![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 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 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 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 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 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 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.
![Ep 174 - June and July 2020 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Aug 01, 2020
Ep 174 - June and July 2020 Round Up
Saturday Aug 01, 2020
Saturday Aug 01, 2020
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?
![Ep 168 - COVID-19 Journal Club #5 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/webinarcover7298g_300x300.png)
Friday May 15, 2020
Ep 168 - COVID-19 Journal Club #5 (May 2020)
Friday May 15, 2020
Friday May 15, 2020
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.
![Ep 166 - COVID-19 Journal Club #4 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Journal-Club-4-1_300x300.png)
Thursday May 07, 2020
Ep 166 - COVID-19 Journal Club #4 (May 2020)
Thursday May 07, 2020
Thursday May 07, 2020
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
Podcast edited from a live webinar by Izzy Carley
![Ep 165 - April 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/april_2020_300x300.jpg)
Sunday May 03, 2020
Ep 165 - April 2020 Round Up
Sunday May 03, 2020
Sunday May 03, 2020
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
![Ep 163 - COVID-19 Journal Club #2](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Webinar_300x300.png)
Saturday Apr 25, 2020
Ep 163 - COVID-19 Journal Club #2
Saturday Apr 25, 2020
Saturday Apr 25, 2020
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
![Ep 162 - Beyond the ED: COVID-19 and Critical Care with Dan Horner](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/COVID_and_ICU_300x300.png)
Wednesday Apr 22, 2020
Ep 162 - Beyond the ED: COVID-19 and Critical Care with Dan Horner
Wednesday Apr 22, 2020
Wednesday Apr 22, 2020
In this podcast, Dan and Iain talk about the clinical journey of a COVID-19 patient, beyond the ED, with insights from the critical care unit. There are some concepts here that we don’t have time to do full justice to in the podcast, so there is a comprehensive set of "show notes" and all the references at www.stemlynsblog.org/covid-19-and-critical-care
![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 159 - Covid 19. Lessons from Sports and Exercise Medicinewith John Rogers and Nathan Lewis](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Apr 02, 2020
Thursday Apr 02, 2020
Simon interviews Dr John Rogers and Dr Nathan Lewis on respiratory infection prevention.
John a Sports and Exercise Medicine Consultant in Manchester. He is also Chief Medical Officer for British Triathlon and Visiting Professor in Sport & Exercise Medicine at Manchester Metropolitan University.
Nathan is lead performance nutrition scientist at the English Institute of Sport and at ORRECO.
These two academics take us through how sports science might be able to support our wellbeing during the Covid19 pandemic.
References
- Recommendations to maintain immune health in athletes https://www.tandfonline.com/loi/tejs20
- Probiotics https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006895.pub3/epdf/full
- Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/23840373/
- Vitamin C for prevention and treatment of pneumonia https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013134/full
- Vitamin C and common cold https://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold
- Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/27184276/
- Vitamin C and Infections https://pubmed.ncbi.nlm.nih.gov/28353648/
- Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage https://pubmed.ncbi.nlm.nih.gov/28515951/
![Ep 154 - January 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Wednesday Feb 12, 2020
Ep 154 - January 2020 Round Up
Wednesday Feb 12, 2020
Wednesday Feb 12, 2020
Iain is back on the podcast with Simon to talk through the best of the blog from January 2020.
![Ep 147 - August 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Oct 06, 2019
Ep 147 - August 2019 Round Up
Sunday Oct 06, 2019
Sunday Oct 06, 2019
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.
![Ep 144 - July 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_2_300x300.png)
Tuesday Sep 10, 2019
Ep 144 - July 2019 Round Up
Tuesday Sep 10, 2019
Tuesday Sep 10, 2019
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
![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 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 139 - May 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Friday Jun 21, 2019
Ep 139 - May 2019 Round Up
Friday Jun 21, 2019
Friday Jun 21, 2019
Our regular monthly round up, this month with Ian and Simon chatting through the best of the blog.
The power of peer review: https://www.stemlynsblog.org/smacc2019-the-power-of-peer-review/
Virtual reality in PED: https://www.stemlynsblog.org/jc-virtual-reality-for-distraction-from-paediatric-procedural-pain/
Wellbeing for the broken: https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlyns/
Traumatic cardiac arrest https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlhttps://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/
Should we cardiovert AF in the ED or wait? https://www.stemlynsblog.org/should-we-rapidly-cardiovert-af-in-the-ed-st-emlyns/
Prolonged field care in the ED https://www.stemlynsblog.org/prolonged-field-care-in-the-ed/
Keppra or Phenytoin for status epilepticus in kids https://www.stemlynsblog.org/jc-enter-sandman-which-agent-as-second-line-in-paediatric-status-epilepticus/
![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 130 - Critical Appraisal Nuggets: p-values](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Feb 23, 2019
Ep 130 - Critical Appraisal Nuggets: p-values
Saturday Feb 23, 2019
Saturday Feb 23, 2019
Part of the critical appraisal nuggets series. You can read more here https://www.stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/
Also mentioned in this podcast
1. Definition of p-values on the bottom line https://www.thebottomline.org.uk/blog/ebm/p-value/
2. Fragility index https://lifeinthefastlane.com/ccc/fragility-index/
3. Confidence interval https://en.wikipedia.org/wiki/Confidence_interval
![Ep 129 - January 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Feb 17, 2019
Ep 129 - January 2019 Round Up
Sunday Feb 17, 2019
Sunday Feb 17, 2019
The latest blog posts, ideas and thoughts from the St Emlyn's podcast. This month with Simon Carley and Rick Body,
![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 125 - November 2018 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Dec 23, 2018
Ep 125 - November 2018 Round Up
Sunday Dec 23, 2018
Sunday Dec 23, 2018
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.
![Ep 122 - Beyond ALS with Salim Rezaie at #stemlynsLIVE](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/STEMLYNS_base_1400_300x300.jpg)
Wednesday Nov 28, 2018
Ep 122 - Beyond ALS with Salim Rezaie at #stemlynsLIVE
Wednesday Nov 28, 2018
Wednesday Nov 28, 2018
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/
![Ep 121 - October 2018 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Tuesday Nov 13, 2018
Ep 121 - October 2018 Round Up
Tuesday Nov 13, 2018
Tuesday Nov 13, 2018
Here's our round up of the best of the blog from October 2018.
In Pursuit of Excellence with Natalie May from #stemlynsLIVE https://www.stemlynsblog.org/in-pursuit-of-excellence/
A FeminEM in NY with Natalie May Part 1. https://www.stemlynsblog.org/fix18-part-one/
JC: Cricoid Pressure, Do we still need it? Simon Carley https://www.stemlynsblog.org/jc-cricoid-pressure-and-rsi-do-we-still-need-it-st-emlyns/
Teaching and Learning in Stretched Environments with Simon Carley https://www.stemlynsblog.org/teaching-and-learning-in-stretched-environments-rsm-2018-st-emlyns/
Five free strategies to improve your resuscitations Simon Carley https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/
PTSD and me, EMDR therapy with Rusty Carroll https://www.stemlynsblog.org/ptsd-and-me-part-3-emdr-therapy-st-emlyns/
![Ep 108 - February 2018 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns21400.jpg)
Tuesday Apr 24, 2018
Ep 108 - February 2018 Round Up
Tuesday Apr 24, 2018
Tuesday Apr 24, 2018
Iain and Simon review the best of the blog from February 2018.
Simon Carley
![Ep 102 - HEMS, reflections and St.Emlyn's e-books.](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Nat_Simon_stemlyns.jpg)
Wednesday Dec 27, 2017
Ep 102 - HEMS, reflections and St.Emlyn's e-books.
Wednesday Dec 27, 2017
Wednesday Dec 27, 2017
Natalie and Simon discuss reflections, e-books and life at Sydney HEMS. This week we have added Lorikeets in the background (Nat recorded at Coogee Bay in NSW). We think they sound cute so we've kept them in (or rather we could not edit them out).
S
![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 90 - Top Ten Trauma Papers 2016](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday Mar 22, 2017
Ep 90 - Top Ten Trauma Papers 2016
Wednesday Mar 22, 2017
Wednesday Mar 22, 2017
Iain and Simon chat through our top ten trauma papers for 2016. Lots here for anyone who is interested in trauma including whole body CT, traumatic cardiac arrest, neurosurgery in severe head injury and much more. As ever we'd suggest you read the original papers, references for which along with a blogpost can all be found here http://stemlynsblog.org/top-10-trauma-papers-2016-st-emlyns/
![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 79 - Critical Appraisal Nugget: Selection Bias](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlynsheader_300x300.jpg)
Thursday Sep 15, 2016
Ep 79 - Critical Appraisal Nugget: Selection Bias
Thursday Sep 15, 2016
Thursday Sep 15, 2016
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".
![Ep 77 - Critical Appraisal Nugget 2: Blinding and Masking in clinical trials](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns21400_300x300.jpg)
Wednesday Aug 24, 2016
Ep 77 - Critical Appraisal Nugget 2: Blinding and Masking in clinical trials
Wednesday Aug 24, 2016
Wednesday Aug 24, 2016
Rick and Simon talk blinding (and masking) for your critical appraisal delight.
See more at http://stemlynsblog.org/cans-critical-appraisal-nuggets-st-emlyns/
![Ep 75 - Critical Appraisal Nugget 1: Randomisation](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns21400_300x300.jpg)
Wednesday Aug 10, 2016
Ep 75 - Critical Appraisal Nugget 1: Randomisation
Wednesday Aug 10, 2016
Wednesday Aug 10, 2016
Our series on critical appraisal nuggets in 5-10 mins. This week it's Randomisation. Great if you are revising for an exam in critical appraisal (e.g. FRCEM).
![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
vb
R
![Ep 32 - The Christmas review podcast 2014](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns1400x1400_300x300.jpg)
Tuesday Dec 23, 2014
Ep 32 - The Christmas review podcast 2014
Tuesday Dec 23, 2014
Tuesday Dec 23, 2014
A Christmas review of the world of EM, CC and resuscitation #FOAMed.
This review is no way exclusive and focuses on sites that people may not be familiar with. Take it as read that EMCRIT, LITFL, PHARM, ICN, SGEM, EMLitofNote, ALiEM, Resus.me, KI docs, etc. are already known to be awesome. Check them out and follow the many excellent #FOAMed sites around the world.
Check out the big hitters here http://www.aliem.com/social-media-index/
There are also so many other sites that we have not mentioned, but which we regularly visit and listen to.
vb
S
![Ep 20 - Understanding Troponin Part 3: The NICE guidance.](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns1400x1400_300x300.jpg)
Thursday Oct 23, 2014
Ep 20 - Understanding Troponin Part 3: The NICE guidance.
Thursday Oct 23, 2014
Thursday Oct 23, 2014
Rick and Iain explore how the latest guidance about the use of high sensitivity troponin was developed and how far we can be assured that it is evidence based.
The NICE guidance is available here. http://www.nice.org.uk/guidance/dg15
vb
S
![Ep 6 - SMACC Back-Back on What to believe and when to change.](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/stemlyns1400x1400_300x300.jpg)
Thursday Jun 26, 2014
Ep 6 - SMACC Back-Back on What to believe and when to change.
Thursday Jun 26, 2014
Thursday Jun 26, 2014
Hopefully you will have already seen and listened to my SMACC talk on 'What to believe and when to change'. If not then please whizz over to the site now and have a listen. I really enjoyed exploring the uncertainties that exist around when we decide to adopt or abandon therapies.
My belief is that it's really difficult to define the perfect moment and that it's only in retrospect that we can define it.
Since appearing on the ICN network and St.Emlyn's, Scott Weingart, one of the best and most innovative clinicians I know has come back and argued for early adoption. You can check out his rationale on his site and see what you think.
I actually agree with many of the things he tells us, although he has confined himself to one side of the argument. In terms of a defence of early adoption he makes a good case, but like all debates there needs to be another side to the story, so sit back and listen to why we must reflect hard on the decisions we make in deciding what we do, why we do it, and most importantly when.
vb
S
![Ep 4 - Understanding diagnostics In Emergency Medicine Part 2 - Beyond Yes or No](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Diagnostic_Tests_yes_or_no_xebu2z_300x300.jpg)
Sunday Jun 15, 2014
Sunday Jun 15, 2014
What is a Diagnosis?
A diagnosis is essentially a label that we put on a patient to indicate what they have, which then guides our treatment decisions. In the ED, our primary focus is on identifying life-threatening conditions. This approach often involves working backwards by first ruling out serious conditions before considering what a patient might actually have.
Initial Diagnostic Approach
As emergency physicians, our initial approach is to use tests with high sensitivity. These tests are designed to pick up anyone who might have the disease. Once we rule out the serious conditions, we look at tests with high specificity to confirm the diagnosis, as treatments often carry risks. For example, therapies such as thrombolysis come with significant risks, so we need to be fairly certain before proceeding, unlike less consequential treatments like wrist splints.
Understanding Probabilities in Diagnoses
When we say a patient has a diagnosis, we’re essentially saying it’s likely enough to treat. Conversely, when we say a patient doesn’t have a diagnosis, we mean it’s unlikely enough to withhold treatment. This probabilistic approach is vital in the ED and can be surprising to many people.
Case Study: Cardiac Chest Pain
Let’s apply this to a patient with cardiac-sounding chest pain. Our goal is to either rule out or confirm the disease and start appropriate treatment. We start with specific tests to rule in a diagnosis, such as an ECG. A positive ECG with significant ST segment changes indicates a high likelihood of disease, warranting immediate treatment. This approach quickly sorts out high-risk patients.
For patients with normal or near-normal ECGs but still concerning symptoms, we need sensitive tests to ensure we don't miss anyone with myocardial disease. About 10% of these patients might have underlying issues, so we need to ensure our tests are sensitive enough to catch these cases.
Using Prevalence and Pre-test Probability
To decide if a patient has the disease, we must consider the prevalence or pre-test probability in our population. For example, in patients with normal ECGs and no alarming history, the pre-test probability might be around 10%. This isn’t low enough to rule out the disease but also not high enough to justify treatment without further testing.
Diagnostic Processes in the ED
We use a step-by-step diagnostic process. Starting with the most specific tests to rule in a diagnosis, we then use sensitive tests like high-sensitivity troponin to rule out diseases. High-sensitivity troponin tests are great for ruling out diseases due to their sensitivity. If the test is negative, we can be confident the patient doesn’t have myocardial damage. If the test is positive but not dramatically high, we may need additional tests to confirm the diagnosis.
Each diagnostic step adjusts our patient’s probability of having the disease. Our goal is to reach a probability low enough to safely rule out the disease or high enough to justify treatment. This process is continuous, and we apply it to every patient, whether they have chest pain or another symptom like a headache.
Understanding Likelihood Ratios
We often use likelihood ratios to interpret diagnostic tests. A positive likelihood ratio increases the probability of the disease, while a negative likelihood ratio decreases it. For example, a high-sensitivity troponin test is excellent at ruling out myocardial infarction because of its high sensitivity, though it’s not as good at ruling in due to lower specificity.
Optimising Diagnostic Tests
Diagnostic tests like troponin can be optimized by adjusting the threshold levels. For instance, a higher threshold might improve specificity and thus be better at ruling in the disease, while a lower threshold improves sensitivity, making it better at ruling out the disease. This principle applies to various tests, including white cell counts and amylase levels.
Continuous Assessment and Reassessment
In the ED, we continuously assess and reassess patients. Each diagnostic step, whether it’s asking a question about symptoms or ordering a lab test, adjusts our understanding of the patient’s condition. This iterative process helps us make informed decisions about treatment and ensures that we don’t miss critical diagnoses.
Applying the Approach to Different Symptoms
This diagnostic approach isn’t limited to chest pain. Whether a patient presents with a headache, abdominal pain, or any other symptom, we apply the same principles of sensitivity, specificity, and likelihood ratios. Each question we ask and each test we perform helps refine our assessment and move closer to a definitive diagnosis.
Conclusion
Mastering diagnostic skills in the ED involves understanding and applying probabilities, using specific and sensitive tests effectively, and continuously reassessing the patient’s condition. By focusing on these principles, we can make more accurate diagnoses, provide appropriate treatments, and ultimately improve patient outcomes.
More listening about diagnosis
Podcast – Diagnosis in Emergency Medicine Part 1 – SpIN and SnOUT
Podcast – Diagnosis in Emergency Medicine Part 2 – Beyond a simple yes or no
Podcast – Diagnosis in Emergency Medicine Part 3 – The importance of prevalence