![The St.Emlyn’s Podcast](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg.jpg)
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A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn ’s team are all passionate educators and clinicians who strive to bring you the best evidence based education. Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles. St Emlyn’s is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians.
Episodes
![Ep 238 - Positive and Negative Predictive Values: Critical Appraisal Nugget](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
4 days ago
4 days ago
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.
![Ep 237 - Hybrid Closed Loop Insulin Pumps with Nicola Trevelyan at PREMIER 2024](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/hybrid_closed_loop_insulin_pumps_qtyp4i_300x300.jpg)
Wednesday Jul 17, 2024
Ep 237 - Hybrid Closed Loop Insulin Pumps with Nicola Trevelyan at PREMIER 2024
Wednesday Jul 17, 2024
Wednesday Jul 17, 2024
In today's episode, taken from live recordings at PREMIER 2024, we dive into an increasingly common treatment for type 1 diabetes: hybrid closed loop insulin pumps. We'll begin with a brief overview of traditional insulin pumps and explain how hybrid closed loops are different. The core of our discussion will be centered around three case studies, illustrating potential scenarios you might encounter in a pediatric emergency department and how to manage them effectively.
With NICE's recent technology appraisal advocating for universal access to hybrid closed loop systems for all type 1 diabetes patients, it's crucial to understand these devices. Over the next few years, you'll likely encounter these systems frequently. We'll cover the essentials of how these pumps work, their benefits, and potential issues that might arise, such as connectivity problems, cannula issues, and handling intercurrent illnesses.
Join us as we explore the revolutionary impact of hybrid closed-loop systems, which offer better glucose control and significantly improve the quality of life for those with type 1 diabetes.
Dr Nicola Trevelyan has been the Clinical Lead for the Paediatric Diabetes Service in Southampton for the last 20 years. During this time, she has seen huge changes in the management of CYP with diabetes. She has been involved in several large multicentre trials for paediatric diabetes, helping to better our understanding of how best to use new technologies in diabetes management in children and move forward access to new treatment technologies. She was one of the founding committee members for the Assoc of Children's Diabetes Clinicians (ACDC) in 2006 and has been on working parties for BSPED helping evidence base and re-write the national DKA guidelines in 2020 and for the National Paediatric Diabetes Audit. For the last 4 years, she has been on the Clinical Advisory Group for the RCPCH Quality Improvement Programme for Paediatric Diabetes.
![Ep 236 - Occlusive Myocardial Infarction, ECGs and AI with Steve Smith](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Occlusive_MI_68c4jx_300x300.jpg)
Wednesday Jul 10, 2024
Ep 236 - Occlusive Myocardial Infarction, ECGs and AI with Steve Smith
Wednesday Jul 10, 2024
Wednesday Jul 10, 2024
It was a huge pleasure to sit down with Steve Smith, a name synonymous with ECG expertise. Steve, renowned worldwide for his influential ECG blog, has been a pivotal figure in advancing our understanding of ECGs. Many of us have honed our ECG skills thanks to Steve’s insights. I had the opportunity to meet Steve about a decade ago at one of the SMACC conferences. Today, we delve into the fascinating world of occlusive myocardial infarction (OMI) and its comparison to STEMI (ST-elevation myocardial infarction), and explore the promising future of artificial intelligence in ECG interpretation.
A comprehensive blog post with references is available here
![Ep 235 - Eating Disorders in the Emergency Department with Anna Kyle at PREMIER 2024](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Eating_disorders_6rvnzd_300x300.jpg)
Tuesday Jul 02, 2024
Tuesday Jul 02, 2024
Eating disorders are a critical health concern that tragically lead to numerous deaths, especially among young women during their transition age. Anorexia nervosa, in particular, is the most deadly psychiatric condition with a 10% lifetime mortality risk. Recent coroner reports highlight significant medical failings and a dire lack of knowledge among healthcare providers. Given the 90% increase in eating disorder admissions over the last five years, this issue demands urgent attention.
In this podcast Anna Kyle, a consultant paediatrician, covers all you need to know when looking after a young person or young adult with an eating disorder in the Emergency Department.
Comprehensive notes can be found here
![Ep 234 - May 2024 Monthly Round Up - RCEM conference highlights, being EPIC and more](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 27, 2024
Ep 234 - May 2024 Monthly Round Up - RCEM conference highlights, being EPIC and more
Thursday Jun 27, 2024
Thursday Jun 27, 2024
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.
![Ep 233 - Sudden Cardiac Death with Harshil Duptia at PREMIER 2024](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 20, 2024
Ep 233 - Sudden Cardiac Death with Harshil Duptia at PREMIER 2024
Thursday Jun 20, 2024
Thursday Jun 20, 2024
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.
![Ep 232 - April 2024 Monthly Round Up - Bougies, cardiac arrest, trauma, sepsis, race and medicine and choosing with intention](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/April_2024_re4qk7_300x300.jpg)
Wednesday Jun 05, 2024
Wednesday Jun 05, 2024
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
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00:00 - 00:34
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Do Bougies increase first pass success?
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00:34 - 04:28
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Cardiac arrest management - dual sequence defibrillation, personalised care and drones for AEDS.
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04:28 -10:50
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Trauma - Cardiac tamponade vs exsanguination
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10:50 - 13:35
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Sepsis - effect of the microcirculation
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13:35 - 15:23
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A history of race and medicine
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16:54 - 18:36
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Differential attainment
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18:37 - 19:27
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What can we do about addressing EDI issues?
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19:28 - 22:20
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Choosing with intention
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20:21 - 26:55
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The ARC-H Principle
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26:56 - 28:32
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Closing thoughts
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28:33 - 30:10
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Recommended Conferences
Premier Conference - 11th-12th June 2024, Winchester
![Ep 231 - February and March 2024 Monthly Round Up - Liver disease, mCPR, Global Health and Elderly patients](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/February_and_March_2024_m75m6h_300x300.jpg)
Saturday May 04, 2024
Saturday May 04, 2024
After the bumper double paper review episode, we fit two months of blog content into one episode. Iain and Simon discuss the management of the patient with chronic liver disease who has an acute decompensation, global health connections, whether mechanical CPR is more effective than human CPR and the potential effects on elderly patients staying in the ED overnight.
References
Conor Crowley, Justin Salciccioli, Wei Wang, Tomoyoshi Tamura, Edy Y. Kim, Ari Moskowitz, The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study, Resuscitation, 2024, 110142, ISSN 0300-9572, https://doi.org/10.1016/j.resuscitation.2024.110142.
Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, Bloom B, Catoire P, Berard L, Cachanado M, Simon T, Laribi S, Freund Y; FHU IMPEC-IRU SFMU Collaborators; FHU IMPEC−IRU SFMU Collaborators. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961. PMID: 37930696; PMCID: PMC10628833.
Recommended Conferences
Premier Conference - 11th-12th June 2024, Winchester
![Ep 230 - Top Twenty Papers of 2023 - Part 2 - Haemorrhage and Cardiac](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Apr 23, 2024
Ep 230 - Top Twenty Papers of 2023 - Part 2 - Haemorrhage and Cardiac
Tuesday Apr 23, 2024
Tuesday Apr 23, 2024
In this second of a two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site.
In Part 2 they discuss papers about major haemorrhage, trauma, cardiac arrest and more.
In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.
Papers
Jansen JO et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1862-1871. doi: 10.1001/jama.2023.20850. PMID: 37824132; PMCID: PMC10570916.
Davenport R et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023 Nov 21;330(19):1882-1891. doi: 10.1001/jama.2023.21019. PMID: 37824155; PMCID: PMC10570921.
PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jul 13;389(2):127-136. doi: 10.1056/NEJMoa2215457. Epub 2023 Jun 14. PMID: 37314244.
Shepherd JM et al Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial. Intensive Care Med. 2023 Aug;49(8):922-933. doi: 10.1007/s00134-023-07135-3. Epub 2023 Jul 20. PMID: 37470832; PMCID: PMC10425486.
Bouzat P et al. Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Apr 25;329(16):1367-1375. doi: 10.1001/jama.2023.4080. PMID: 36942533; PMCID: PMC10031505.
Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg. 2023 May 1;158(5):532-540. doi: 10.1001/jamasurg.2022.6978. Erratum in: JAMA Surg. 2023 Apr 5;: PMID: 36652255; PMCID: PMC9857728.
Marsden MER, Kellett S, Bagga R, Wohlgemut JM, Lyon RL, Perkins ZB, Gillies K, Tai NR. Understanding pre-hospital blood transfusion decision-making for injured patients: an interview study. Emerg Med J. 2023 Nov;40(11):777-784. doi: 10.1136/emermed-2023-213086. Epub 2023 Sep 13. PMID: 37704359; PMCID: PMC10646861.
Wohlgemut JM, Pisirir E, Stoner RS, Kyrimi E, Christian M, Hurst T, Marsh W, Perkins ZB, Tai NRM. Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome. Trauma Surg Acute Care Open. 2024 Jan 12;9(1):e001214. doi: 10.1136/tsaco-2023-001214. PMID: 38274019; PMCID: PMC10806521.
Cheskes S, Verbeek PR, Drennan IR, McLeod SL, Turner L, Pinto R, Feldman M, Davis M, Vaillancourt C, Morrison LJ, Dorian P, Scales DC. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151.
Siddiqua N, Mathew R, Sahu AK, Jamshed N, Bhaskararayuni J, Aggarwal P, Kumar A, Khan MA. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial. Emerg Med J. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. PMID: 38050078.
Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2023 Feb;40(2):108-113. doi: 10.1136/emermed-2021-212294. Epub 2022 Sep 30. PMID: 36180168.
Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR; ARREST trial collaborators. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023 Oct 14;402(10410):1329-1337. doi: 10.1016/S0140-6736(23)01351-X. Epub 2023 Aug 27. PMID: 37647928.
Issa EC, Ware PJ, Bitange P, Cooper GJ, Galea T, Bengiamin DI, Young TP. The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture. J Emerg Med. 2023 Mar;64(3):400-404. doi: 10.1016/j.jemermed.2023.01.013. PMID: 37019501.
![Ep 229 - Top Twenty Papers of 2023 - Part 1 - Airway](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday Apr 17, 2024
Ep 229 - Top Twenty Papers of 2023 - Part 1 - Airway
Wednesday Apr 17, 2024
Wednesday Apr 17, 2024
In this two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site.
In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.
Check out part 2 for papers about major haemorrhage, trauma, cardiac arrest and more.
Papers
![Ep 228 - January 2024 Monthly Round Up - New Year Resolutions, intubating poisoned patients and wellbeing in the ED](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Feb 24, 2024
Saturday Feb 24, 2024
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.
![Ep 227 - December 2023 Round Up -Major bleeding decison making, E-scooters, AI and advanced resuscitation possibilities](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Feb 02, 2024
Friday Feb 02, 2024
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
![Ep 226 - October and November 2023 Monthly Round Up - Trauma, Resuscitation, Aortic Dissection and Silence](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Dec 18, 2023
Monday Dec 18, 2023
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.
![Ep 225 - A deep dive into ECMO with Andy Curry](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Nov 09, 2023
Ep 225 - A deep dive into ECMO with Andy Curry
Thursday Nov 09, 2023
Thursday Nov 09, 2023
One of the benefits of the use of online platforms for meetings is the ability to record and disseminate talks more widely. This is an edited version of a talk given by Dr Andy Curry, Consultant Cardiothoracic Intensive Care Consultant at University Hospital Southampton, covering the origins of Extra Corporeal Membrane Oxygenation (ECMO) right up to the present day. Throughout the talk, he gives real world experience, coupled with a knowledge of the literature to communicate all you could ever want to know about this fascinating and potentially very exciting therapy.
References
Peek GJ, Clemens F, Elbourne D, Firmin R, Hardy P, Hibbert C, Killer H, Mugford M, Thalanany M, Tiruvoipati R, Truesdale A, Wilson A. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res. 2006 Dec 23;6:163. doi: 10.1186/1472-6963-6-163. PMID: 17187683; PMCID: PMC1766357.
Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, Hockings L, Shaw J, Duffy SJ, Burrell A, Cameron P, Smit de V, Kaye DM. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015 Jan;86:88-94. doi: 10.1016/j.resuscitation.2014.09.010. Epub 2014 Oct 2. PMID: 25281189.
Belohlavek J, Smalcova J, Rob D, et al. Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2022;327(8):737–747. doi:10.1001/jama.2022.1025
Martje M. Suverein, M.D., Thijs S.R. Delnoij, M.D., et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. The INCEPTION trial. N Engl J Med 2023; 388:299-309. DOI: 10.1056/NEJMoa2204511
![Ep 224 - September 2023 Monthly Round Up - Top Ten Papers and more](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday Oct 11, 2023
Ep 224 - September 2023 Monthly Round Up - Top Ten Papers and more
Wednesday Oct 11, 2023
Wednesday Oct 11, 2023
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.
![Ep 223 - July and August 2023 Monthly Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Sep 18, 2023
Ep 223 - July and August 2023 Monthly Round Up
Monday Sep 18, 2023
Monday Sep 18, 2023
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.
![Ep 222 - Monthly Round Up June 2023 - Airways, AMAX4, Head Injuries, TXA and more](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jul 13, 2023
Ep 222 - Monthly Round Up June 2023 - Airways, AMAX4, Head Injuries, TXA and more
Thursday Jul 13, 2023
Thursday Jul 13, 2023
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.
![Ep 221 - Brief Resolved Unexplained Events with Jilly Boden at the PREMIER Conference](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday Jun 21, 2023
Ep 221 - Brief Resolved Unexplained Events with Jilly Boden at the PREMIER Conference
Wednesday Jun 21, 2023
Wednesday Jun 21, 2023
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.
![Ep 220 - Penetrating Injuries with John O’Neil at the PREMIER Conference](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Jun 19, 2023
Ep 220 - Penetrating Injuries with John O’Neil at the PREMIER Conference
Monday Jun 19, 2023
Monday Jun 19, 2023
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
![Ep 219 - Blast Injuries with Chris Hillman at the PREMIER Conference](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Jun 17, 2023
Ep 219 - Blast Injuries with Chris Hillman at the PREMIER Conference
Saturday Jun 17, 2023
Saturday Jun 17, 2023
Chris brought us his reflections amnd knowledge from some of his extensive experience as a military EM consultant in two wars. Blast injury could be blunt, penetrating, may involve major haemorrhage: you have to expect any injury possible. It’s worldwide and it’s getting more common.
Blast injury affects every body cavity, but it is the CABC approach that matters, Doing the basics well is still the key. Bleeding points may not be obvious so apply tourniquets wherever stops the bleeding.
Often patients will not arrive in ones or twos but as a whole group affected by an incident, so it is vital we are prepared. The Paediatric Blast Injury Field Manual is a free resource available to download here and is highly recommended.
Chris Hillman is a Consultant in Emergency Medicine and Paediatric Emergency Medicine, working in Southampton. Serving in the Royal Navy since university, he has deployed on Ships, Submarines and with Commando units globally, and with the Army to Afghanistan and Iraq. He is the outgoing Consultant Advisor in Emergency Medicine and Clinical Director Commando Forward Surgical Group.
![Ep 218 - Non epileptiform seziures with Steve Warriner at the PREMIER Conference](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 15, 2023
Ep 218 - Non epileptiform seziures with Steve Warriner at the PREMIER Conference
Thursday Jun 15, 2023
Thursday Jun 15, 2023
This is the second in our series of talks recorded live in June 2023 at the PREMIER conference.
Looking after patients with non-epileptiform seizures are a challenging, and common, event in the Emergency Department. 10% of attendances at paediatric neurology clinics are thought to be 'functional' and a lot of these will also present to the ED. These problems can involve a wide range of physical or sensory manifestations, almost all of wide have significant differentials which we cannot miss.
A large number of these patients can end up with an incorrect diagnosis, some of this due to confirmation bias by clinicians, but also some with psychogenic non-epileptiform seizures may coexist with organic problems.
The history is key and can be helped significantly by watching videos of events. There may be other factors giving a clue to a non-epileptic cause. Sometimes this will only happen in one place, like school, and the history may be inconsistent. Awareness and generalised bilateral movements, with episodes that are different each time all point to a non epileptiform origin. And then there are symptoms just 'not fitting' with our knowledge of dermatomal distribution.
There are Red Flags - Events happening during exercise, neurological signs, unpredictability and patterns to the events all point to a more sinister diagnosis
Management is incredibly difficult, particularly in trhe ED. Don't suggest an organic diagnosis and leave some ambiguity. There is time to get more information and there are few definitive diagnostic tests. EEGs are notoriously unreliable. Self help groups can help.
Steve Warriner has worked as a paediatrician at the QA in Portsmouth for the last 16 years. He trained in various regions in the UK including the Midlands, Yorkshire and the North East of England before working in Somerset for a brief period. He has a particular interest in epilepsy and neurological conditions in children and lead the district epilepsy service in Portsmouth. He teaches on the British Paediatric Neurology Association epilepsy training courses both in the UK and across the world. He was part of the team who designed and implemented the training course (initially in Myanmar) and the method of cascade training has recently been recognised by the World Health Organisation and the course now runs in nearly 30 counties in 3 languages. Steve recently chaired a multidisciplinary working group to update the Advanced Life Support Group guideline for management of prolonged seizures. In his spare time, Steve is a triathlete who qualified for and competed in the World Ironman Championship race in Hawaii in 2022.
![Ep 217 - Weaning the wheezy child with David James at the PREMIER Conference](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Jun 13, 2023
Ep 217 - Weaning the wheezy child with David James at the PREMIER Conference
Tuesday Jun 13, 2023
Tuesday Jun 13, 2023
This is the first in a series of podcasts, recorded live at the Premier Conference in Winchester.
In this episode, David James challenges our current practice when we give a 'weaning plan' for children discharged with wheeze.
There is a plan here that you can review and give to patients and their carers.
More information at these excellent websites
David James has been a PEM Consultant at University Hospital Southampton since 2018. His main interests are in training and education, adolescent emergency medicine and Quality Improvement. He is the Divisional Director of Medical Education and a Training advisor on the PEMISAC. He is the acute care lead for Wessex Healthier Together and has led several projects including those around acute wheeze at UHS and regionally. Outside of work he enjoys swimming, cycling and running and is extremely average at triathlons.
![Ep 216 - April 2023 Monthly Round Up: HALO procedures and Blood Transfusion](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Jun 10, 2023
Ep 216 - April 2023 Monthly Round Up: HALO procedures and Blood Transfusion
Saturday Jun 10, 2023
Saturday Jun 10, 2023
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.
![Ep 215 - March 2023 Monthly Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday May 03, 2023
Ep 215 - March 2023 Monthly Round Up
Wednesday May 03, 2023
Wednesday May 03, 2023
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
![Ep 214 - Shock from St Emlyn’s Medical School](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Apr 24, 2023
Ep 214 - Shock from St Emlyn’s Medical School
Monday Apr 24, 2023
Monday Apr 24, 2023
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
![Ep 213 - Sensitivity and Specificity (CAN 10)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Apr 17, 2023
Ep 213 - Sensitivity and Specificity (CAN 10)
Monday Apr 17, 2023
Monday Apr 17, 2023
The latest CAN is one of our brand-new 'revision editions' -- brief podcasts aimed at covering the essentials of critical appraisal for medical students and junior doctors preparing for exams.
With the help of Gregory Yates, an academic doctor based in Manchester, this episode introduces two core concepts: sensitivity and specificity. These are two ways of thinking about the accuracy of a diagnostic test. Knowing the sensitivity and specificity of an investigation will give you a decent idea of how it should be used in the emergency department.
Sensitivity (Sn) describes the chance that a test will be positive if your patient has the condition you're testing for. Some people call it the 'true positive rate' or alternatively the positivity in disease (PID) rate. If you need a hand remembering it, you can always remember that PID is a sensitive issue.
Meanwhile, specificity (Sp) considers the chance of a test being negative if the patient doesn't have the condition you're testing for. It's the 'true negative rate' or alternatively the negativity in health (NIH) rate. There are times when we particularly need a test to have a high sensitivity. This is generally when we want to be particularly confident that a test accurately identifies everyone with the relevant condition because we really don't want to miss it. We need a high sensitivity to rule out disease. (Sn-uff it out). At other times, we need to be confident that a patient with a positive test actually has the disease - for example, if the treatment is unpleasant or involves exposing patients to risk. In that case, we want a high specificity to rule in disease. (Sp-in it in).
In this CAN, we use D-Dimer as an example of a very sensitive investigation: it’s positive in nearly 100% of cases of venous thromboembolism. Specificity describes the likelihood that the test will be negative if your patient does not have the disease. We use HbA1c as an example of a highly specific investigation: it’s rarely used in the emergency department, but if it’s elevated, we can be almost certain that the patient is diabetic. HbA1c is almost never (<1%) raised in non-diabetics.
The trouble is, many patients with a positive D-Dimer do not have a venous clot, and the majority of diabetics will have a normal HbA1c! No test is perfect, and we discuss how emergency physicians weigh up sensitivity and specificity when choosing which investigations are the best "fit" for clinical decision-making. By the end of this CAN, you will be ready to do the same -- in your exams, and on the shop floor.
![Ep 212 - February 2023 Monthly Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Mar 20, 2023
Ep 212 - February 2023 Monthly Round Up
Monday Mar 20, 2023
Monday Mar 20, 2023
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.
![Ep 211 - Semi structured interviews (CAN 9)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Feb 27, 2023
Ep 211 - Semi structured interviews (CAN 9)
Monday Feb 27, 2023
Monday Feb 27, 2023
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?
![Ep 210 - January 2023 Monthly Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Feb 13, 2023
Ep 210 - January 2023 Monthly Round Up
Monday Feb 13, 2023
Monday Feb 13, 2023
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
![Ep 209 - November and December 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Jan 16, 2023
Ep 209 - November and December 2022 Round Up
Monday Jan 16, 2023
Monday Jan 16, 2023
A special double edition covering the blog posts from November and December and more. We discuss evidence based medicine with the DoseVF trial, and more from RECOVERY, discussion about 'what is downtime' and how we organise follow up for patients who don't live in our area and what happened at the amazing London Trauma Conference
We also announced some of the plans for StEmlynsWILD. Look out for booking details and more in the coming weeks.
![Ep 208 - What is Wellbeing with Liz Crowe](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/wellbeing_yndyq5_300x300.png)
Saturday Dec 10, 2022
Ep 208 - What is Wellbeing with Liz Crowe
Saturday Dec 10, 2022
Saturday Dec 10, 2022
Wellbeing is very complex, as it is an individual construct that is strongly aligned and interpreted through a lens of personal values, philosophy, culture, faith, and goals for life. Most importantly, wellbeing is dynamic rather than homeostatic and a subjective state determined by the individual.
Yet we use the term wellbeing to describe a wide variety of different things (often in terms of being the opposite of burnout which it most certainly isn't).
In this second episode of our series Liz Crowe discusses in detail what the literature says about wellbeing and how we may be able to use this going forward.
Please do like and subscribe. Thanks for listening.
![Ep 207 - Burnout with Liz Crowe](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Burnout_cover_id89sq_300x300.png)
Sunday Nov 27, 2022
Ep 207 - Burnout with Liz Crowe
Sunday Nov 27, 2022
Sunday Nov 27, 2022
Burnout is a term that seems to be used a lot these days, but what does it really mean? In this episode Dr Liz Crowe explains all, and will almost certainly change the way you view burnout.
Liz, who be well known to St Emyn's audiences, has just completed her PhD on "Understanding the risk and protective factors for burnout and wellbeing of staff working in the Paediatric Intensive Care Unit: PICU staff wellbeing" and has an unrivalled real world and evidence based experience of what these terms really mean.
In this first in a special series Liz goes into depth describing not only what burnout is, but how it can be measured (and the limitations of this) and most importantly how this is a system issue and not a diagnosis.
In the next episode we will discuss another commonly used term 'wellbeing'.
We think this series is incredibly important and hope you will help us share it far and wide. You can read the accompanying blogpost here.
![Ep 206 - October 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Monday Nov 14, 2022
Ep 206 - October 2022 Round Up
Monday Nov 14, 2022
Monday Nov 14, 2022
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.
![Ep 205 - September 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Oct 18, 2022
Ep 205 - September 2022 Round Up
Tuesday Oct 18, 2022
Tuesday Oct 18, 2022
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.
![Ep 204 - August 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Oct 08, 2022
Ep 204 - August 2022 Round Up
Saturday Oct 08, 2022
Saturday Oct 08, 2022
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.
![Ep 203 - June and July 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Aug 07, 2022
Ep 203 - June and July 2022 Round Up
Sunday Aug 07, 2022
Sunday Aug 07, 2022
Simon and Iain run through the latest highlights from the St Emlyn's blog and podcast, including the FORCE study, the EXIT study and more about Vitamin C in sepsis...
We hope you enjoy the podcast. Please do like and subscribe on your preferred podcast app and tell your friends and colleagues about us.
![Ep 202 - May 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 16, 2022
Ep 202 - May 2022 Round Up
Thursday Jun 16, 2022
Thursday Jun 16, 2022
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...)
![Ep 201 - March/April 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday May 12, 2022
Ep 201 - March/April 2022 Round Up
Thursday May 12, 2022
Thursday May 12, 2022
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!
![Ep 200 - February 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Mar 25, 2022
Ep 200 - February 2022 Round Up
Friday Mar 25, 2022
Friday Mar 25, 2022
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.
![Ep 199 - Feedback: Update and inter-speciality complexity. St Emlyn’s](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Mar 12, 2022
Ep 199 - Feedback: Update and inter-speciality complexity. St Emlyn’s
Saturday Mar 12, 2022
Saturday Mar 12, 2022
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.
![Ep 198 - January 2022 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Feb 22, 2022
Ep 198 - January 2022 Round Up
Tuesday Feb 22, 2022
Tuesday Feb 22, 2022
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.
![Ep 197 - December 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Jan 14, 2022
Ep 197 - December 2021 Round Up
Friday Jan 14, 2022
Friday Jan 14, 2022
The Season Finale that you've all be waiting for. Our last episode of season 8 includes discussion about racial bias in sats monitoring, CT scans to investigate subarachnoid haemorrhage and the importance of (consensual) touch.
Thanks again for listening. Please like and subscribe and all that. We look forward to seeing you next season (in about a month...)
Iain and Simon
![Ep 196 - November 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Dec 14, 2021
Ep 196 - November 2021 Round Up
Tuesday Dec 14, 2021
Tuesday Dec 14, 2021
Iain is flying solo this month, with discussion about narrative story tellling, airway management in the ED and using pigtail catheters in management of haemothorax.
We hope all you all have a very happy Christmas and chance over the festive period to relax. Do explore our back catalogue of podcasts for more on wellbeing and grief at Christmas.
Please do subscribe and rate and review us on your chosen podcast provider.
Take care all.
![Ep 195 - October 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Nov 19, 2021
Ep 195 - October 2021 Round Up
Friday Nov 19, 2021
Friday Nov 19, 2021
Our round up of all the blog had to offer in October 2021. There's discussion about evidence based medine in the REST and CTCA for intermediate chest pain trials, more about cauda equina and highlights from the Paediatric Colloquium in Australia, as well as the good humoured chat.
Please see the website for more information and don't forget to subscribe and rate the podcast (if you think it's any good).
![Ep 194 - August 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Sep 25, 2021
Ep 194 - August 2021 Round Up
Saturday Sep 25, 2021
Saturday Sep 25, 2021
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.
![Ep 193 - June and July 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Aug 08, 2021
Ep 193 - June and July 2021 Round Up
Sunday Aug 08, 2021
Sunday Aug 08, 2021
Iain and Simon discuss the best from the blog in June and July. There's COVID chat (of course). thunderstorm asthma, a glance into the future and much, much more.
![Ep 192 - May 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 17, 2021
Ep 192 - May 2021 Round Up
Thursday Jun 17, 2021
Thursday Jun 17, 2021
It's been a busy month on the blog with plenty for Iain and Simon to talk about. The Manchester Arena bombing, new guidelines for Anaphylaxis management, Adult Congenital Heart Disease, Calcium in Major Haemorrhage and Spontaneous Coronary Artery Dissection all get a mention alongside the usual witterings of two middle aged emergency physicians.
![Ep 191 - Adult Congenital Heart Disease in the ED: Part 2](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday May 26, 2021
Ep 191 - Adult Congenital Heart Disease in the ED: Part 2
Wednesday May 26, 2021
Wednesday May 26, 2021
This is the second in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.
In this episode we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta.
![Ep 190 - Adult Congenital Heart Disease in the ED: Part 1](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/ACHD_cover8bpna_300x300.png)
Thursday May 20, 2021
Ep 190 - Adult Congenital Heart Disease in the ED: Part 1
Thursday May 20, 2021
Thursday May 20, 2021
This is the first in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.
Look out for Part 2, which will be released next week, where we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta.
Background
With advances in paediatric cardiac surgery, more and more patients with complex congenital heart disease are surviving to adulthood: in the 1950s you might expect a survival rate of about 10%, whereas now this is more like 85%. In fact, there are more patients in the adult congenital heart disease population than there are in the paediatric one (with 2.3 million adults vs 1.9 million children in Europe).
Many patients with Adult Congenital Heart Disease are young and able to live a relatively normal life. This means that they can travel and take part in just the same sort of activities as those without ACHD. They may well turn up in your Emergency Department one day, regardless of whether you are a tertiary centre or a district general hospital (DGH).
They are experts, and know their disease well, but this does not abstain you from a responsibility to know about them too! When these patients become unwell, they can go downhill very fast and you may not have the chance to discuss with them their exact lesion and its management.
The anatomy and physiology of these patients is abnormal, so they may present in atypical ways, and may not respond to usual medical interventions: in fact, some of our usual treatments may even be harmful.
However, starting with our usual 'ABC' approach is by far the best way to go, whilst gathering more information and contacting their specialist centre. Many patients will have their last clinic letter and ECG with them (which will also have the direct dial number of their specialist). And if they, or their relative, say there is something wrong you must believe them and do all you can to make sure they are fully investigated.
![](https://www.stemlynsblog.org/wp-content/uploads/2021/05/Picture1.png)
The presence of scars may give you some clues as to the patient's underlying condition and previous surgical repairs. (BMJ 2016; 354: i3905)
A General Approach
- Do your usual ABC assessment.
- Pay particular attention to the respiratory rate - this should be normal.
- Give oxygen if they look unwell.
- They should have a 'normal' blood pressure - any hypotension should be taken as abnormal and investigated.
The Fontan Circulation
This is not a condition in itself, but in fact the resulting circulation after a series of operations that could've been performed due to a number of different underlying conditions:
- Tricuspid Atresia
- Double Inlet Left Ventricle
- Atrio-ventricular Septal Defect – unbalanced
- Pulmonary Atresia
- Hypoplastic Left Heart Syndrome
In essence these patients are born with a single functioning ventricle, that has to be utilised to supply the systemic side of the circulation, whilst the Fontan acts as a passive means of returning blood to the pulmonary circulation.
It was first devised in the early 1970s by Dr Francis Fontan, so the majority of patients with this are in their mid thirties and younger.
Potential reasons for admission to the ED - Fontan circulation
1, Arrythmia
As the patient is entirely dependent on their systemic ventricle to work optimally, any disturbance of the delivery into it is very poorly tolerated. Thus, any arrhythmia is life threatening, even a mild atrial tachycardia.
These patients need to be returned to sinus rhythm as quickly as possible and the recommended method for this is DC cardioversion in expert hands.
Fontan patients have an incredibly fragile circulation and any change in their respiratory physiology can be life threatening, especially if it increases their pulmonary pressures (and thus prevents the passive flow within the Fontan circulation). These patients are not candidates for sedation in the ED and should have an experienced anaesthetist to manage them during the procedure.
Beware if the patient comes in and tells you they are fasted! This means they have been in this situation before and needed DC cardioversion.
2, Haemoptysis
Over time the patient develops venous hypertension within the Fontan connection. This causes the formation of collateral vessels, that may link into the bronchial arterial tree.
If the patient presents in shock treat them as you would any other patient with emergency blood transfusion.
Any haemoptysis, however small, may herald the beginning of a massive bleed. These patients need further investigation, probably a CT chest with contrast. These vessels may then be coiled by interventional radiology.
3, Cyanosis
If the patient has a non fenestrated Fontan they should have normal oxygen saturations. However, if there is a fenestration there will be shunting and therefore a reduction in oxygenation.
For patients this is trade of between being pink or blue, each of which have complications.
Dr Sam Fitzsimmons
Dr Sam Fitzsimmons is a Consultant Cardiologist in Adult Congenital Heart Disease (ACHD) at the University Hospital Southampton, UK. Sam also subspecialises in pulmonary hypertension and maternal cardiology. Working within a tertiary surgical ACHD centre, Sam delivers an ACHD on call service for emergency admissions, inpatient care, routine outpatient follow-up, intra-operative imaging and post-surgical care, as well as specialist clinics in Pulmonary Hypertension and Maternal Cardiology. Sam holds a Honorary Senior Clinical Lecturer post with the University of Southampton as she is passionate about teaching and in particular, she is enthusiastic about helping demystify congenital heart disease for many non-specialist to improve patient care. Sam is well published in peer review journals, cardiology textbooks and specialist guidelines.
![Ep 189 - April 2021 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/April_2021_Round_Upbiuq7_300x300.jpg)
Friday May 14, 2021
Ep 189 - April 2021 Round Up
Friday May 14, 2021
Friday May 14, 2021
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.