![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 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 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 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 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 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 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 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 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 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 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 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.
![Ep 185 - February 2021 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Copy-of-Untitled-1_300x300.jpg)
Monday Mar 15, 2021
Ep 185 - February 2021 Round Up
Monday Mar 15, 2021
Monday Mar 15, 2021
Our regular podcast round up from February 2021. Iain and Simon highlight the key learning points from this month on the St Emlyn’s blog and podcast.
Topics discussed this month include tocilizumab in COVID19, TIA risk scores, new Emergency Care standards (targets) and TXA use in epistaxis. We also pay tribute to Dr Cliff Mann, former President of RCEM who sadly died this month.
Please remember to subscribe to the podcast on iTunes/Google Play and please do leave us some reviews and ratings there.
![Ep 182 - COVID-19 vaccines update (January 2021)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Jan 17, 2021
Ep 182 - COVID-19 vaccines update (January 2021)
Sunday Jan 17, 2021
Sunday Jan 17, 2021
A vaccine update with Rick Body, Simon Carley, Pam Vallely, Paul Klapper and Charlie Reynard. Bringing RCEM, St Emlyn's and the University of Manchester together for the latest thoughts and wisdom on the vaccines that might get us out of this pandemic.
Moderna vaccine phase 3 trial - https://www.nejm.org/doi/full/10.1056/nejmoa2022483
Oxford vaccine phase 2/3 - https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)32466-1.pdf
Pfizer vaccine trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
#vaccines #COVID19 #coronavirus
![Ep 181 - Christmas 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Christmas_Podcast_Round_Up_Cover6gdft_300x300.jpg)
Thursday Dec 17, 2020
Ep 181 - Christmas 2020 Round Up
Thursday Dec 17, 2020
Thursday Dec 17, 2020
A special festive edition of our round up podcast featuring six weeks of blog posts and plenty more besides.
From all at St Emlyn's we hope you have a very happy festive season and we cannot wait to talk to you again in 2021.
Take care,
Simon and all the team
![Ep 179 - October 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/October_Podcast_Round_Up_Coveraph4n_300x300.jpg)
Friday Nov 06, 2020
Ep 179 - October 2020 Round Up
Friday Nov 06, 2020
Friday Nov 06, 2020
A bumper edition of the podcast where Iain and Simon discuss TXA (twice), antibiotics in appendicits, VTE, Blood products in trauma, use of ultrasound in cardiac arrest and plasma in traumatic brain injury. Oh, and COVID19 (but not for long)...
An evidence based cornucopia of aural pleasure.
Please like and subscribe (as all podcasters seem to say).
Take care,
Iain
![Ep 178 - Surviving the Second Wave with Liz Crowe (October 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Oct 24, 2020
Ep 178 - Surviving the Second Wave with Liz Crowe (October 2020)
Saturday Oct 24, 2020
Saturday Oct 24, 2020
In this special edition of the podcast, Liz Crowe discusses with Iain how we can find contentment, despite the relentless nature of COVID19 and the impending second wave. She gives practical, realistic advice that everyone can consider and encourages us all to be kind to ourselves in these strange and difficult times.
![Crackcast - Head Injury](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Crackcast_icon9fljn_300x300.png)
Wednesday Sep 23, 2020
Crackcast - Head Injury
Wednesday Sep 23, 2020
Wednesday Sep 23, 2020
This excellent epsiode of Crackcast covers all you need to know about head injury in the ED.
![Ep 175 - August 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/August_Podcast_Round_Up_Cover7gvu4_300x300.png)
Thursday Sep 10, 2020
Ep 175 - August 2020 Round Up
Thursday Sep 10, 2020
Thursday Sep 10, 2020
Welcome to our audio round up of everything on the blog during August.
As the world continues to be in the grips of the Coronavirus pandemic there have been more papers looking at all aspects of this disease.
Simon reviewed the latest paper on Hydroxychloroquine and Charlie collated some of the top papers covering aspects from aerosol spread and use of CPAP to the effect on vulnerable groups and the effect on staff psychological health
It's not all COVID though. Sepsis is a condition we all want to be able to treat more effectively. Sadly there doesn't seem to be any encouraging news about the use of Vitamin C, Steroids and Thiamine in this latest RCT.
Many of the St Emlyn's group have special expertise in toxicology and Gareth wrote this incredibly informative post about the use of GBL. If you're not sure what "ChemSex" is then this post from a few years ago by Janos is worth a read.
The anonymously written "Look at what they make you give" post really struck a chord with readers, with an astonishing number of views. There are messages here for us all.
The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think.
![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 173 - The St Emlyn's Lesson Plans](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/IMG_7114_300x300.jpg)
Thursday Jun 25, 2020
Ep 173 - The St Emlyn's Lesson Plans
Thursday Jun 25, 2020
Thursday Jun 25, 2020
We are delighted to introduce you to the "St Emlyn's Lesson Plans", which we hope will help structure some of your education sessions over coming months (and years).
Each lesson plan starts with a descrete learning outcome, to set the scene, as well as details of the RCEM curriculum item(s) that will be covered.
The first tasks are aimed at aquiring some background knowledge and can either be done as part of the session, or beforehand. These utilise the vast "FOAMed" resources (including, but not exclusively, those of St Emlyn's).
Our experience is that time constraints often mean that "background reading" isn't achieved before the session, so would encourage allowing time within it to complete these. They are designed to take about 30 minutes and occupy the first half of the session.
Everything you need for each lesson is included in the plan. We would recommend that each learner has an internet enabled device available (with headphones) to read and listen to the background material at their own pace.
The second half of the session should be facilitated by an expert. This can happen in person, but also online, via any of the interfaces that are now so familiar.
In many plans we have given some case examples, but it would be even better if learners can bring cases of their own for discussion. This element is very much within the control of the facilitator (who should been fully cogniscent of the contents of the knowledge section).
The session finishes off with a summary, this should emphasise again the most important learning points. To really embed the knowledge and skills the particiapants should be encouraged to reflect on what they have learned, and to even talk to thse who were unable to attend about what they missed.
For learners this also gives an opportunity to easily link teaching sessions to their portfolio.
You may want to record the "face-to-face" elements, so that those who were not present are able to access them when they can (and those that did can rewatch to refresh their learning).
Although these plans are designed for delivery in a single centre, there is absolutely no reason why regional (or even national) teaching could take place in this way. The recent COVID19 Journal Clubs have demonstrated beautifully how a group of learners can engage with an online panel.
We would be very happy to receive lessons plans to add to the collection. This is very much a collaborative effort.
Please let us know what you think of these lesson plans and if you are using them in your Department. We'd love to hear your ideas about how we can take medical education forward.
![Ep 172 - Dexamethasone and COVID - Show us the Data! (June 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Jun 19, 2020
Ep 172 - Dexamethasone and COVID - Show us the Data! (June 2020)
Friday Jun 19, 2020
Friday Jun 19, 2020
St Emlyn's three professors, Carley, Body and Horner* critically appraise the Press Release regarding Dexamethasone in the treatment of COVID-19.
What does this mean for the future of Evidence Based Medicine? Can we really start using a medication when the trial hasn't been peer reviewed and the full dataset not released?
The blog post by Josh Farkas, that is mentioned in the podcast, is here.
*Professor Simon Carley, Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in Adult and Paediatric Emergency Medicine at Manchester Foundation Trust, Professor Rick Body Professor of Emergency Medicine in Manchester and Honorary Consultant in Emergency Medicine at Manchester Foundation Trust. Professor Dan Horner, Professor of Emergency Medicine of the Royal College of Emergency Medicine and Consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust.
![Ep 170 - COVID-19 Journal Club #7 (June 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 04, 2020
Ep 170 - COVID-19 Journal Club #7 (June 2020)
Thursday Jun 04, 2020
Thursday Jun 04, 2020
Welcome to our seventh webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.
The live event took place on Tuesday 26th May.
Today's panel will be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Ellie Hothershall (Consultant in Public Health), Prof Simon Carley and special guest Kelly Ann Janssens (Emergency Physician in Ireland) to discuss five papers about COVID-19 infection.
This will be the last weekly journal club, but we will be back with more EBM goodness very soon. Do let us know what you like to be included at stemlyns@gmail.com
References
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Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. N Engl J Med. Published online May 22, 2020. doi:10.1056/nejmoa2007764
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Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 2020. doi:10.1016/s0140-6736(20)31180-6
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Gray N, Calleja D, Wimbush A, et al. “No test is better than a bad test”: Impact of diagnostic uncertainty in mass testing on the spread of Covid-19. Published online April 22, 2020. doi:10.1101/2020.04.16.20067884
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Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019. Annals of Emergency Medicine. Published online May 2020. doi:10.1016/j.annemergmed.2020.05.022
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Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatr. Published online May 19, 2020. doi:10.1111/apa.15371
![Ep 169 - COVID-19 Journal Club #6 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/covid19-webinar-6_300x300.png)
Friday May 22, 2020
Ep 169 - COVID-19 Journal Club #6 (May 2020)
Friday May 22, 2020
Friday May 22, 2020
Welcome to our sixth COVID-19 Journal Club Podcast.
The panel was hosted by Rick Body and included Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Liz Crowe (Advanced Clinician Social Worker and PhD candidate in health staff wellbeing in Brisbane) to discuss four papers about COVID-19 infection. We were especially pleased to welcome Liz this week, which enabled us to focus on the important topics of grief, loss and communication during the COVID-19 pandemic.
References
![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 167 - Troponin Update and LoDED Study Review with Rick Body](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday May 13, 2020
Ep 167 - Troponin Update and LoDED Study Review with Rick Body
Wednesday May 13, 2020
Wednesday May 13, 2020
Over the last few years many of us in the UK have started to incorporate high-sensitivity troponin into the assessment of patients presenting with chest pain.
We have seen these samples taken at ever shorter intervals, aiming to discharge low risk patients safely, sooner from the Emergency Department (ED). This has been driven in part by the "Four Hour Emergency Access Target" as well as increased crowding in overwhelmed EDs.
In this podcast, internationally renowned researcher Prof Rick Body discusses the latest in troponin research and the recent LoDED study.
The Shownotes
The various organisations mentioned by Rick can be found here:
The Innovation Agency Webinar Series
The NHS Accelerated Access Collaborative
The CQUIN that will be implemented later this year (page 15 for the Troponin section)
The Draft NICE recommendations
![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 164 - COVID-19 Journal Club #3](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/covid19_podcasts_300x300.png)
Thursday Apr 30, 2020
Ep 164 - COVID-19 Journal Club #3
Thursday Apr 30, 2020
Thursday Apr 30, 2020
Welcome to our third webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The live event took place on Tuesday 28th April at 11am BST (10am GMT).
The panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Dan Horner (RCEM Professor), Prof Pam Vallely (Professor of Medical Virology), Salim Rezaie (Emergency Physician and Founder of REBEL EM) and Prof Simon Carley (you know him…) to discuss five papers about COVID-19 infection. There will be another COVID 19 Journal Club next week (Tuesday 5th May at 11am).
Edited by Izzy Carley and Iain Beardsell
References
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Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine. April 2020:1-21. https://www.esicm.org/wp-content/uploads/2020/04/863_author_proof.pdf.
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Caputo ND, Strayer RJ, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID‐19 Pandemic. Acad Emerg Med. April 2020. doi:10.1111/acem.13994
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Garcia FP, Perez Tanoira R, Romanyk Cabrera JP, Arroyo Serrano T, Gomez Herruz P, Cuadros Gonzalez J. Rapid diagnosis of SARS-CoV-2 infection by detecting IgG and IgM antibodies with an immunochromatographic device: a prospective single-center study. April 2020. doi:10.1101/2020.04.11.20062158
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Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. April 2020. doi:10.1001/jama.2020.6775
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Metzler B, Siostrzonek P, Binder R, Bauer A, Reinstadler S. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. April 2020. doi:10.1093/eurheartj/ehaa314
![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 161 - COVID-19 Journal Club #1](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Journal_Club_300x300.png)
Wednesday Apr 15, 2020
Ep 161 - COVID-19 Journal Club #1
Wednesday Apr 15, 2020
Wednesday Apr 15, 2020
Professor Rick Body is joined by Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynolds (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer) and Prof Simon Carley (you know him...) to discuss six papers about COVID-19 infection.
03:10 - Paper 1 – Guan et al. Clinical characteristics of Coronavirus disease 2019 in China. NEJM Feb 28 2020
https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
16:54 Paper 2 – Zou et al. Single Cell RNA-SEQ Data Analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-NCOV infection. Frontiers of Medicine. Mar 12 2020.
https://link.springer.com/content/pdf/10.1007/s11684-020-0754-0.pdf
21:43 Paper 3 – Gautret et al. Hydroxychloroquine and azithromycin treatment of COVID-19: Results of an open-label non-randomised clinical trial. International Journal of Antimicrobial Agents. 20 Mar 2020
https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub
25:25 Paper 4 – Cao et al. A trial of Lopinavir-Ritonavir in adults hospitalized with severe COVID-19. NEJM Mar 18 2020
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2001282
29:35 Paper 5 – Cui et al. Prevalence of venous thromboembolism in patients with severe Coronavirus pneumonia. Journal of Thrombosis and Haemostasis. Apr 9 2020 doi:10.1111/jth.14830
https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14830
34:14 Paper 6 – Lynarts et al. Prediction models for diagnosis and prognosis of COVID-19 infection: systematic review and critical appraisal. BMJ. Apr 7 2020 BMJ 2020;369:m1328
![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 158 - Understanding Fear and Anxiety around COVID19 with Liz Crowe](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Mar 29, 2020
Ep 158 - Understanding Fear and Anxiety around COVID19 with Liz Crowe
Sunday Mar 29, 2020
Sunday Mar 29, 2020
The world is consumed by the Coronavirus pandemic, but how do we look after ourselves? Liz and Iain discuss some strategies to stay well over the coming weeks and months. Recorded on 25th March 2020.