summarise the whole podcast. You have to listen to it all yourself to see what's relevant to you. These are some of my take away messages. Divide your department into resp patients and non-resp patients Wear PPE and know how to use it You will need clinicians who do not usually work in ED. Train and orientate them now (before you need them). Most patients are hypoxic and this responds to O2 and CPAP. You're going to need a lot of CPAP and how that happens could be tricky. They found hoods the best (Ed - but how many of those do we have?). Although hypoxic, patients have good lung compliance. They regularly saw diurnal variation with many patients presenting in the early afternoon. It's emotionally exhausting. Prepare yourself and your team psychologically and support them during the pandemic. Roberto's department has an embedded psychologist. Health care worker infections were quite low (because they wore PPE for all resp cases). Flow through the department and onto wards is absolutely vital. Flow out the the main hospitals to other units that can rehabilitate is vital. Decisions for ICU level care were similar to normal (in his hospital) We rarely declare one of our podcasts a 'must listen' but this is an exception. Please listen and share widely. Please think hard about the issues Roberto raises and PLEASE ACT NOW. vb S     How you can support St Emlyn's Join us for #stemlynsLIVE conference May 12th 2020 Subscribe to the blog (look top right for the link) Subscribe to our PODCAST on iTunes Follow us on twitter @stemlyns PLEASE Like us on Facebook Find out more about the St.Emlyn's team Find out more about the MMU MSc in Emergency Medicine here. Download one of our FREE e-books here Shortcode            

Simon Carley is a consultant in Emergency Medicine working in adult and paediatric emergency and trauma centres in one of the busiest hospitals in Manchester, England.  He is also the founder of the excellent St Emlyn’s website. You are working in the Emergency Department and the standby phone rings…Professor Carley takes us on a journey...

The latest from the St Emlyn's blog

Our regular round up of the best and the brightest from the St Emlyn's blog. This is a round up of our August content.

The best from the blog and podcast in July 2019.  JC: Clot's the Problem? Vena Cava filters in trauma patients. St Emlyn's Psychological performance in the resus room. Ashley Liebig at #stemlynsLIVE JC: The Resuscitative Care Unit. St Emlyn's The great day paradox. St.Emlyn's All you need to know about Listeria. St Emlyn's. GI Emergencies – Chris Gray at #StEmlynsLIVE Similar challenges, different approaches – Mass Casualty Incident training lessons from Pakistan. St Emlyn's  

This talk focuses on how we can optimise our psychological performance in critical care situations, the type of situations that Simon describes as Time Critical, Information light. The Audio is available below, or watch the full presentation above. Don't forget to watch the video on the St Emlyn's site http://www.stemlynsblog.org vb S

This is the podcast that accompanies the recent blog post on Jason's latest research on traumatic cardiac arrest and closed chest compressions. This discussion is more wider ranging and explores how the management of TCA has changed, and is changing as we begin to gain a better understanding of the physiological mechanisms underpinning our resuscitation strategies. Read the blog here. http://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/ Key references Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest.Watts S, Smith JE, Gwyther R, Kirkman E. Resuscitation. 2019 May 9;140:37-42. doi: 10.1016/j.resuscitation.2019.04.048. [Epub ahead of print]   Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Nov;35(11):669-674. doi: 10.1136/emermed-2018-207739. Epub 2018 Aug 28. 5. Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Rickard AC, Vassallo J, Nutbeam T, Lyttle MD, Maconochie IK, Enki DG, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Jul;35(7):434-439. doi: 10.1136/emermed-2017-207226. Epub 2018 Apr 28. The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry. Barnard EBG, Hunt PAF, Lewis PEH, Smith JE. J R Army Med Corps. 2018 Jul;164(3):150-154. doi: 10.1136/jramc-2017-000818. Epub 2017 Oct 6. Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. January 2015:11-16. doi:10.1177/0141076814560837 May N. Traumatic Cardiac Arrest. St Emlyn's. http://www.stemlynsblog.org/traumatic-cardiac-arrest/. Published 2012. Accessed 2019.

Here is the latest from the St Emlyn's team  

The latest blog posts, ideas and thoughts from the St Emlyn's podcast. This month with Simon Carley and Rick Body,

This is a really important concept developed by Charlie Reynard and Rick Body here in Manchester. There is an accompanying paper in the EMJ that you can read via this link https://emj.bmj.com/content/34/12/A870  This concept could radically change how we make probabilistic prescribing decisions in the ED. Have a listen and look out for a blog post on St Emlyn's soon.

This podcast and presentation was recorded at the St Emlyn's LIVE conference in Manchester 2018. In this presentation Clare takes us through the rationale, principles, training and practice that we need in order to continually develop as prehospital and resuscitation practitioners. You can read more from the event at http://www.stemlynsblog.org  This is a great presentation for anyone interested in continually developing their own and their colleagues practice, delivered by someone who really knows what they are talking about and who works for one of the best developed resuscitation services in the world. Clare is an Emergency Physician and specialist in Pre-Hospital Care and Retrieval medicine based in Sydney, with Royal Prince Alfred Hospital and Sydney HEMS. She has completed a fellowship in simulation based education, and enjoys training with “real” people - patients, bystanders and the other clinicians we come across as we treat our patients every day. She is a lecturer with the University of Sydney, and is involved in education for the NSW Institute for Trauma Injury Management. When Clare is not working on helicopters or training teams, she is studying yoga or hanging out with her puppy, Archie. 

This is the monthly round up of blogs from the St Emlyn's team Tribalism with Ross Fisher https://www.stemlynsblog.org/breaking-down-tribalism-onetribeemta-st-emlyns/ Conservative management of chest trauma https://www.stemlynsblog.org/jc-conservative-management-of-chest-trauma-st-emlyns/ ICS SOA day 1 https://www.stemlynsblog.org/st-emlyns-on-tour-icssoa2018/  Handover principles https://www.stemlynsblog.org/handover-process-practice-and-controversy-icssoa2018-st-emlyns/  ICS SOA day 2 https://www.stemlynsblog.org/icssoa2018-day-2-st-emlyns-on-tour/  ICS SOA day 3 https://www.stemlynsblog.org/icssoa2018-day-3-st-emlyns-on-tour/  FeminEM part 4 https://www.stemlynsblog.org/fix18-part-four/  PEP, PEPSE and HIV https://www.stemlynsblog.org/pep-prep-and-all-things-hiv-st-emlyns/  Game of Thrones https://www.stemlynsblog.org/ste-journal-club-a-christmas-games-of-thrones-issue/ 

  November was a busy month for the St Emlyn's team with a variety of blogs on conferences, EBM, philosophy and education. Here's the podcast and the links to the blogs mentioned in November.   FeminEM part 2 with Natalie May https://www.stemlynsblog.org/fix18-part-two/    FeminEM part 3 with Natalie May https://www.stemlynsblog.org/fix18-part-three/    Dan Horner on the POLAR trial of hypothermia in brain injury https://www.stemlynsblog.org/jc-hypothermia-in-brain-injury-the-polar-trial-st-emlyns/    Zaf Qasim on whole blood in trauma https://www.stemlynsblog.org/whole-blood-in-trauma-st-emlyns/    Nick Smith on Cognitive Load theory https://www.stemlynsblog.org/education-theories-you-should-know-cognitive-load-theory-st-emlyns/    Claire Bromley on her experience on elective in Cape Town https://www.stemlynsblog.org/south-africa-as-a-medical-student-elective-claire-bromley/    Natalie May on why resuscitation is not sexy https://www.stemlynsblog.org/so-unsexy/    Learning in the social age with Simon Carley https://www.stemlynsblog.org/learning-in-the-social-age-st-emlyns-at-emerge10/    Salim Rezaie on Advanced ACLS - beyonfd the guidelines https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/   

Five strategies to improve your resuscitations. 1. Zero point survey 2. Peer review 3. 10 in 10 4. Hot debriefs 5. Fly the patient You can read about these strategies, watch the video and learn about the background on the St Emlyn's blog here https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/ 

Discussion with Dr. Damian Roland, a Paediatric Emergency Consultant from Leicester Royal Infirmary about best ways to keep up to date with new evidence in paediatrics.   A podcast for you: the paediatric commuter. We are joining you on your daily journey from home to work and we discuss interesting topics with guests from different specialities. Have a safe commute!   Host: Dr. Alexandra Pelivan Guest: Dr. Damian Roland Music: Komiku - Mushrooms   Don’t forget the Bubbles: https://dontforgetthebubbles.com/ Don’t forget the Bubbles 2019 conference: https://dontforgetthebubbles.com/dftb19/ http://www.pemdatabase.org/ St Emlyn’s: https://www.stemlynsblog.org/ Paediatric Emergencies: http://www.paediatricemergencies.com/ GP Paeds Tips: http://gppaedstips.blogspot.com/ Paediatric FOAM: https://paediatricfoam.com/ EM3: https://em3.org.uk/   Twitter accounts: @paediatricFOAM @PEMTweets @EMtogether @DrSimonCraig @Damian_Roland @TessaRDavis @DrSarahMcNab @dftbteam @TessaRDavis @henrygoldstein @andrewjtagg @paedsem@broomedocs @nmay @perukitweep @pedemmorsels

Salim Rezaie from the REBEL EM podcast takes us through the optimal management of cardiac arrest and also explores some of the controversies and difficulties that make the difference to our patients.  You can read a lot more about the background to this talk, see the evidence and watch the video on the St Emlyn's site. Just follow this link. https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/ 

We've heard a lot about advanced airway management recently, with some really significant publications over the last few months and in the last few weeks in JAMA we've had another! Cricoid pressure during emergency anaesthesia and for those at high risk of aspiration has been common place for more than half a century. But it's a topic that has caused quite some debate. On one hand it has the potential to reduce aspiration, a very real and potentially very serious complication of RSI. But on the other it has the potential to hinder the view on laryngoscopy and decrease first pass success. The founding evidence for cricoid pressure has always been a little soft. In this podcast we look at the background of cricoid pressure and then run through this key paper, discussing the implications it holds for both pre and in-hospital advanced airway management. As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you. Enjoy! Simon, Rob & James References Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anaesthesia: The IRIS Randomized Clinical Trial. Birenbaum A. JAMA Surg 2018 Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA Lancet.1961 Safer Prehospital Anaesthesia 2017;AAGBI JC: Cricoid Pressure and RSI, do we still need it?St Emlyn’s Cricoid: To press, or not to press?(Hinds and May)  

A little later than planned, but here is the podcast round up of the St Emlyn's blog for August 2018. The following blogs are discussed. Lessons learned at EMSA https://www.stemlynsblog.org/lessons-learned-at-emsa18/ Troponin and Biotin https://www.stemlynsblog.org/troponin-and-biotin-a-lethal-combination/ Top apps at EMSA https://www.stemlynsblog.org/top-apps-at-emsa18-st-emlyns/ Navigating the CESR route in UK emergency medicine training https://www.stemlynsblog.org/et-tu-brute-one-mans-battle-with-cesr-st-emlyns/ JC: IV fluids review paper https://www.stemlynsblog.org/jc-intravenous-fluid-therapy-in-critically-ill-adults-review-st-emlyns/ Moral Injury in emergency medicine https://www.stemlynsblog.org/moral-injury-in-emergency-and-pre-hospital-care-esther-murray-on-st-emlyns-podcast/

This month we have a podcast on how we approach patients with mental health needs in the ED. It outlines the rationale and delivery of a change in how we manage some of the most vulnerable patients in the ED. We hope you find it interesting and I suspect you will also find it quite challenging. We are aiming to improve the care of patients with Mental Health needs, but in doing so we must face our own prejudices and practices, which are not always healthy. Editorial note on language – as you listen to the podcast you might be surprised to hear us use words like ‘insane' in relation to decisions and systems. In some ways it seems incongruous to use such terms in a podcast that promotes a better understanding of mental health issues. We considered taking them out, but after consideration we left them in an attempt to illustrate the false dichotomy between medical and psychiatric needs that is embedded in much of our work. Perhaps the use of language reflects this and makes the point that we can do better. Why do we need to rethink our approach to Psychiatric emergencies in the ED? There are a group of life threatening conditions that present to your ED that you don't deal with, or at least you don't deal with very well. This group of conditions has a significant mortality and an incredibly high morbidity, but if you are a typical emergency physician you probably don't think you own the problem. This group of conditions is at least as common as chest pain and yet it's unlikely that you feel the same level of ownership of the problem.  The issue is of course that of psychiatric illness. In Virchester it accounts for about 1 in 20 patients through the door, and that number is much, much higher if we were to include substance abuse and its related outcomes.  In general, the approach in many UK units is to divide the patient up on arrival into physical and mental health needs. We feel responsible for the physical problem and then we try and offload any psychiatric problems onto the psychiatrists and mental health teams. At the centre of this is the patient who really does not see or feel this dichotomy and we really need to challenge our approach to this. Such dichotomies are embedded in our systems. I'm sure that many readers will be familiar with the request to ‘medically clear' a patient in order that they can then be assessed by the mental health team. Bizareer customs and practice take place around these assessments, for example in Virchester the rule that a patient with a heart rate of more than 100 cannot be medically fit for assessment is sometimes used to decline psychiatric assessment. Such informal rules (none are actually written down or appear in any agreed protocol) result in delayed assessments, patient distress and long waits in the ED. I could go on, and whilst there is good and practice amongst all teams and specialities (we are just as bad at the mental health teams in promoting this dichotomy), the point is that we really don't act in the patient's best interests by dividing mental and physical health. This clear difficulty was one of the starting points for the APEX course, which aims to bring psychiatry and emergency medicine together for the benefit of patients, services and staff.  The interview on the podcast is recorded with Prof. Kevin Mackway-Jones who many of you will know through his work with the Advanced Life Support Group. He was the instigator of APLS at a time when there was a clear need for emergency physicians to improve their approach and knowledge of paediatric emergencies. APEx feels the same. A common condition in our EDs for which we are not currently doing the best that we can for our patients and where a joint teaching and learning approach is needed between the ‘tribes' of medicine. This could be a game changer to how we manage a very common and very vulnerable group of patients in the ED. So what's on the course? I can't give you the whole courses here but there are a few principles that underpin the content and approach. Key points. It's co-written and developed between psychiatry and emergency medicine It's a symptom based approach (just like APLS) and so it deals with how we deal with the presenting complaint first and not the underlying diagnosis (as you may not know what this is when you are dealing with the patient). The approach will be familiar to many Eps. Primary Survey Resuscitation Secondary Survey Definitive management There is a unified approach. The patient needs an ABC approach for physical health, but in addition and concurrently they also need the AEIOU approach. A – Assessment of Aggression and Agitation E – The Environment in which you are assessing the patient I – The Intent of the patient O – The Objects the patient has to carry out the intent U – The Unified assessment (as you will also be carrying out an ABC assessment alongside AEIOU) Rapid tranquilisation is a key conern for EPs and so there is lots on this that does not automatically default to restraint, a needle and syringe and a significant risk. Oral tranquilisation works Ketamine is not the answer to every patient It's a risk based approach as every intervention (including no intervention) has a risk Find out more You can find out more on the ALSG website here. What has APEx got to do with St Emlyn's? At St Emlyn's we are letting you know about the course for several reasons. Many of us teach and support the work of the ALSG charity (for free and because we believe in it), but also that we all believe that the care of patients with mental health needs can be improved. They are a vulnerable group who generally get a bad deal when they present in crisis to emergency departments. We know we can do better and we believe that this course will help us achieve our goal to do the best that we can for our patients. APEX Course information.   S @EMManchester Subscribe to the blog (look top right for the link) Subscribe to our PODCAST on iTunes Follow us on twitter @stemlyns PLEASE Like us on Facebook Find out more about the St.Emlyn's team Come join us at our conference in October 2018  

Iain and Simon catch up on what happend on the St Emlyn's blog and podcast in March 2018. Visit http://www.stemlynsblog.org for more info and links to the articles mentioned in the podcast. This month we cover IV fluids and the never-ending debate around balanced crystalloids vs. saline, we look at working in Africa on secondment or as a placement and we round off with a discussion of the utility of pupillary signs in the prognosis of patients post cardiac arrest. S

Professor Simon Carley from St. Emlyns caught up with us at the superb Trauma Care Conference and talked through his top papers in trauma from the last 12 months. There's something for everyone from diagnosing arterial injuries, blood pressure targets in the head injury patient, to i.v. contrast all the way through to imaging in kids. If you haven't already, make sure you go and check out the St Emlyn's blog that underpins the talk that Simon gave. And if you're looking for a great value conference to suit all health care disciplines then make sure to keep an eye out for tickets when they go on sale for Trauma Care 2019. A huge thanks to Simon C for his time recording the podcast and we'd love to hear any comments or feedback. Enjoy! Simon L & Simon C References & Further Reading For all the papers pop over to the St Emlyn's blog for the hyperlinks and abstracts

The Physician Response Unit (PRU) is an innovative service in East London that takes the emergency department to the patient. The PRU is led by Tony Joy, consultant in emergency medicine and prehospital care and is a fairly unique service to the UK. In this podcast our very own Richard Carden interviews Tony for an in depth understanding of how the service is supporting the entire emergency care system in London. You can read more about the PRU here https://londonsairambulance.co.uk/our-service/news/2017/10/remodelled-pru-to-be-a-seven-day-service-for-the-first-time and look out for a blog post on the St Emlyn's blog site very soon.

How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient? Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them. In the podcast we cover the following; Whats the big deal with crystalloids Previous trials on fluid administration NEJM papers on crystalloids Myburgh's editorial Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below. We'd love to hear any thoughts and comments below. Enjoy! Simon & Rob References & Further Reading Fluid Na K Cl Ca Mg Lact Acet Glucon Dext Osmol mOsm/L 0.9% N Saline 154 0 154 0 0 0 0 0 0 308 Lactated Ringers 131 5 11 2.7 0 29 0 0 0 273 Hartmanns 129 5 109 4 0 29 0 0 0 278 Plasma Lyte 140 5 98 0 3 0 27 23 0 280 Constituents measured in mEq/L Reference; University Texas  Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018 Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018 Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018 REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over? PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s JC: So long Salt and Saline? St Emlyn’s The Bottom Line; SALT-EM The Bottom Line; SMART

Vicky Vella is an emergency physician practicing in the United Kingdom with a special interest and expertise in eating disorders. In December of last year, Vicky had a guest post on the St Emlyn’s blog about the MARSIPAN Guidelines. Never heard of them? Neither had pretty much anybody. MARSIPAN is an acronym for Management of Really Sick Patients with Anorexia Nervosa. Anorexia is often viewed as a chronic condition that doesn't really warrant emergency care, but that's not the case. Mortality with anorexia nervosa is high (on the order of 10-20%) and patients can present, as MARSIPAN suggests, really sick.   Consider an eating disorder/anorexia in patients presenting with Self Harm. Up to 70% of patients with anorexia will self harm Diabetic Ketoacidosis.  In the UK around half of 15-25 year olds with type 1 diabetes will withhold insulin to try and lose weight. Not all of them will have an eating disorder, but many will Vasovagal syncope. We often ask if a patient had breakfast or enough to drink today, but there may be an underlying eating disorder   What question(s) to ask Vicky starts with, "What's your relationship with food?" "Do you eat regular meals?" The patient may not disclose that there's a problem. Information may come from a family member   Who has anorexia nervosa Highest risk is 13-17 yo age group, both male and female Can actually affect all ages, races, genders   What's the difference between anorexia nervosa and someone who just doesn't eat much? Anorexia is a mental illness. Sometjing the person doesn't have much control over Less of a desire to be thin than a fear of being obese Guilt associated with eating May restrict intake, exercise to burn off consumed calories Often mood swings, social isolation, can become aggressive toward family DSM 5 Criteria Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.   Red Flags in the Anorexia Workup (from the MARSIPAN Guidelines) BMI low risk 15–17.5 medium risk 13–15 high risk

Section 1 - St Emlyn's, Section 2 - Paper 1 - Thrive Trial, Section 3 - Trauma, Section 4 - O2, Section 5 - Paper 2 - Pik on Antiemetics, Section 6 - Rosa Macnamara, Section 7 - Chris Walsh, Section 8 - Tetanus, Section 9 - Paper 3 - Rectal Massage & Outro

So today Rob and I were lucky enough to be asked to attend the Trauma Care Conference 2017, to listen to some of the great talks and catch up with some of the speakers for their take on the highlights of the talks. We managed to catch the following speakers, here are the topics they covered and relevant links to the resources discussed. Speakers Gareth Davies, Consultant Emergency Medicine, Royal London Hospital; Understanding where, when and how people die? Dave Gay, Consultant Radiologist, Derriford Hospital; The Role of Ultrasound in Trauma Fiona Lecky, Professor Emergency Medicine, Salford; Traumatic Brain Injury: recent progress & future challenges Simon Carley, Professor Emergency Medicine, Central Manchester; The Top 10 trauma papers of 2016 St Emlyn's Top 10 +1 Trauma Papers 2016 Tim Rainer,  Professor Emergency Medicine, Cardiff; Permissive hypotension in blunt trauma David Raven, Emergency Medicine Consultant, Heart of England Foundation Trust; HECTOR & Elderly Trauma The HECTOR Course (& free online manual!!) Ross Fisher, Consultant Paediatric Surgeon Sheffield Children’s Hospital; TARN report for paediatrics p3 presentations TARNlet Database   Have a listen to the podcast and again huge thanks to the speakers for taking their time to share their superb talks with a wider audience. Simon

In a new podcast format Simon (@EMManchester) and Iain (@docib) discuss the month's offerings from the St Emlyn's blog and podcast (www.stemlynsblog.org).   It's been a month full of interesting posts on subjects as diverse as Thrombolysis in Stroke (Alan Grayson), The Future of Emergency Medicine in the Social Age (Simon), Cardiac Arrest Centres (Simon), Love in Critical Care (Liz Crowe), Transfers (Nat and Simon), Thrombolysis in PE (a guest post from FOAMed legend Anand Swarminathan) and Benzos in Back Pain (Janos). Head to the website for the articles themselves and all the references and links you need.   We're aiminig to make this a regular monthly podcast - let us know if it's useful and enjoyable and how we could make it even more educational.

The fabulous Liz Crowe (@LizCrowe2) returns to the St Emlyn's podcast to chat with Iain about how we can communicate more effectively with children in critical care. This podcast explores topics that are important not just for clinicians, but anyone who works with or has children.

Prof Rick Body and Niall Morris, Clinical Research Fellow, discuss selection bias and how it can affect clinical research. This podcast is the third in the St Emlyn's series "Clinical Appraisal Nuggets".

We've all had headaches, but not often severe enough to prompt us to seek help in an Emergency Department. In our practice 10% of patients who do present to the ED  with a primary presentation of headache will have serious pathology and our job as Emergency Physicians is to work out who these are. Key to this is actively ruling out the life-threatening and life-changing diagnoses: Subarachnoid Haemorrhage Meningitis Tumours and Space Occupying Lesions Temporal Arteritis Listen to Simon and Iain discuss how to approach these patients here Further ResourcesHeadaches at Life in the Fast Lane - a great summary from the LiTFL crew NICE Guidelines (NCG150) - diagnosis and management of headaches; there's a flowchart and some red flags although you could read the St Emlyn's summary here! Headache from the Flipped EM Classroom

After the recent publication of the process trial in the NEJM and discussion all over the FOAM forums - I have been contemplating how we might apply the findings in our smaller EDs, in the small rural towns where patients still get sepsis, and I believe should get world's best care. PROCESS has many helpful findings that I think we can utilise... despite being a negative trial! Here's my thoughts in the first "Broome Pearl" podcast - its just me, solo with my thoughts.... A few links that I mention: The ProCess trial in NEJM and supplementary data are HERE The New York STOP SEPSIS collaboration has info on EMCRIT HERE Simon Carley's piece on St Emlyn's looking at our outcomes with Sepsis over the past dozen years Seth Trueger's analysis on MDAware is here