![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 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 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 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 160 - March 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/march_300x300.jpg)
Sunday Apr 05, 2020
Ep 160 - March 2020 Round Up
Sunday Apr 05, 2020
Sunday Apr 05, 2020
Iain and Simon discuss Covid19 and more in this review of the best of the blog from March 2020.
![Ep 157 - ICU for the non-intensivist with Sarah Thorton](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Mar 24, 2020
Ep 157 - ICU for the non-intensivist with Sarah Thorton
Tuesday Mar 24, 2020
Tuesday Mar 24, 2020
Simon chats to Sarah Thornton, consultant anaesthetist, intensivist and head of the NW school of anaesthesia on preparing to work in a critical care unit during the Covid-19 pandemic.
![Ep 143 - The Future of Diagnostics with Rick Body](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Aug 31, 2019
Ep 143 - The Future of Diagnostics with Rick Body
Saturday Aug 31, 2019
Saturday Aug 31, 2019
Prof. Rick Body is an internationally recognised expert in diagnostic testing. In this podcast he takes us through diagnostics today and also the near future which may change almost everything.
You can read more and see the slides/video at http://www.stemlynsblog.com
![Ep 142 - Psychological performance in the Resus Room with Ashley Liebig](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Tuesday Jul 23, 2019
Ep 142 - Psychological performance in the Resus Room with Ashley Liebig
Tuesday Jul 23, 2019
Tuesday Jul 23, 2019
This talk focuses on how we can optimise our psychological performance in critical care situations, the type of situations that Simon describes as Time Critical, Information light. The Audio is available below, or watch the full presentation above.
Don't forget to watch the video on the St Emlyn's site http://www.stemlynsblog.org
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![Ep 141 - June 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Jul 14, 2019
Ep 141 - June 2019 Round Up
Sunday Jul 14, 2019
Sunday Jul 14, 2019
Here's our regular round up of the blog and podcast from June 2019.
Beyond ATLS https://www.stemlynsblog.org/beyond-atls-with-alan-grayson-at-stemlynslive-st-emlyns/
Traumatic Cardiac Arrest https://www.stemlynsblog.org/traumatic-cardiac-arrest-tca-podcast-with-prof-jason-smith-rn-st-emlyns/
The psychological impact of emergency medicine https://www.stemlynsblog.org/how-events-in-emergency-medicine-impact-doctors-psychological-well-being-st-emlyns/
Can we use IO aspirate for analysis https://www.stemlynsblog.org/jc-can-we-really-use-io-blood-for-analysis-st-emlyns/
Don't forget the Bubbles conference and site https://dontforgetthebubbles.com/
![Ep 140 - GI emergencies with Chris Gray at #stemlynsLIVE](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Thursday Jul 04, 2019
Ep 140 - GI emergencies with Chris Gray at #stemlynsLIVE
Thursday Jul 04, 2019
Thursday Jul 04, 2019
This is Chris's talk from #stemlynsLIVE on GI emergencies. Remember to check out the blog for the background, references and more.
![Ep 135 - April 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Wednesday May 01, 2019
Ep 135 - April 2019 Round Up
Wednesday May 01, 2019
Wednesday May 01, 2019
Here is the latest from the St Emlyn's team
![Ep 134 - March 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Wednesday Apr 24, 2019
Ep 134 - March 2019 Round Up
Wednesday Apr 24, 2019
Wednesday Apr 24, 2019
Here’s our regular monthly round up of the best of the blog from March 2019
![Ep 133 - February 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Apr 13, 2019
Ep 133 - February 2019 Round Up
Saturday Apr 13, 2019
Saturday Apr 13, 2019
Our regular monthly round up of the best of the blog from Feb 2019.
![Ep 128 - Can we use diagnostic probability to guide treatment thresholds in ACS with Charlie Reynard and Rick Body](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Wednesday Jan 30, 2019
Wednesday Jan 30, 2019
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.
![Ep 126 - December 2018 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Monday Dec 31, 2018
Ep 126 - December 2018 Round Up
Monday Dec 31, 2018
Monday Dec 31, 2018
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/
![Ep 112 - Acute Psychiatric Emergencies in the ED.](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns21400.jpg)
Thursday May 31, 2018
Ep 112 - Acute Psychiatric Emergencies in the ED.
Thursday May 31, 2018
Thursday May 31, 2018
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.
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- Subscribe to the blog (look top right for the link)
- Subscribe to our PODCAST on iTunes
- Follow us on twitter @stemlyns
- PLEASE Like us on Facebook
- Find out more about the St.Emlyn’s team
- Come join us at our conference in October 2018
![Ep 99 - October 2017 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Oct 21, 2017
Ep 99 - October 2017 Round Up
Saturday Oct 21, 2017
Saturday Oct 21, 2017
Simon (@EMManchester) and Iain (@docib) review some of the articles from the St Emlyns blog site (http://stemlynsblog.org/) from recent weeks and chat about the current state of Emergency Medicine in the UK.
1:00 - How to declare a Major Incident - http://stemlynsblog.org/how-to-declare-a-major-incident-st-emlyns/
3:10 - RCEM ASC 2017 – Update on the TiLLI study - http://stemlynsblog.org/rcem-asc-2017-update-on-the-tilli-study/
6:03 - The rise and SURPRISE of the DOACs - http://stemlynsblog.org/the-rise-and-surprise-of-the-doacs/
8:08 - Life as an EM Trainee in South Africa - https://itunes.apple.com/gb/podcast/the-st-emlyns-virtual-hospital-podcast/id547326956?mt=2&i=1000393179333
9:26 - Rheum for Improvement? The physical challenge of EM training - http://stemlynsblog.org/rheum-for-improvement-st-emlyns/ Harriet's website is here - https://www.rheumforimprovement.com/
10:47 - JC: Oxygen in ACS. A fuss about nothing? The DETO2X Trial - http://stemlynsblog.org/oxygen-in-acs-a-fuss-about-nothing/. Paper is here - http://www.nejm.org/doi/full/10.1056/NEJMoa1706222
11:57 - Is cMyC the new troponin? - http://stemlynsblog.org/cmyc-new-troponin/
13:00 - Who gets a Tetanus? You get a Tetanus! - http://stemlynsblog.org/tetanus-in-the-ed/
14:22 - Mass Casualty Incidents: Lessons from AAST - http://stemlynsblog.org/mass-casualty-incidents-lessons-aast-st-emlyns/
15:00 - The Annual Scientific Conference and the State of EM
![Ep 96 - Everybody's free - Top Tips for the Class of 2017](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Aug 01, 2017
Ep 96 - Everybody's free - Top Tips for the Class of 2017
Tuesday Aug 01, 2017
Tuesday Aug 01, 2017
It's that time of year again, where we get new colleagues in the Emergency Department (and across lots of other areas of the hospital too).
These are some of the top tips for new starters (and life in the ED in general) gathered from the senior medical and nursing team at Virchester (South).
More induction guidance and education available at http://stemlynsblog.org/induction/
Oh. And one tip we left out - always wear sunscreen.
With thanks (and apologies) to Baz Luhrmann.
![Ep 89 - March 2017 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Mar 05, 2017
Ep 89 - March 2017 Round Up
Sunday Mar 05, 2017
Sunday Mar 05, 2017
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.
![Ep 57 - When things go wrong - the difficult conversation](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns21400_300x300.jpg)
Monday Nov 02, 2015
Ep 57 - When things go wrong - the difficult conversation
Monday Nov 02, 2015
Monday Nov 02, 2015
Simon and Nat talk about how to have that tricky conversation when you have to tell a colleague that they may have made a mistake.
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![Ep 54 - Intro to EM: Analgesia in the ED.](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/PAIN_300x300.jpg)
Sunday Jul 26, 2015
Ep 54 - Intro to EM: Analgesia in the ED.
Sunday Jul 26, 2015
Sunday Jul 26, 2015
Iain and Simon discuss the core skills that all EM clinicians need to manage pain in the ED.
These are the basics, but don't be put off. The basics are more important than the fancy stuff that we will discuss in a later podcast.
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![Ep 35 - New (or are they really new) Oral Anticoagulants and the Emergency Physician PART 1](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns1400x1400_300x300.jpg)
Sunday Jan 18, 2015
Sunday Jan 18, 2015
Rick Body and Kerstin de Wit discuss the role of NOACs in clinical management. Part 1 addresses the basics, stuff you should know if you are prescribing these drugs.
Part 1 tells us the good stuff, don't forget to listen to 2 and 3 in the next few weeks as not everything is perfect ;-)
Check out the BLOG POST HERE
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