The St.Emlyn’s Podcast
#FOAMed
Episodes
Monday Jun 02, 2014
Ep 1 - St.Emlyn's the podcast.
Monday Jun 02, 2014
Monday Jun 02, 2014
Welcome to the St.Emlyn's podcast. After a few years messing around with the blog at stemlynsblog.org the Choirmaster at St.Emlyn's has decided that some audio contributions are necessary. We will therefore be relaunching the podcast in a uniquely British way.
Please, put the kettle on, make yourself a nice cup of tea (I recommend Lady Grey or Gunpowder), sit back, relax and listen*.
Congo will take place every couple of weeks so keep checking iTunes for this weeks order of service.
We have the honour to be, always, your most faithful servants.
Yours etc.
The Choirmaster at St.Emlyn's
*If you are listening to this podcast whilst driving do not put the kettle on....
Tuesday Jun 10, 2014
Ep 3 - Understanding diagnostics 1. SNout SpIn and Probability. St.Emlyn's
Tuesday Jun 10, 2014
Tuesday Jun 10, 2014
A podcast discussing sensitivity and specificity of diagnostic tests and how we can use this in our everyday medical care of patients.
This article from the Centre for Evidence Based Medicine is also useful.
Sunday Jun 15, 2014
Ep 4 - Diagnostics 2. Beyond simple yes vs no diagnostics. St.Emlyn's
Sunday Jun 15, 2014
Sunday Jun 15, 2014
Dear all,It would appear that the organ member was correct and we cannot be certain about the organ pipes. Apparently there are doubts about whether they are safe or need replacing. We will once again turn to Dr Beardsell and Prof. Carley to see if there is anything more that we can do. As I am due to allocate funds for repairs to musical instruments this year then we must ensure that these are spent wisely. If there is a less than 2% chance of failure we will wait. If there is a greater than 50% chance of failure then we should spend the money. The situation is uncertain and we need help.I have the honour to be et. etc. etc.The Choirmaster at St.Emlyn's
Sunday Jun 22, 2014
Ep 5 - Understanding diagnostics 3. Why prevalence helps us stay in practice
Sunday Jun 22, 2014
Sunday Jun 22, 2014
Iain and Simon tackle the effect of prevalence on diagnostic performance. Mrs Trellis of North Wales makes a return appearance to discuss the delicate issues of sensitivity and Rick Body joins us by mail to raise concerns about the difficulties of missing patients with myocardial disease.Listen and enjoy, visit the blog site and keep in touch.Don't forget to subscribe to the podcast via iTunes, to subscribe to the blog site and to like us on facebook.vbS
Sunday Jul 27, 2014
Ep - 11 Understanding Troponin Part 1
Sunday Jul 27, 2014
Sunday Jul 27, 2014
Do you remember when it took three days to 'rule in' or 'rule out' an acute myocardial infarction (AMI)? When I was a medical student doing my first clinical attachments, I remember doing ward rounds on the CCU seeing patients with suspected AMI. The way they were managed is a million miles from what we do now. Back then, patients would have serial ECGs and then be admitted for cardiac enzyme evaluation over the course of the next 3 days. We'd measure CK, AST and LDH. 'CK' was the so-called 'early marker', which would rise early after the start of an AMI. Today we use CK as a marker of skeletal muscle damage (e.g. rhabdomyolysis). AST and LDH (today we think of these as liver function tests, I know) were the 'late markers' - and by late I really mean late - we might see a rise on days 2 and 3.Could you imagine for a second, in today's world, ruling out AMI because their CK and LFTs were normal? It's completely unthinkable. That's how much cardiac troponin has changed our practice. We rely on it so completely to diagnose AMI. And yet, it's one of the most misunderstood tests in medicine. Given how much we use it, I guess we feel that we all should know lots about this test. But doctors still have so many questions. Here are just a few:What is cardiac troponin?Why is it a marker of AMI?What else causes a raised troponin and how?Should we be doing troponins at 3 hours, 6 hours, 12 hours? What's the difference and what's the evidence?What is a 'delta troponin'?What do you need to 'rule in' AMI?How do you use cardiac troponin in patients with renal failure?This is just a brief list. With the research I do in this area and my experience developing protocols/guidelines, people get in touch to ask questions like this quite a lot. There are loads of questions that people ask - but there are lots of themes in common. We thought it was about time we produced a handy run down in the true spirit of #FOAMed.Take a listen to Part 1 of our troponin podcast. While Simon and Iain have been prolifically churning out spectacular stuff for some time now, this is my debut on the St. Emlyn's podcast. I really enjoyed talking about troponin with Iain - and I hope we covered some useful stuff.We'll cover more in part 2, when we'll move on to discussing high sensitivity troponins, what they are, how to use them and how to speak the troponin lingo. Please get in touch if there's anything we haven't covered that you'd like us to, or if there's anything you'd like us to elaborate on some more!Rick
Friday Aug 01, 2014
Ep 12 - Intro to EM: The patient with headache
Friday Aug 01, 2014
Friday Aug 01, 2014
We've all had headaches, but not often severe enough to prompt us to seek help in an Emergency Department.In
our practice 10% of patients who do present to the ED with a primary
presentation of headache will have serious pathology and our job as
Emergency Physicians is to work out who these are. Key to this is
actively ruling out the life-threatening and life-changing diagnoses:Subarachnoid HaemorrhageMeningitisTumours and Space Occupying LesionsTemporal ArteritisListen to Simon and Iain discuss how to approach these patients hereFurther ResourcesHeadaches at Life in the Fast Lane - a great summary from the LiTFL crewNICE Guidelines (NCG150) - diagnosis and management of headaches; there's a flowchart and some red flags although you could read the St Emlyn's summary here!Headache from the Flipped EM Classroom
Sunday Aug 03, 2014
Ep 13 - Intro to EM: The patient with shortness of breath
Sunday Aug 03, 2014
Sunday Aug 03, 2014
Breathless patients are a challenge in the ED. Shortness of
breath can be a frightening presenting complaint for both patients and
doctors. As always, think about the possible life threatening causes and
actively rule them out. For breathless patients think especially about:PneumoniaAsthma/COPDPulmonary EmbolismAcute left ventricular failurePneumothorax Breathless Patients PodcastIn
this podcast Iain and Simon discuss their approach to
breathless patients in the ED which we hope will provide you with a good
starting point. For
those of you who are more visual learners here is the video recorded a
few years ago for SEMEP featuring our very own Iain Beardsell.http://vimeo.com/35310564 Take Home PointsOxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia killsAlways rule out life threatening causes firstThese patients are sick - do not be afraid to ask advice from a senior colleague earlyLook for clues - you don't have to wait until the penultimate page of the story to solve the mystery.What have you learned about breathless patients? Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute
setting - and can save lives. So yes, when you first approach a patient
who is short of breath, get that oxygen on while you make your
assessment then think about the finer points of respiratory failure
afterwards. Where do I begin? A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs
(especially respiratory rate), looking for clues as to the underlying
cause of their breathlessness, remembering the five common causes. What treatments might be useful?
A small fluid bolus might help and carries relatively little risk;
think about the need for nebulised bronchodilators for patients with
asthma or COPD, and remember that antibiotics given early to patients
with sepsis save lives. If the patient has pain we should definitely treat that too.Which investigations might help me find out more?A
chest x-ray is often useful in patients who are short of breath; your
ED seniors might be able to use bedside ultrasound to further ascertain
the underlying pathology, so get help early!ECGs are often useful in these patientsBlood
gases can also provide lots of useful information - think carefully
about whether you need arterial gases and if so, please use local
anaesthetic.If nothing makes sense - get a blood sugar,
remembering that metabolic disease may cause an acidosis, presenting
with an increased respiratory rate (although not often true dyspnoea).And
GET SENIOR HELP (including getting your seniors to assess you for those
all-important workplace-based assessments; definitely start those
early)Other resourcesChest RadiographsOne
of the key investigations in patients with shortness of breath is the
humble chest radiograph. There are some phenomenal FOAM resources for
interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).Chest X-Ray Anatomy - Chest X-Ray Abnormalities - Chest X-Ray Systematic ApproachBlood GasesThink! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links).Natalie May
Thursday Aug 07, 2014
Ep 15 - Understanding Troponin Part 2
Thursday Aug 07, 2014
Thursday Aug 07, 2014
Recently we published part one of our series on cardiac troponins. If you haven't checked it out yet, you can find it here.
In the second part, we're going to take a look at high sensitivity
troponins and some of the more advanced areas around understanding
cardiac troponin and its use in practice. We'll give you a quick run
down on the troponin lingo - the language you need to be able
to speak in order to fully understand how to use high sensitivity
troponin in your practice, including terms like the limit of blank, limit of detection, co-efficient of variation and 99th percentile.We'll also ask whether Joe Lex had a point when he stirred up controversy around these assays with this legendary tweet:What if we called it "low specificity troponin" instead of "high sensitivity troponin?" Would that knock some sense into people?— Joe Lex (@JoeLex5) October 9, 2012So, check out the associated BLOG POST here and listen to the podcast. There is more on diagnostics and troponin to come very soon.Hope you enjoy! Please keep the feedback, questions and comments coming. As always, we'd love to hear from you.RickDOI:
Much of my research work involves HsT. To help with this I have
received reagents from companies who make HsT assays, but I not received
any other financial benefit or gifts in kind as part of my work and
have no financial ties to any companies.
Friday Sep 12, 2014
Ep 17 - Diffuse Axonal Injury with John Hell
Friday Sep 12, 2014
Friday Sep 12, 2014
John Hell is a Neurointensivist at University Hospital Southampton
and very kindly gave up an afternoon to record his thoughts and share
his considerable wisdom about Diffuse Axonal Injury.I also
managed to get him to discuss some other topics including the choice of
induction agents and intravenous fluids in patients with head injury.Please listen, enjoy and comment. We'd love to hear from you, and don't forget to visit the blog site for additional information, slides and content.vbIain Beardsell
Tuesday Sep 23, 2014
Ep 18 - Victoria Brazil on great presentations with St.Emlyn's
Tuesday Sep 23, 2014
Tuesday Sep 23, 2014
Vic Brazil of #FOAMed and #SMACC fame came to talk to the St.Emlyn's team in Virchester. Listen in for top tips on looking great and sounding super.vbS
Tuesday Sep 30, 2014
Ep19 - In Situ and Guerrilla Sim in the ED
Tuesday Sep 30, 2014
Tuesday Sep 30, 2014
Iain and Simon talk through the practicalities of in situ sim in the ED. How do we make it happen in a way that works and helps individuals, teams and departments learn together.Much of the work in this podcast should be attributed to John Gatward from Sydney Australia who inspired us to start and to Kirten Walthall our new Sim Fellow who introduced records and departmental learning processes to our systems. There are a couple of errors on the podcast. Firstly it's roughly 18 months that we have been doing in situ sim, time must fly so much that I said 9 months! Secondly, on reflection we average 2-4 sim sessions per week, but that includes some sessions that are not in situ, held in a separate area when training other groups of docs in the hospital. The ED in situ frequency is 2-3 sessions per week.As ever we stand on the shoulders of these giants who support what we all hope to achieve.vbS
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/dg15vbS
Friday Oct 31, 2014
Ep 23 - Smacc Chicago update
Friday Oct 31, 2014
Friday Oct 31, 2014
Iain and Simon talk about the upcoming SMACC conference in Chicago and do their very best to persuade you to come to the best conference in the worldVisit the site for the full program here. http://www.smacc.net.au/SDOI - Both Iain and myself are being funded to attend.
Wednesday Nov 12, 2014
Ep 24 - Getting started in Emergency Medicine Research
Wednesday Nov 12, 2014
Wednesday Nov 12, 2014
The Challenge and Value of Research in Emergency Medicine: at DGINA 2014Rick Body's talk from DGINA on the need for research in EM.Check out the associated blog post at http://stemlynsblog.org
Monday Nov 24, 2014
Ep 26 - Intro to EM: The ED approach to the child with shortness of breath
Monday Nov 24, 2014
Monday Nov 24, 2014
Iain Beardsell and Natalie May talk you through a wise and safe approach to the child with moderate shortness of breath. Listen and learn from the St.Emlyn's team.
Wednesday Dec 03, 2014
Ep 28 - Iain and Nat preview the amazing London Trauma Conference.
Wednesday Dec 03, 2014
Wednesday Dec 03, 2014
Next week Iain and Nat will be in London for the best trauma conference in the world. Join them in person, online, on the podcast and on twitter.Check out the program here, it's amazing.http://www.londontraumaconference.com/Have fun :-)S
Tuesday Dec 09, 2014
Ep 29 - London Trauma Conference: Day one round up.
Tuesday Dec 09, 2014
Tuesday Dec 09, 2014
Whilst I remain in Virchester healing the sick and injured, Nat and Iain are sharing the #FOAMed love at the London Trauma Conference. This is the first round up from day 1 with many highlights and a few tasters for some more podcasts to come.vbS
Wednesday Dec 10, 2014
Ep 30 - London Trauma Conference: Day two round up.
Wednesday Dec 10, 2014
Wednesday Dec 10, 2014
Old, young, pregnant, social, airways, cricoid and dogmalysis. There is loads to catch up on from #LTC2014. Iain and Nat take you through the day.vbS
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. vbS
Tuesday Jan 06, 2015
Ep 33 - Impact Brain Apnoea with Gareth Davies from London HEMS (LTC 2014)
Tuesday Jan 06, 2015
Tuesday Jan 06, 2015
First of our podcasts from the London Trauma Conference.A fantastic episode with Iain talking to Gareth Davies (from London HEMS) talking about Impact Brain Apnoea.vbSt.Emlyn's
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
vbR
Saturday Jan 24, 2015
Ep 36 - The GoodSAM app with Mark Wilson (LTC 2014)
Saturday Jan 24, 2015
Saturday Jan 24, 2015
Live from the London Trauma Conference 2014. Iain Beardsell interviews Mark Wilson on the need for rapid response, digital technology and the GoodSAM app.
Monday Feb 02, 2015
Ep 37 - Karim Brohi at LTC (LTC 2014)
Monday Feb 02, 2015
Monday Feb 02, 2015
Karim Brohi joins the St.Emlyn's team at the London Trauma Conference to talk on vascular injury and arterial dissection. A whole range of diagnoses that you should not miss, but which is easy to miss.Tricky!Check out the blog post that accompanies this podcast here.S
Tuesday Feb 10, 2015
Tuesday Feb 10, 2015
Rick and Kirstin delve deeper into the world of Novel Oral Anti Coagulants.
Sunday Mar 15, 2015
Ep 41 - Is trauma an elite sport? with Tom Evens (LTC 2014)
Sunday Mar 15, 2015
Sunday Mar 15, 2015
Tom Evens is a doctor, rowing coach, prehospitalist and awesome resuscitationist. In this podcast he talks about aspiring to be excellent and whether we can draw parallels with sport.Great stuff.Check out the marginal gains post which is referenced in the podcast here http://stemlynsblog.org/ed-need-matt-parker-st-emlyns/More on Tom here http://londonsairambulance.co.uk/our-service/news/2014/05/high-performance-sport-high-performance-medicine-with-dr-tom-evansS
Sunday Mar 22, 2015
Ep 42 - Paediatric Major Trauma with Ross Fisher (LTC 2014)
Sunday Mar 22, 2015
Sunday Mar 22, 2015
I recently met Ross in the flesh. What a super chap. A great clinician who really wants to improve care for injured children in the UK and around the world.In this podcast he gives us a paediatric perspective on how we should approach the seriously injured child.Great stuff, controversial in places, challenging to adult dogma and always excellent.SPS. If you ever get to hear him speak.... then do, he's awesome. Check this out.
Thursday Mar 26, 2015
Ep 43 - APLS 2015 updates for the management of the serious injured child
Thursday Mar 26, 2015
Thursday Mar 26, 2015
A short podcast updating the UK Advanced Paediatric Life Support (APLS) course guidelines for the management of trauma in children.Don't forget to read the blog post here. APLS Updates: New kids on the block,vbS
Monday Apr 27, 2015
Ep 45 - Top 10 trauma papers 2014-2015.
Monday Apr 27, 2015
Monday Apr 27, 2015
A first podcast with Simon Laing from the RCEMFOAMed team. We look back at influential trauma related papers from 2014-2015.This talk was presented at the Trauma Care Conference in Telford 2015. It's a great conference and I'd encourage you to attend.If you want to know more visit www.stemlynsblog.org for more discussion and links to all the papers discussed.vbS
Wednesday May 06, 2015
Ep 46 - Intro to EM: The patient with asthma
Wednesday May 06, 2015
Wednesday May 06, 2015
Iain and Simon discuss the initial management of severe and life threatening asthma in the resus room. Another podcast in the induction series aimed at new starters in Emergency Medicine.vbS
Friday May 22, 2015
Ep 47 - Barbra Backus on Risk scores in Acute Coronary syndromes
Friday May 22, 2015
Friday May 22, 2015
Barbra Backus joins Rick Body to discuss the origin, development and future of risk scores for ED patients with possible acute coronary syndromes. Two researchers at the top of their game, and authors of the HEART and MACS scores.
vb
S
Thursday Jun 04, 2015
Ep 48 - Intro to EM: The patient with back pain.
Thursday Jun 04, 2015
Thursday Jun 04, 2015
Another induction podcast on a common condition in the ED. Back pain in the ED - it's not all musculoskeletal and there are some really risky diagnoses out there that you need to think about.Back pain is a multi system disorder....., until you can prove otherwise.Don't forget to listen to Iain's talk on chronic pain link here. https://vimeo.com/97811644vbSRed flag symptoms and analgesia advice below.
Wednesday Jun 24, 2015
Ep 49 - SMACC Workshops Review and Pearls
Wednesday Jun 24, 2015
Wednesday Jun 24, 2015
Recorded in Chicago at the SMACC US Conference, Nat, Rick, Simon and Iain discuss the day of workshops and look forward to the main conference.
Wednesday Jun 24, 2015
Ep 50 - All in a day's work (SMACC 2015)
Wednesday Jun 24, 2015
Wednesday Jun 24, 2015
Iain and Simon discuss Iain's SMACC talk and how we deal with difficult cases in the ED.
Thursday Jun 25, 2015
Ep 51 - Day One Round Up (SMACCUS)
Thursday Jun 25, 2015
Thursday Jun 25, 2015
The first day of #smacc15 was amazing. An incredible introduction and an amazing program.Have a listen to what the St.Emlyn's team got up to on day one.S
Tuesday Jul 07, 2015
Ep 52 - Managing grief in the ED with Liz Crowe
Tuesday Jul 07, 2015
Tuesday Jul 07, 2015
Liz Crowe has delivered some great talks at SMACC, and her talents do not stop there. In her real job she is a social worker on PICUs in Australia. She has a wealth of experience at helping people through difficult times and she shares that with us here on the podcast.In truth this is something we planned to do when we were all in Chicago but the podcast has added poignancy following the tragic death of John Hinds. Although planned as a stand alone subject we cannot help but contextualise the topic in light of recent tragic events. We hope it helps now and in the future.RIP John HindsCrack the Chest talk at SMACCUSvbSt.Emlyn's
Sunday Jul 12, 2015
Ep 53 - Day 2 and 3 Round Up (SMACCUS)
Sunday Jul 12, 2015
Sunday Jul 12, 2015
Day 2 and 3 at #smaccUS. Iain and Simon round up the highlights and look forward to #smaccDUB.S
Thursday Jul 16, 2015
Ep 54 - A tribute to John Hinds
Thursday Jul 16, 2015
Thursday Jul 16, 2015
A podcast mini to round up and look forward to the next few months on the podcast.We also have a special recording of Danny Boy from the Irish Youth Choir and conducted by Greg Beardsell. This performance was dedicated to Dr John Hinds in Dublin following his untimely death in a motorcycle accident.Please listen and take a moment to remember him and all that he has done to inspire everyone involved in the care of the injured.vbS
Sunday Jul 26, 2015
Ep 54 - Intro to EM: Analgesia in the ED.
Sunday Jul 26, 2015
Sunday Jul 26, 2015
Iain and Simon discuss the core skills that all EM clinicians need to manage pain in the ED. These are the basics, but don't be put off. The basics are more important than the fancy stuff that we will discuss in a later podcast.vbS
Saturday Sep 05, 2015
Ep 55 - Communicating (not Breaking) Bad News with Liz Crowe
Saturday Sep 05, 2015
Saturday Sep 05, 2015
Liz Crowe joins Iain Beardsell to discuss really difficult conversations in the ED. How do we communicate terrible news in the ED and critical care.vbSt.Emlyn's
Sunday Sep 27, 2015
Ep 56 - Intro to EM: How to refer a patient
Sunday Sep 27, 2015
Sunday Sep 27, 2015
How to make a referral from the ED to an in patient team.Iain and Simon give you tips on making it great.
Monday Nov 02, 2015
Ep 57 - When things go wrong - the difficult conversation
Monday Nov 02, 2015
Monday Nov 02, 2015
Simon and Nat talk about how to have that tricky conversation when you have to tell a colleague that they may have made a mistake.vbS
Friday Dec 04, 2015
Ep 59 - Lessons learned from the November Paris attacks with Youri Yordanov
Friday Dec 04, 2015
Friday Dec 04, 2015
We are truly honored to listen and learn from Dr Youri Yordanov from Paris. Youri was the senior emergency physician on duty on the 13/11/15 during the brutal and terrifying terrorist attacks in Paris. Here he joins St.Emlyn's to discuss how they managed a mass casualty incident with lessons for us all.There is no doubt that without the skills, preparation and response of Youri, his ED team, the wider hospital and the emergency service in general the death rate would have been much worse.Thanks Youri for your wisdom and reflections.vbS
Tuesday Dec 08, 2015
Ep 60 - Londoon Trauma Conference 2015 Day 1 Summary
Tuesday Dec 08, 2015
Tuesday Dec 08, 2015
Greetings from the London Trauma Conference!As
has become our pre-Christmas custom, Iain and I have been hanging out
at the fabulous London Trauma Conference, hearing about advances and
controversies in trauma care and tracking down some of the speakers to
find out exactly what they really think (and recording it, for podcasts we'll release in due course).The
conference extends over four days, incorporating the Air Ambulance and
Prehospital Day and the Cardiac Arrest Symposium; unfortunately we can't
stick around for those but our colleagues over at the RCEM FOAM network will be podcasting from those days too, so keep an eye on their site and podcast feed too.
Thursday Dec 17, 2015
Ep 61 - Grief at Christmas with Liz Crowe
Thursday Dec 17, 2015
Thursday Dec 17, 2015
Iain and Liz discuss how we can manage bad outcomes at Christmas. It's especially tough for patients and their families when tragedy occurs at times when we are all suposed to be festive. It's also tricky for staff and their families. Liz and Iain talk through why we feel like we do and how we can manage ourselves and others better.
Wednesday Dec 30, 2015
Ep 62 - The role of paediatric surgeons in trauma with Ross Fisher (LTC)
Wednesday Dec 30, 2015
Wednesday Dec 30, 2015
Simon and Ross Fisher from Sheffield discuss the emerging role of paediatric surgeons in trauma. This podcast was recorded at the London Trauma Conference (so sorry for a bit of background noise at times).vbS
Wednesday Dec 30, 2015
Ross Fisher on Paediatric Major Trauma management and systems.
Wednesday Dec 30, 2015
Wednesday Dec 30, 2015
Ross and Simon discuss paedatric major trauma systems and quality indicators. Most of this podcast focuses on UK systems and training but should be relevant to all emergency clinicians who deal with injured children.
Wednesday Jan 13, 2016
Ep 63 - The Role of UK Trauma Units with Tim Coates (LTC)
Wednesday Jan 13, 2016
Wednesday Jan 13, 2016
Iain Beardsell joins Tim Coats, chair of the UK Trauma Audit Network, to discuss the role of trauma units within major trauma networks.
Monday Jan 25, 2016
Monday Jan 25, 2016
Sandra Viggers and Vic Brazil grace St.Emlyn's with a conference report from Sand Diego and the
International Meeting for
Simulation in Healthcare (IMSH) #IMSH2016.
Thursday Feb 04, 2016
Ep 65 - The management of Paediatric trauma in the UK with Ross Fisher
Thursday Feb 04, 2016
Thursday Feb 04, 2016
Ross Fisher, consultant paediatric surgeon and lead for TARNlet joins Simon Carley at the London Trauma Conference to discuss the challenges in managing paediatric trauma in the UK.
Wednesday Feb 24, 2016
Ep 66 - When Professional and Personal Worlds Collide with Liz Crowe
Wednesday Feb 24, 2016
Wednesday Feb 24, 2016
Iain and Liz discuss boundaries and medicine. What do you do when your personal life impacts on your clinical practice.
vb
S
Wednesday Mar 23, 2016
Ep 67 - Intro to EM: Sepsis
Wednesday Mar 23, 2016
Wednesday Mar 23, 2016
For the induction series in EM. Tips, pointers and awareness of sepsis in the ED.
Friday Apr 29, 2016
Ep 68 - An Englishman in South Africa with Robert Lloyd
Friday Apr 29, 2016
Friday Apr 29, 2016
Robert Lloyd aka @ponderingEM from the Pondering EM blog joins Simon to talk about his experiences in a South African ED. This is an amazing tribute to the work our South African colleagues and how an Englishman found a way to adapt to the challenges (and there are many) of SA EM practice.
You can find his references for the talk here.
Tuesday Jun 14, 2016
Ep 69 - SMACC Dublin Day 1 Round Up
Tuesday Jun 14, 2016
Tuesday Jun 14, 2016
Simon and Iain reflect on an emotional day at the SMACC conference in Dublin 2016
S
Thursday Jun 16, 2016
Ep - 70 SMACC Dublin Day 2 Round Up.
Thursday Jun 16, 2016
Thursday Jun 16, 2016
Nat and Iain round up day 2 at SMACC Dublin
Wednesday Jun 22, 2016
Ep - 71 SMACC Dublin Day 3 Round Up
Wednesday Jun 22, 2016
Wednesday Jun 22, 2016
Iain and Liz reflect on day 3 of the SMACC Dublin Conference
Sunday Jun 26, 2016
Ep 72 - Wellbeing with Liz Crowe
Sunday Jun 26, 2016
Sunday Jun 26, 2016
If you want to be the best clinician for your patients then it's important to look after yourself.
In this podcast Liz and Iain talk about making a plan to fell better, be better and be well.
S
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).
Wednesday Aug 17, 2016
Ep 76 - Communication workshop with Liz Crowe (SMACC DUB)
Wednesday Aug 17, 2016
Wednesday Aug 17, 2016
Liz and Iain review the communication workshop at SMACC Dublin. This is relevant to everyone who works in clinical care.
More great stuff from Liz (and Iain ;-) ).
S
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/
Friday Sep 09, 2016
Ep 78 - Intro to EM: Upper GI bleeding
Friday Sep 09, 2016
Friday Sep 09, 2016
As part of our induction series we look at the management of upper GI bleeds in the ED.
S
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".
Monday Oct 03, 2016
Ep 80 - EuSEM Half Time Talk
Monday Oct 03, 2016
Monday Oct 03, 2016
Simon and Iain chat about the first few days at EuSEM in Vienna. Some of the clinical and social highlights. We also have a bonus podcast at the end recorded with a volunteer at Iain's "Podcasting for Beginners'" talk. For more from EuSEM (The European Society for Emergency Medicine) congress follow the #eusem16 hashtag on Twitter.
Wednesday Oct 12, 2016
Ep 81 - Difficult Conversations with Children in Critical Care with Liz Crowe
Wednesday Oct 12, 2016
Wednesday Oct 12, 2016
The fabulous Liz Crowe (@LizCrowe2) returns to the St Emlyn's podcast to chat with Iain about how we can communicate more effectively with children in critical care. This podcast explores topics that are important not just for clinicians, but anyone who works with or has children.
Saturday Oct 29, 2016
Ep 82 - Apparent Life Threatening Events in Babies
Saturday Oct 29, 2016
Saturday Oct 29, 2016
Here's the podcast on BRUE and ALTE's in the emergency department.
Check the associated blog too http://stemlynsblog.org/alte-brue/
Nat and Simon talk through the key points.
S
Thursday Nov 17, 2016
Ep 83 - The Teaching Course in NYC Round Up
Thursday Nov 17, 2016
Thursday Nov 17, 2016
A quick round up of events from the excellent Teaching Course in New York (https://flippingmeded.com/) with guests Ross Fisher (@ffoliet), Ashley Leibig (@ashleyliebig), Sandra Viggers (@StarSkaterDK) and Camilla Sorenson (@Camillabirgitte).
For brilliant summaries of each day, with details from every talk, visit http://scanfoam.org/teaching-course-nyc-day-1-ttcnyc16/ (Day 1) and http://scanfoam.org/teaching-course-nyc-day-2-ttcnyc16/ (Day 2)
Friday Dec 09, 2016
Ep 84 - Critical Appraisal Nugget 4: Intention to Treat
Friday Dec 09, 2016
Friday Dec 09, 2016
Another Critical Appraisal Nugget on why analysis by intention to treat is so important.
Tuesday Dec 13, 2016
Ep 85 - Top tips for chest drains.
Tuesday Dec 13, 2016
Tuesday Dec 13, 2016
This podcast accompanies the St.Emlyn's blog post on top tips for chest drainage.
http://stemlynsblog.org/chest-drain-excellence-microskills/
S
Friday Jan 06, 2017
Ep 86 - Critical Appraisal Nugget 5: Journal Clubs
Friday Jan 06, 2017
Friday Jan 06, 2017
Setting up a really great journal club.
Tuesday Feb 14, 2017
Ep 88 - ED transfers. Patient, Preparation and People.
Tuesday Feb 14, 2017
Tuesday Feb 14, 2017
Nat and Simon discuss the complexities of transferring a patient from the resus room to CT and back again. Look out for the blog post soon on stemlynsblog.org
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.
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/
Thursday Jun 22, 2017
Ep 92 - The Teaching Course Copenhagen Day 1
Thursday Jun 22, 2017
Thursday Jun 22, 2017
Nat, Simon and Ash discuss day one of The Teaching Course in Copenhagen.
EMZen, wellness, icebreakers and feedback.
Friday Jun 23, 2017
Ep 93 - The Teaching Course Copenhagen Day 2
Friday Jun 23, 2017
Friday Jun 23, 2017
Chris Nickson, Natalie May and Simon Carley discuss simulation and educational theory on day 2 of the teaching course.
Friday Jun 23, 2017
Ep 94 - The Teaching Course Copenhagen Day 3
Friday Jun 23, 2017
Friday Jun 23, 2017
Our last podcast from the teaching course in Copenhagen #dasTTC. George Wills, Simon Carley, Natalie May, Jesse Spurr and Salim Rezzaie give the faculty perspective.
The short version is we think and hope that the delegates learned something, but as a faculty we once again learned loads and met some amazing people.
Roll on the next course. (hint they are in San Fransisco and Melbourne).
S
Friday Jul 28, 2017
Ep 95 - Non accidental injury in the ED.
Friday Jul 28, 2017
Friday Jul 28, 2017
This podcast links to a previous blog on St.Emlyns which you can find here.
Thinking the unthinkable.
S
Tuesday Aug 01, 2017
Ep 96 - Everybody's free - Top Tips for the Class of 2017
Tuesday Aug 01, 2017
Tuesday Aug 01, 2017
It's that time of year again, where we get new colleagues in the Emergency Department (and across lots of other areas of the hospital too).
These are some of the top tips for new starters (and life in the ED in general) gathered from the senior medical and nursing team at Virchester (South).
More induction guidance and education available at http://stemlynsblog.org/induction/
Oh. And one tip we left out - always wear sunscreen.
With thanks (and apologies) to Baz Luhrmann.
Thursday Aug 17, 2017
Ep 97 - Foreskins: A PED primer with Ross Fisher
Thursday Aug 17, 2017
Thursday Aug 17, 2017
A podcast on foreskin problems in the paediatric emergency department with Ross Fisher and Simon Carley.
This podcast links to the blog post which you can find here. Foreskins a PED primer.
Friday Oct 06, 2017
Ep 98 - Life as an EM trainee in South Africa. A panel discussion
Friday Oct 06, 2017
Friday Oct 06, 2017
I recently met up with some amazing UK docs working in South Africa at the EMSSA conference. This conference was held in Sun City near Johannesburg and brought together emergency physicians from across the contient.
It was great to catch up some UK docs who were on postgraduate electives working in hospitals like Khayelitsha which you may remember from this amazing blog by Robert Lloyd.
So please listen, learn and get in touch if it's something that you want to do.
On the podcast we have
Simon Carley (@EMManchester), Jennifer Hulse (@coffeeheadaches), Chris Wearmouth (@CCWearmouth), Jacob Smith (@DrJacobSmith), Emma Gold (@EmmaRGold) and Chloe Sanderson.
There are also Marina Queisser & Eveline Baerends in the photo.
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
Saturday Dec 09, 2017
Ep 100 - How to use WhatsApp and other group messaging systems in a Major Incident.
Saturday Dec 09, 2017
Saturday Dec 09, 2017
A quick summary on how you can use group messaging systems in a major incident. A vast improvement on telephone cascades BUT you have to set this up in advance. If you make it up on the day it will be a disaster. Here's the tips and tricks from the Virchester team. You can read more here http://stemlynsblog.org/tag/whatsapp/
Saturday Dec 09, 2017
Ep 101 - November 2017 Round Up
Saturday Dec 09, 2017
Saturday Dec 09, 2017
Our November round up of news from the blog with Simon and Nat.
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
Tuesday Jan 16, 2018
Ep 103 - December 2017 Round Up
Tuesday Jan 16, 2018
Tuesday Jan 16, 2018
December round up of St.Emlyn's
Dates for your diary.
1. Cape Town Teaching Course
2. Manchester Teaching Course
3. BadEMFest18
Blog posts.
1.Dan does part of State of the Art #ICSSOA2017. St.Emlyn’s
2.Management of paracetamol therapeutic excess in the ED. St.Emlyn’s.
3.The ED Spa. Wellness and Support in #Virchester. St.Emlyn’s. (NOTE - We forgot to mention the incredible contribution of Kirsten Ballantyne on this project - it's more than just Laura)
4.JC : Paracetamol, NSAID’s or both in MSK trauma. St.Emlyn’s
5. 104 Reflections from Sydney HEMS – the eBook. St.Emlyn’s
6.MARSIPAN – Not just for (Christmas) Cakes. St.Emlyn’s
7.How to ask a question at a conference. The origin of ‘that’ algorithm. St.Emlyn’s
8.Review of 2017. St.Emlyn’s
If anyone wants to know more about any of the conferences we talk about please get in touch with the team stemlyns@gmail.com
S
Wednesday Jan 24, 2018
Wednesday Jan 24, 2018
In this podcast Simon talks to Dan Harvey (ITU) and Mark Wilson (Neurosurgeon) on the management of complex patients with a perceived devastating brain injury.
This podcast is linked to the blog on the St.Emlyn's website.
http://stemlynsblog.org/jc-devastating-brain-injury-complex-decisions-in-the-resus-room-st-emlyns/
S
Wednesday Feb 14, 2018
Ep 105 - Critical Apprasal Nugget 8: Diagnostics and PICTR questions.
Wednesday Feb 14, 2018
Wednesday Feb 14, 2018
Rick and Simon talk about critical appraisal and diagnostic studies. How does a PICTR question work and how can you use it to assess the quality of a published study, and how can it be used in research design.
Friday Feb 23, 2018
Ep 106 - Debriefing in Critical Care with Liz Crowe
Friday Feb 23, 2018
Friday Feb 23, 2018
In this episode, the fabulous Liz Crowe (@LizCrowe2) discusses how to approach debriefing after critical (and non critical) incidents in healthcare. We focus on the debriefing that takes place 5-7 days after an incident. For more on a "hot" debrief listen to this podcast by Ashley Liebig and Rob Orman
Monday Apr 02, 2018
Ep 107 - January 2018 Round Up
Monday Apr 02, 2018
Monday Apr 02, 2018
Iain and Simon round up the blog posts from January 2018. You can listen to the podcast below. Links to all the blog posts mentioned are listed below.
As 2017 ends and we look forward to 2018 it’s time to reflect on a year with the St.Emlyn’s team. Despite our chronological and geographical dispersal it’s really felt like a team effort in 2017. We have travelled, learned, listened,…Read more
JC: Devastating Brain Injury. Complex decisions in the resus room. St.Emlyn’s
Simon Carley January 4, 2018 3 Comments Social media can sometimes give the impression that all is rosy in the world of resuscitation. We hear of the amazing saves, the wonders of ECMO, helicopters and heroic acts with great outcomes, but the reality is of course very…Read more
[caption id="attachment_31228" align="alignleft" width="300"] northern emergency medicine conference[/caption]
St.Emlyn’s goes further north – NEM Conference #NEMC18
Chris Gray January 9, 2018 0 Comments It’s the second time I’ve been to the Northern Emergency Medicine conference, this year held in the sunny city of Durham. I say sunny… I needed my jacket. Last year’s programme was great and included some fantastic speakers, including our…Read more
JC: Can I safely discharge dizzy patients from the ED?
Janos Baombe January 12, 2018 4 Comments Last month, I came across a clinical review published in the Annals of Emergency Medicine1 that got me really excited! It got me excited (in a geeky professional sense of course…) as it covered a topic that causes significant…Read more
On Reflection
Natalie May January 16, 2018 3 Comments On Reflection I’ve been reflecting on reflection for some time now, at least since I started formally collecting my lessons from Sydney HEMS and probably even before that, because this sort of meta nonsense is something medical education enthusiasts like…Read more
CRYOSTAT-2 with Ross Davenport
Richard Carden January 21, 2018 2 Comments You might be aware that an exciting new trial has started called Cryostat-2. This is exciting as it has the potential to improve patient outcomes, but also because it will involve all the Major Trauma Centres in England and 8…Read more
The End of the ‘Roid? JC: ADRENAL
Dan Horner January 22, 2018 4 Comments So another year, another Critical Care Reviews meeting. Rob is doing an absolutely fantastic job with these, inviting lead authors from major critical care trials to present and defend their work. In fact, this is going so well that this…Read more
Belgian EM at BeSEDiM 2018.
Simon Carley January 28, 2018 0 Comments Last weekend, the BeSEDiM (Belgian Society of Emergency and Disaster Medicine) organised their annual symposium. It is the scientific organization of the Belgian emergency physicians with Said Idrissi as chairman. 13 years ago, Belgian Emergency medicine was born as a…Read more
Is there anything else I need to know? Working in Africa.
Simon Carley January 29, 2018 0 Comments This is a guest post from our good friend Stevan Bruijns aka @codingbrown Stevan has been an advocate of international emergency medicine for many years and he, like us feels that there is much that high income countries can do…Read more
vb
S
@EMManchester
Before you go please don’t forget to…
Subscribe to the blog (look top right for the link)
Subscribe to our PODCAST on iTunes
Follow us on twitter @stemlyns
See our best pics and photos on Instagram
PLEASE Like us on Facebook
Find out more about the St.Emlyn’s team
Simon and Iain belatedly reflect on a tough winter and the posts in January.
Check out stemlynsconference.com if you want to know more about #StEmlynsLIVE
S
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
Sunday Apr 29, 2018
Ep 109 - The Physican Response Unit (PRU) with Rich Carden and Tony Joy
Sunday Apr 29, 2018
Sunday Apr 29, 2018
The Physician Response Unit (PRU) is an innovative service in East London that takes the emergency department to the patient. The PRU is led by Tony Joy, consultant in emergency medicine and prehospital care and is a fairly unique service to the UK.
In this podcast our very own Richard Carden interviews Tony for an in depth understanding of how the service is supporting the entire emergency care system in London.
You can read more about the PRU here https://londonsairambulance.co.uk/our-service/news/2017/10/remodelled-pru-to-be-a-seven-day-service-for-the-first-time and look out for a blog post on the St Emlyn's blog site very soon.
Thursday May 17, 2018
Ep 110 - March 2018 Round Up
Thursday May 17, 2018
Thursday May 17, 2018
Iain and Simon catch up on what happend on the St Emlyn's blog and podcast in March 2018.
Visit http://www.stemlynsblog.org for more info and links to the articles mentioned in the podcast.
This month we cover IV fluids and the never-ending debate around balanced crystalloids vs. saline, we look at working in Africa on secondment or as a placement and we round off with a discussion of the utility of pupillary signs in the prognosis of patients post cardiac arrest.
S
Saturday May 26, 2018
Ep 111 - April 2018 Round Up
Saturday May 26, 2018
Saturday May 26, 2018
Simon and Iain talk through what the team has been up to in April. All the blogs should be on the website and of course you can subscribe to the podcast via iTunes or via PodBean.
Key publications in April.
1. Our e-book on health and wellbeing for the resuscitationist. http://stemlynsblog.org/the-resuscitationists-guide-to-health-and-wellbeing-a-st-emlyns-e-book/
2. Police drop offs for penetrating trauma in the US. http://stemlynsblog.org/to-protect-and-serveand-drop-off-st-emlyns/
3. The latest blogs on the amazing #badEMfest18 conference in South Africa http://stemlynsblog.org/bademfest18-day-3-st-emlyns/
4. The top 10 trauma papers of the year http://stemlynsblog.org/top-10-trauma-papers-2017-2018-for-traumacareuk-conference-st-emlyns/
5. Complications of anticoagulation http://stemlynsblog.org/complications-of-anticoagulation-and-how-to-manage-them-st-emlyns/
6. Trauma CT in kids http://stemlynsblog.org/jc-trauma-paediatric-wbct/
7. The folly of dichotomous diagnosis http://stemlynsblog.org/50-shades-black-white-folly-dichotomy/
8. Bonded in Blood with Ashley Liebig and Noah Gallagher http://stemlynsblog.org/bonded-in-blood/
9. How to coach your team and the Austrian EM conference http://stemlynsblog.org/how-to-coach-feedback-team-st-emlyns/
Gosh, when you write it down and think about all the work the rest of the team puts in to teach and learn it makes me kind of proud. Don't forget to join us later this year for the live version at #stemlyneLIVE in Manchester.
S
Subscribe to the blog (look top right for the link)
Subscribe to our PODCAST on iTunes
Follow us on twitter @stemlyns
PLEASE Like us on Facebook
Find out more about the St.Emlyn’s team
Come join us at our conference in October 2018
Thursday May 31, 2018
Ep 112 - Acute Psychiatric Emergencies in the ED.
Thursday May 31, 2018
Thursday May 31, 2018
This month we have a podcast on how we approach patients with mental health needs in the ED. It outlines the rationale and delivery of a change in how we manage some of the most vulnerable patients in the ED. We hope you find it interesting and I suspect you will also find it quite challenging. We are aiming to improve the care of patients with Mental Health needs, but in doing so we must face our own prejudices and practices, which are not always healthy.
Editorial note on language – as you listen to the podcast you might be surprised to hear us use words like ‘insane’ in relation to decisions and systems. In some ways it seems incongruous to use such terms in a podcast that promotes a better understanding of mental health issues. We considered taking them out, but after consideration we left them in an attempt to illustrate the false dichotomy between medical and psychiatric needs that is embedded in much of our work. Perhaps the use of language reflects this and makes the point that we can do better.
Why do we need to rethink our approach to Psychiatric emergencies in the ED?
There are a group of life threatening conditions that present to your ED that you don’t deal with, or at least you don’t deal with very well. This group of conditions has a significant mortality and an incredibly high morbidity, but if you are a typical emergency physician you probably don’t think you own the problem. This group of conditions is at least as common as chest pain and yet it’s unlikely that you feel the same level of ownership of the problem.
The issue is of course that of psychiatric illness. In Virchester it accounts for about 1 in 20 patients through the door, and that number is much, much higher if we were to include substance abuse and its related outcomes.
In general, the approach in many UK units is to divide the patient up on arrival into physical and mental health needs. We feel responsible for the physical problem and then we try and offload any psychiatric problems onto the psychiatrists and mental health teams. At the centre of this is the patient who really does not see or feel this dichotomy and we really need to challenge our approach to this.
Such dichotomies are embedded in our systems. I’m sure that many readers will be familiar with the request to ‘medically clear’ a patient in order that they can then be assessed by the mental health team. Bizareer customs and practice take place around these assessments, for example in Virchester the rule that a patient with a heart rate of more than 100 cannot be medically fit for assessment is sometimes used to decline psychiatric assessment. Such informal rules (none are actually written down or appear in any agreed protocol) result in delayed assessments, patient distress and long waits in the ED. I could go on, and whilst there is good and practice amongst all teams and specialities (we are just as bad at the mental health teams in promoting this dichotomy), the point is that we really don’t act in the patient’s best interests by dividing mental and physical health.
This clear difficulty was one of the starting points for the APEX course, which aims to bring psychiatry and emergency medicine together for the benefit of patients, services and staff.
The interview on the podcast is recorded with Prof. Kevin Mackway-Jones who many of you will know through his work with the Advanced Life Support Group. He was the instigator of APLS at a time when there was a clear need for emergency physicians to improve their approach and knowledge of paediatric emergencies. APEx feels the same. A common condition in our EDs for which we are not currently doing the best that we can for our patients and where a joint teaching and learning approach is needed between the ‘tribes’ of medicine.
This could be a game changer to how we manage a very common and very vulnerable group of patients in the ED.
So what’s on the course?
I can’t give you the whole courses here but there are a few principles that underpin the content and approach.
Key points.
It’s co-written and developed between psychiatry and emergency medicine
It’s a symptom based approach (just like APLS) and so it deals with how we deal with the presenting complaint first and not the underlying diagnosis (as you may not know what this is when you are dealing with the patient).
The approach will be familiar to many Eps.
Primary Survey
Resuscitation
Secondary Survey
Definitive management
There is a unified approach. The patient needs an ABC approach for physical health, but in addition and concurrently they also need the AEIOU approach.
A – Assessment of Aggression and Agitation
E – The Environment in which you are assessing the patient
I – The Intent of the patient
O – The Objects the patient has to carry out the intent
U – The Unified assessment (as you will also be carrying out an ABC assessment alongside AEIOU)
Rapid tranquilisation is a key conern for EPs and so there is lots on this that does not automatically default to restraint, a needle and syringe and a significant risk.
Oral tranquilisation works
Ketamine is not the answer to every patient
It’s a risk based approach as every intervention (including no intervention) has a risk
Find out more
You can find out more on the ALSG website here.
What has APEx got to do with St Emlyn’s?
At St Emlyn’s we are letting you know about the course for several reasons. Many of us teach and support the work of the ALSG charity (for free and because we believe in it), but also that we all believe that the care of patients with mental health needs can be improved. They are a vulnerable group who generally get a bad deal when they present in crisis to emergency departments. We know we can do better and we believe that this course will help us achieve our goal to do the best that we can for our patients.
APEX Course information.
S
@EMManchester
Subscribe to the blog (look top right for the link)
Subscribe to our PODCAST on iTunes
Follow us on twitter @stemlyns
PLEASE Like us on Facebook
Find out more about the St.Emlyn’s team
Come join us at our conference in October 2018
Friday Jun 15, 2018
Ep 113 - The best of badEMfest 2018
Friday Jun 15, 2018
Friday Jun 15, 2018
Nat and Simon discuss the recent #badEMfest18 conference.
You can read more about the conference on our posts on the stemlynsblog website.
Day 1
Day 2
Day 3
Day 4... it's coming
vb
S
Friday Aug 17, 2018
Ep 115 - July 2018 Round Up
Friday Aug 17, 2018
Friday Aug 17, 2018
A quick round up of the best from the blog in July 29.
Infinite Game theory and Emergency Medicine with Craig Ferguson
http://stemlynsblog.org/only-a-game-infinite-game-theory-in-emergency-medicine/
Epinephrine in Cardiac Arrest: Journal Club post (and a really important one)
http://stemlynsblog.org/jc-does-epinephrine-work-in-cardiac-arrest-st-emlyns/
Keep on Walking: PTSD and me with Rusty Carroll
http://stemlynsblog.org/keep-walking-ptsd-and-me-part-2-st-emlyns/
Tamulosin in Renal Colic: Journal Club post
http://stemlynsblog.org/jc-tamsulosin-and-renal-colic-st-emlyns/
Pointing the Finger: Paronychia in the ED from Natalie May
http://stemlynsblog.org/paronychia/
vb
S
Thursday Aug 30, 2018
Ep 116 - Moral Injury in emergency and prehospital care with Esther Murray
Thursday Aug 30, 2018
Thursday Aug 30, 2018
This week we recorded a podcast inspired by a recent publication in the EMJ. Esther Murray aka @EM_Healthpsych is a psychologist working in London.
Her recent paper on whether the experiences of medical students might precipitate moral injury during their pre-hospital experiences gives an insight into how we all cope with and respond to the clinical work we do. Some of the work we do is traumatic, painful and morally difficult to rationalise. We are witness to the very worst aspects of some of our patient’s lives and there may be a price to pay.
I was delighted to explore some of the concepts around moral injury in this podcast and would really recommend that you read the paper 1 and consider whether this is something that can affect ourselves and our colleagues. The paper is open access at the moment so there is no excuse not to 😉
Although the paper is based on a small number of participants from only one aspect of the healthcare system it does recognise this limitation and alludes to future work with different groups of clinician.
What is Moral Injury?
Esther describes ‘moral injury’ as a concept emerging from work with military veterans. It is used to describe the psychological sequelae of ‘bearing witness to the aftermath of violence and human carnage
Friday Sep 28, 2018
Ep 117 - EMS Gathering 2018 with Aiden Baron
Friday Sep 28, 2018
Friday Sep 28, 2018
EMS Gathering round up 2018 with Simon Carley and Aidan Baron. See www.stemlynsblog.org Apologies for the sound quality on this one, it was all done in a fairly noisy environment.
Don't forget to listen to special guests from 23 mins onwards.
Tuesday Oct 16, 2018
Ep 118 - August 2018 Round Up
Tuesday Oct 16, 2018
Tuesday Oct 16, 2018
A little later than planned, but here is the podcast round up of the St Emlyn's blog for August 2018.
The following blogs are discussed.
Lessons learned at EMSA https://www.stemlynsblog.org/lessons-learned-at-emsa18/
Troponin and Biotin https://www.stemlynsblog.org/troponin-and-biotin-a-lethal-combination/
Top apps at EMSA https://www.stemlynsblog.org/top-apps-at-emsa18-st-emlyns/
Navigating the CESR route in UK emergency medicine training https://www.stemlynsblog.org/et-tu-brute-one-mans-battle-with-cesr-st-emlyns/
JC: IV fluids review paper https://www.stemlynsblog.org/jc-intravenous-fluid-therapy-in-critically-ill-adults-review-st-emlyns/
Moral Injury in emergency medicine https://www.stemlynsblog.org/moral-injury-in-emergency-and-pre-hospital-care-esther-murray-on-st-emlyns-podcast/
Monday Oct 22, 2018
Ep 119 - September 2018 Round Up
Monday Oct 22, 2018
Monday Oct 22, 2018
Here's our round up of the best of the blog from September 2018.
The following blogs are discussed.
OOHCA and airway management. Do we need a tube? http://www.stemlynsblog.org/jc-oohca-and-airway-management-do-we-need-a-tube-st-emlyns/
The Zero Point Survey. Optimising resuscitation teams in the ED. https://www.stemlynsblog.org/jc-the-zero-point-survey-optimising-resuscitation-teams-in-the-ed-st-emlyns/
Subacute and massive PE management https://www.stemlynsblog.org/we-call-it-massiiiiiiivve-pe-at-st-emlyns/
EMS Gathering and podcast https://www.stemlynsblog.org/ems-gathering-review-and-podcast-st-emlyns/
ResusTO: A simulation/resuscitation conference like no other https://www.stemlynsblog.org/resusto-a-simulation-resuscitation-conference-like-no-other/
Monkeypox has arrived https://www.stemlynsblog.org/monkeypox-has-arrived-is-the-panic-justified-st-emlyns/
Micro Machines: Sick neonates at RATH18 https://www.stemlynsblog.org/micromachines/
Equality and Diversity in EM. What I learned as a recovering racist. https://www.stemlynsblog.org/equality-and-global-health-what-i-learned-from-being-a-recovering-racist/
StEmlyn's at EusEM (Four posts)
https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-4/
https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-3/
https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-2/
https://www.stemlynsblog.org/st-emlyns-at-eusem18-day-1/
Sunday Oct 28, 2018
Ep 120 - The pursuit of excellence with Nat May at #stemlynsLIVE
Sunday Oct 28, 2018
Sunday Oct 28, 2018
This presentation was given at the inaugural #stemlynsLIVE conference on the 8th of October 2018 in Manchester. You can read more about the presentation and the conference here. https://www.stemlynsblog.org/in-pursuit-of-excellence/
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/