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The St.Emlyn’s Podcast

St Emlyn’s Blog and Podcast

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.

  • 296 episodes
  • Updated July 11

Episodes296

  • Dec 18, 2024 · 27 min

    Ep 254 - Monthly Round Up October 2024 - Toxicology, Cardiac Arrest and more

    In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley provide a comprehensive update for October 2024. They discuss key blog posts covering diverse medical topics, including highlights from the Royal College of Emergency Medicine's academic science conference focusing on toxicology, high-potency opioids, novel benzodiazepines, and the use of flumazenil. They also explore the Green ED project and the impact of climate change on healthcare. Additionally, they delve into recent research on ventricular fibrillation pad positions, the use of tranexamic acid (TXA) in trauma care, and the importance of maintaining a positive outlook amidst winter challenges by seeking small wins and engaging in enjoyable aspects of emergency medicine. The episode offers valuable insights and updates for emergency medicine professionals. 00:00 Welcome and Introduction 01:27 Highlights from the Royal College of Emergency Medicine Conference 01:50 Toxicology Insights: High Potency Opioids and Benzodiazepines 05:11 Climate Change and Healthcare: The Green ED Project 08:23 Medical Conferences: A Phoenix from the Ashes 10:38 Ventricular Fibrillation and Pad Position: New Insights 17:22 Tranexamic Acid (TXA) in Trauma Care 24:01 Maintaining Positivity in Challenging Times

  • Dec 11, 2024 · 19 min

    Ep 253 - Highlights from the London Trauma Conference 2024

    In this episode of the St Emlyn's podcast, Iain Beardsell and Natalie May reflect on their experiences at the London Trauma Conference, a four-day event covering various aspects of trauma and pre-hospital care. They discuss key takeaways from sessions on cardiac arrest, including talks on perioperative cardiac arrest and the prognostication of cardiac arrest patients. The episode also delves into wellness in the medical field, featuring insights from senior emergency physician Rod McKenzie and pre-hospital expert Matt Hooper on practical psychosocial care. Additionally, the podcast highlights advancements in trauma care, defibrillation strategies, and the importance of correct pad placement and basic practices. The episode underscores the holistic approach to patient care and the significance of personal well-being for medical professionals. 00:00 Welcome to the St Emlyn's Podcast 00:52 Highlights from the London Trauma Conference 01:13 Cardiac Arrest Symposium Insights 03:53 Prognostication After Cardiac Arrest 06:44 Defibrillation Strategies and Basics 08:29 Wellness and Mental Health in Emergency Medicine 11:10 Palliative Care in Pre-Hospital Settings 12:32 Trauma Conference Highlights and Innovations 16:48 Poster Presentations and Stand-Up Science 17:58 Key Takeaways and Reflections 18:43 Closing Remarks

  • Dec 4, 2024 · 13 min

    Ep 252 - ECMO in Trauma with Chris Bishop at Tactical Trauma 24

    In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe are joined by Chris Bishop, a clinical research fellow at the Centre for Trauma Sciences at Queen Mary University of London. Chris discusses his PhD research on veno-arterial ECMO support for cardiogenic shock following major trauma haemorrhage and explains the principles and applications of ECMO, particularly in trauma patients. The conversation covers the current practices, challenges, and future directions in the use of ECMO for trauma care, including multidisciplinary decision-making, patient selection criteria, and pioneering techniques like selective aortic arch perfusion and emergency preservation and resuscitation. 00:00 Introduction 01:12 Understanding ECMO and Its Applications 02:20 ECMO in Trauma Patients 04:17 Challenges and Resistance in ECMO Adoption 05:36 Current Research and Practices 11:31 Future Directions in Trauma Resuscitation 13:28 Conclusion

  • Nov 27, 2024 · 18 min

    Ep 251 - Bad Behaviours in Teams with Liz Crowe at Tactical Trauma 24

    This episode, recorded live at Tactical Trauma 24 explores the concept of bad behaviour within high-performing medical teams. Liz Crowe, who will be well known to regular listeners, discusses what constitutes bad behaviour, its impacts on team dynamics and patient safety, and the importance of self-awareness among medical professionals. Key findings from recent research highlight that even subtle actions like eye-rolling can negatively affect patient safety as much as overt harassment. The speaker emphasises the importance of psychological safety, trust, competence, authenticity, consistency, and empathy in maintaining a healthy team environment. Practical advice includes assessing one's own behaviour and seeking honest feedback from colleagues and loved ones. Comprehensive show notes are available here 00:00 Introduction: Addressing Bad Behaviour 01:18 Defining Bad Behaviour 01:49 Impacts of Bad Behaviour 03:15 Psychological Safety and Team Dynamics 04:24 Personal Experiences and Observations 05:46 Types of Bad Behaviour 07:19 Research Findings on Workplace Behaviour 09:10 Self-Awareness and Behavioural Impact 14:21 The Karpman Drama Triangle 17:29 Conclusion and Final Thoughts

  • Nov 20, 2024 · 28 min

    Ep 250 - Monthly Round Up September 2024 - Patient Experience in the ED, Dirty Adrenaline, and More!

    In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley discuss various facets of emergency medicine. They highlight a study on patient experience in emergency departments, focusing on issues like loss of autonomy, unmet expectations, and vulnerability. Suggestions for improvement include better communication, effective signage, and patient comfort. The podcast also covers a 'dirty adrenaline drip' study from Australia, emphasizing remote inotrope management. Discussions include the use of arterial blood pressure monitoring in pre-hospital settings and the merits of CT scans beyond the traditional six-hour window for diagnosing subarachnoid haemorrhage. The episode wraps up with reflections on the positives of emergency medicine and the importance of maintaining enthusiasm and mastery in the field. 00:00 Introduction 01:08 Patient Experience in the Emergency Department 02:33 Improving Patient Experience: Practical Tips 04:05 Qualitative Studies in Healthcare 06:43 Dirty Adrenaline Drip: A Practical Insight 10:44 Emergency Endoscopy for Caustic Ingestions 14:15 Subarachnoid Hemorrhage Diagnosis: The S.H.E.D. Study 18:14 Arterial Blood Pressure Monitoring in Pre-Hospital Settings 24:18 Reflections on Emergency Medicine as a Career 27:41 Conclusion

  • Nov 14, 2024 · 24 min

    Ep 249 - Care in the Hot Zone with Claire Park at Tactical Trauma 2024

    In this episode, recorded live at Tactical Trauma 2024, Dr Claire Park explores the critical lessons learned from civilian and military incidents, focusing on her extensive experience in the Army and their role as chief investigator in a UK trial examining responses to terrorist attacks. The talk covers the significance of 'hot zones,' illustrated by detailed analyses of the London Bridge and Fishmongers' Hall attacks and key topics include risk assessment, the importance of rapid medical intervention, the concept of survivability, the need for integrated communication among emergency services, and the human factors influencing decision-making in high-pressure environments. Claire also delves into practical strategies like the 10-second triage and bridging interventions, emphasizing the need for timely and effective medical responses to save lives. 00:00 Introduction to Learning from Incidents 01:52 Setting the Scene: Hot Zones 01:55 Case Study: London Bridge Attack 04:23 Understanding Hot Zones 05:51 Case Study: Fishmongers Hall 07:58 Risk Assessment in Pre-Hospital Care 09:23 Communication and Coordination Challenges 10:16 International Models and Time Management 12:13 Triage and Life-Saving Interventions 15:18 Data and Research on Causes of Death 21:43 Human Factors in Emergency Response 24:00 Conclusion Dr Claire Park is a consultant in pre-hospital emergency medicine for London's HEMS, as well as anaesthesia and critical care medicine at Kings College Hospital in London. She also is an army consultant with over 20 years of deployed military experience. Claire is the Medical Adviser to the Specialist Firearms teams of the Metropolitan Police Service and has worked closely with all of the emergency services in London on developing the joint response to high-threat incidents, particularly following the attacks of 2017. She is the Chief Investigator on a UK nationally-funded research grant looking at evidence for improving patient outcomes in the hot zone of major incidents. She is also a CTECC Committee member.

  • Nov 6, 2024 · 14 min

    Ep 248 - Prehospital eCPR with Alice Hutin at Tactical Trauma 2024

    Join Iain Beardsell and Liz Crowe in an engaging discussion with Alice Hutton, an emergency physician from Paris, at Tactical Trauma 24 in Sundsvall, Sweden. The episode delves into the implementation and logistics of pre-hospital eCPR (Extracorporeal Cardiopulmonary Resuscitation) by SAMU in Paris. Alice shares insights from her PhD research on refractory cardiac arrest and discusses the use of therapeutic hypothermia, including experimental approaches like total liquid ventilation. Key topics include team composition, decision-making for patient eligibility, real-time management strategies, bypassing traditional emergency rooms for specialized facilities, and the challenges of scene management, family communication, and post-event debriefing. This conversation offers a comprehensive look at the latest innovations that could transform pre-hospital emergency medical services. Read more here... 00:00 Introduction and Guest Introduction 01:29 eCPR in Paris: Current Practices 02:35 Dispatch and Response Protocols 03:32 On-Scene Procedures and Challenges 04:23 Decision Making and Scene Management 05:53 Training and Handling Difficult Situations 06:59 Challenges of eCPR Decision-Making 08:07 Importance of Team Debriefing 08:52 Post-Resuscitation Procedures 10:12 Operational Logistics and Success Rates 11:20 Innovative Research in Therapeutic Hypothermia 13:13 Future of Pre-Hospital Cooling Techniques 13:46 Conclusion and Final Thoughts

  • Oct 30, 2024 · 20 min

    Ep 247 - August 2024 Round-Up - Goldilocks Moments, Nasal Analgesia, and Public Health in the ED

    In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Simon Carley share their insights from recent conferences, including Gateshead's RCEM scientific conference, Tactical Trauma 24 in Sweden, and the Premier Conference. They explore 'Goldilocks moments' for executing life-saving procedures in critical care, emphasizing optimal timing for interventions like thoracotomies. The episode also discusses innovative training methods like shadowboxing to enhance decision-making in high-stress medical scenarios. In addition, they review a significant trial on smoking cessation in emergency departments, highlighting its potential role in broader public health initiatives, including sexual health and HIV screening. Discussions also cover various pain management strategies, such as the use of intranasal vs. intravenous Ketorolac for renal colic. The hosts critique the traditional peer review process in medical research and advocate for open peer review to support equitable and accessible scientific publishing. 00:00 Introduction and Catching Up 02:07 The Goldilocks Moment in Critical Care 05:25 Training and Decision-Making in Emergency Procedures 07:23 Smoking Cessation in Emergency Departments 10:07 Challenges in Implementing Preventive Health Strategies 10:38 Successful Public Health Projects in Emergency Medicine 11:19 Exploring Alternative Interventions in Emergency Departments 11:52 Highlights from the Premier Conference 12:54 Intranasal Ketorolac for Pain Management 15:46 The Future of Peer Review in Medical Research 20:09 Concluding Thoughts and Upcoming Content

  • Oct 23, 2024 · 20 min

    Ep 246 - Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024

    In this episode, recorded at Tactical Trauma 2024, Andrew Petrosoniak discusses real-world experiences in trauma care, and the innovative use of simulation to resolve systematic issues in blood delivery and overall trauma resuscitation protocols. Key takeaways include the concept of intelligent failure, reducing cognitive overload for medical staff, and the creation of efficient medical environments. Moreover, the episode delves into the significant improvements achieved through simulation, such as a 50% reduction in blood delivery times, and the integration of performance data to enhance CPR and clinical space design. Emphasizing the importance of using data to drive improvements, the conversation explores the implementation of roles like a CPR coach and the scalable application of these practices across individual, team, and systemic levels. Listeners are encouraged to view failures constructively and leverage simulations and data for better patient outcomes and team performance. 00:00 Introduction to Simulation in Emergency Medicine 01:05 A Real-Life Trauma Case 02:18 Identifying Systemic Issues 02:46 Implementing and Testing Solutions 05:45 The Concept of Intelligent Failure 09:41 Scaling and Impact of Simulation 10:22 The Power of Simulation in Experimentation 10:56 Data Integration in Healthcare and Sports 11:29 Evaluating CPR Quality Through Simulation 12:14 Using Data to Improve Clinical Performance 13:47 Designing Clinical Spaces with Simulation Data 15:28 Scaling Impact with Simulation 18:02 Efficient Team Communication in Trauma Bays 19:04 Broadcasting and Recording Simulations for Education 19:39 Conclusion and Future Directions The Speaker Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael’s Hospital and an Assistant Professor in the Department of Medicine at the University of Toronto. He has completed a Master of Science in medical education where he focused on the use of in situ simulation (practice in the actual workplace) in procedural skill acquisition. Andrew’s field of research includes in situ simulation and simulation-based technical skill acquisition. His work focuses on usability testing and the identification of personnel- and systems-based safety threats within acute care medicine. He is the principal investigator of the TRUST study (Trauma Resuscitation Using in Situ simulation for Team Training) that includes a partnership with human factors experts to evaluate systems and processes during high-stakes trauma simulations.

  • Oct 18, 2024 · 34 min

    Ep 245 - Leading through failure with Kevin Cyr at Tactical Trauma 2024

    Recorded at Tactical Trauma 2024, in this episode of the St. Emlyn’s podcast, Iain Beardsell and Liz Crowe sit down with Kevin Cyr, commander of a SWAT-like unit in the Royal Canadian Mounted Police, to discuss leadership, failure, and resilience in high-stakes environments. Kevin shares the powerful story of a tragic hostage situation that resulted in the unintended death of the hostage by the police, a failure of the highest order. Through this tragedy, Kevin highlights the importance of visible leadership, team resilience, and learning from failure in both law enforcement and healthcare settings. Key Themes: 1. Handling Failure in High-Pressure Situations: Kevin discusses a significant incident where a hostage was killed by his SWAT team during a rescue attempt, describing it as the “epitome of failure.” This tragic event not only made national news but left an indelible mark on the team. The podcast dives into the lessons learned from this event and how the team used it to drive growth and improvement. In healthcare, much like in policing, failure can feel devastating and highly public, but it’s also a critical aspect of development for teams and leaders. 2. Visible Leadership and Unwavering Support: In the aftermath of a traumatic event, Kevin emphasizes the importance of leadership being present and supportive. He recounts how he and his commanding officer went to visit the officers involved in the shooting immediately after the event, providing what he calls “unwavering support.” In healthcare, leaders should adopt similar strategies, offering visible and sustained support to their teams in the immediate aftermath of difficult cases. 3. Sustained Support Over Time: While initial support following a traumatic event is crucial, Kevin points out that it’s often after 48 hours, or even weeks later, that people start feeling isolated. Leaders must continue to check in with their teams weeks after the event, when the immediate crisis may have passed, but the emotional toll is still present. This ongoing visibility and emotional support are key to retaining staff and ensuring their well-being in both law enforcement and healthcare. 4. Debriefing to Learn, Not to Blame: Kevin advocates for a debriefing process that focuses on learning from failure rather than assigning blame. After their tragic event, his team didn’t just move on; they dissected the event to understand what went wrong and how to prevent similar failures in the future. In healthcare, this process is equally valuable—debriefs should aim to identify learning opportunities and reinforce positive actions, not to point fingers. 5. The Role of Organizational Culture: Kevin touches on how organizational apathy, or a lack of emotional and psychological support, can cause more damage than the actual traumatic event itself. He highlights the importance of developing a high-trust environment where team members feel safe to express vulnerability. In healthcare, fostering a culture of open communication and mutual support is essential to prevent burnout and moral injury. 6. The Value of Failure in Team Growth: One of the most profound insights Kevin shares is the idea that failure is a necessary part of growth. Three years after their tragic hostage situation, his team was called to a similar event, but this time they were successful in rescuing both hostages. Kevin attributes this success directly to the lessons learned from their earlier failure, emphasizing that failure, when handled correctly, can lead to transformational change. 7. Selection and Resilience in High-Performance Teams: Kevin discusses the importance of selecting team members with high emotional intelligence and the humility to ask for help when needed. He explains how his team differentiates between rank and role, giving autonomy to those with the most subject matter expertise, regardless of their rank. In healthcare, this is a critical point—leaders must recognize that true leadership isn’t just about authority, but about empowering others to take charge when appropriate. 8. Managing Expectations and Mental Health: The episode also delves into how individuals in high-stakes roles, whether in policing or healthcare, cope with the psychological aftermath of traumatic events. Kevin explains how his team has shifted from the belief that emotional support is unnecessary to recognizing the value of helping team members process their experiences in a healthy way. This parallels the increasing focus in healthcare on preventing burnout and ensuring emotional well-being through proactive support. Key Takeaways: - Failure is Inevitable: In high-stakes environments like policing and healthcare, failure will happen. What matters is how teams respond to failure—learning from it, growing stronger, and preventing future mistakes. Leadership Requires Visibility: Leaders must be present, especially in the aftermath of failure. Showing unwavering support and maintaining visibility over time is crucial for maintaining team morale and trust. - Debriefing to Learn: After a failure, it’s essential to have structured debriefs that focus on learning and improving, rather than blaming. This helps teams identify areas of improvement and ensures they grow stronger from difficult experiences. - Long-Term Support is Critical: Immediate support after a traumatic event is important, but equally important is sustaining that support over time, checking in with team members weeks or even months later to ensure their well-being. - Resilience through Humility: Teams should be built on trust and humility, where members can ask for help when needed and offer help to others. Selecting individuals with high emotional intelligence is key to creating a resilient team. - Failure Leads to Growth: When handled correctly, failure can drive transformational change within teams. It allows for the development of new skills and ensures that teams are better prepared for future challenges. Quotes: - “Failure is a necessary part of growth. It’s not just something to get over, it’s something you get better from.” - “Visible leadership and unwavering support are critical in the immediate aftermath of failure. Your team needs to know you’re there with them.” - “Debriefing to learn, not to blame, is essential. We must focus on what went well, what went wrong, and how to improve next time.” - “In high-pressure environments, we can’t control every variable, but we can control how we respond to them and how we prepare for the future.”

  • Oct 6, 2024 · 27 min

    Ep 244 - July 2024 Monthly Update - Chest Pain, REBOA, Lidocaine patches and lots of paediatric emergency medicine

    In this episode, hosts Iain Beardsell and Simon Carley provide the St Emlyn's podcast blog update for July 2024. They discuss their recent experiences, including Simon's trip to Malaysia for the MRCEM exams and Iain's upcoming attendance at the Tactical Trauma conference in Sweden. The main topics include a systematic review on the Manchester Acute Coronary Score (MACS) and its application in emergency departments, the potential influence of AI in diagnosing occlusive myocardial infarctions through ECGs, and guidelines for managing non-fatal strangulation cases. Additionally, they touch on the feasibility of using lidocaine patches for elderly patients with rib fractures and the role of partial REBOA in pre-hospital care for exsanguinating subdiaphragmatic haemorrhage. They also highlight informative segments from the premier conference on pediatric emergency medicine, covering topics such as eating disorders, hybrid closed-loop insulin pumps, and button battery ingestion. Finally, they emphasize the importance of understanding medical statistics and using diagnostic tests effectively in emergency medicine practice. 00:00 Introduction and Summer Updates 00:55 Upcoming Conferences and Events 01:44 Manchester Acute Coronary Score (MACS) Review 05:30 AI in ECG Analysis with Steve Smith 08:18 Non-Fatal Strangulation Awareness 10:45 Reboa: Pre-Hospital Use and Insights 14:11 Pediatric Emergency Medicine Highlights 14:36 Eating Disorders and Diabetes Management 19:00 Lidocaine Patches for Rib Fractures 21:46 Critical Appraisal and Medical Statistics 24:28 Button Battery Ingestion Dangers 26:12 Conclusion and Farewell

  • Sep 26, 2024 · 41 min

    Ep 243 - The Subarachnoid Haemorrhage in Emergency Department (SHED) Study

    In this episode of the St Emlyn's podcast, Iain Beardsell is joined by Dan Horner, a consultant in Emergency Medicine and Neurocritical Care, and Tom Roberts, an Emergency Medicine Registrar and clinical lecturer, to discuss their recently published SHED study on subarachnoid haemorrhage in the Emergency Department (ED). This landmark study, published in the Emergency Medicine Journal, explores the safety of CT scans in diagnosing subarachnoid haemorrhage up to 24 hours after headache onset and evaluates the role of further investigations like a lumbar puncture. The study examines acute severe headache presentations in the ED and the diagnostic approach to ruling out subarachnoid haemorrhage, a critical and often feared diagnosis among emergency physicians. Conducted through the Trainee Emergency Research Network (TURN), the study included over 3,600 patients from 88 UK EDs with acute severe headaches reaching maximum intensity within one hour and no focal neurology. Data collection included CT scans, lumbar puncture results, and 28-day follow-up to identify missed cases of subarachnoid hemorrhage. Key findings from the study revealed a 6.5% prevalence of subarachnoid haemorrhage, with a significant number presenting within six hours of headache onset. The sensitivity of CT scans remained high beyond the traditional six-hour window, suggesting that CT alone could safely rule out subarachnoid haemorrhage up to 18 hours in many cases, potentially reducing the need for lumbar puncture. The risk of missing an aneurysmal subarachnoid haemorrhage after a negative CT was found to be extremely low, around 1 in 1,000. These findings challenge the routine use of lumbar puncture in patients presenting beyond six hours if the CT scan is negative, potentially changing ED practice and reducing unnecessary invasive procedures. The discussion also emphasized the importance of shared decision-making and recognizing that diagnostic testing is about managing probabilities, not certainties. For clinicians, the episode highlights the need to expedite CT scans for patients with acute severe headaches, especially those presenting within 10 minutes of onset, as they are more likely to have significant pathology. Emergency physicians are encouraged to own the decision-making process for ruling out serious causes of headaches and not defer solely to 'specialists'. The SHED study supports extending the diagnostic window for CT scans in ruling out subarachnoid hemorrhage up to 18 hours, reducing the need for lumbar puncture in many cases. This data empowers emergency clinicians to make informed decisions, manage patient expectations, and streamline ED processes. For more information, listeners are encouraged to read the SHED Study in the Emergency Medicine Journal and explore the related blog post on the St Emlyn’s website. Emergency clinicians are also invited to connect with TERN to get involved in future research opportunities. This episode provides valuable insights for clinicians in managing acute severe headaches, emphasizing a more nuanced approach to subarachnoid hemorrhage diagnosis and the importance of clinical decision-making in the ED.

  • Aug 21, 2024 · 11 min

    Ep 242 - Prehospital Neuroprotection with Ed Langford at PREMIER 2024

    In this episode, we delve into the critical role of neuroprotection in pre-hospital care, particularly in pediatric head injuries. Through a real-life case study of a 13-year-old boy who suffered a traumatic brain injury after being hit by a car, we explore the steps taken by paramedics and critical care teams to stabilize him and prevent further neurological damage. From airway management to advanced interventions, this episode highlights the challenges of pre-hospital neuroprotection and the incredible teamwork that led to the patient’s remarkable recovery. There is more detail on the full blogpost here. This podcast was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organizing 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 highly recommend them. The Speaker Ed is a Speciality Trainee in Emergency Medicine in Wessex and a trainee Critical Care Practitioner with Dorset and Somerset Air Ambulance. Ed is also the co-founder and Managing Director of Enhanced Care Services, a Southampton-based company delivering enhanced and critical care to the event medical sector, providing frontline ambulance services across Hampshire and clinical education at all levels, employing over 200 clinicians. Ed holds the Diploma in Immediate Medical Care (RCSEd) and, having promised to not take on any more work, is currently undertaking a Masters in Resuscitation, Pre-hospital and Emergency Medicine at QMUL. Enhanced Care Services Enhanced Care Services' mission is to provide and influence excellent patient care, irrespective of injury, illness or location, through the delivery of high-quality clinical operations and education. Founded in 2015, ECS now provide frontline ambulance operations across the South, delivers extensive medical cover to some of the most prestigious events across the UK and provides education from its bespoke education centre in Southampton and beyond.

  • Aug 14, 2024 · 10 min

    Ep 241 - Paediatric Palliative Care with Tim Warlow at PREMIER 2024

    In this episode, Dr Tim Warlow, a consultant in Paediatric Palliative Care, explores the complexities of caring for children with life-limiting conditions in the emergency department (ED). The discussion highlights the increasing prevalence of paediatric life-limiting conditions and the growing medical complexity of these cases, which pose significant challenges for ED staff. The episode begins by clarifying what paediatric palliative care truly involves. Contrary to common misconceptions, palliative care is not about withdrawing care but rather enhancing the quality of life for children from the point of diagnosis, whether the condition is present from birth or develops as the child deteriorates. This proactive approach often involves increasing the level of care and support as the child’s needs evolve. As the number of children with life-limiting conditions continues to rise, EDs are encountering more medically complex cases, including children who are technology-dependent and require high levels of care at home. These challenges are compounded by the evolving expectations of parents, who are often better informed and more involved in their child's care decisions. Post-COVID, community services have struggled to recover, particularly in nursing support, making the role of the ED even more critical. The episode provides practical tips for ED professionals to better manage these cases. Key strategies include: Recognising Life-Limiting Conditions: With over 400 recognized life-limiting conditions and many more undiagnosed, it’s crucial to assess whether a child might have palliative care needs. Listening to Families: Families often have an intimate understanding of their child’s unique medical baseline. Listening deeply to their insights, even when they seem unusual, is essential for providing appropriate care. Building Rapid Rapport: Quickly establishing a connection with the family is vital, as these children can deteriorate rapidly. Acknowledging the child’s presence, summarizing the situation, and validating the family’s experience can help build trust. Understanding the Child Beyond Their Illness: Families worry that healthcare professionals only see their child when they are unwell. Taking the time to learn about the child’s life outside of the hospital can lead to better care decisions. Reading the Advanced Care Plan: If available, review the child’s advanced care plan before discussing the case with the family. This ensures that the family doesn’t have to recount their entire journey and that care decisions are based on the most current information. The episode also addresses the importance of being aware of unconscious prejudice. Healthcare professionals must ensure that decisions are based on the child’s specific needs rather than assumptions about their quality of life due to their disability. In conclusion, the episode emphasizes that while caring for children with life-limiting conditions in the ED is challenging, it is also deeply rewarding. The key to providing excellent care lies not just in medical interventions but in being present, listening, and supporting the family through difficult times. Whether things go as planned or not, your presence and compassion are what families remember most. This episode is a must-listen for anyone involved in pediatric care, offering valuable insights into the critical role of the ED in supporting children with life-limiting conditions and their families. There is more detail on the blogpost here.

  • Aug 7, 2024 · 33 min

    Ep 240 - June 2024 Monthly Round Up - Nebulised Ketamine, Risky Intubations, Better Presentations, DSED, Preoxygenation and more

    As the UK enjoys its unpredictable summer, with everything from sunshine to hailstorms, we bring you a mix of updates and discussions on emergency medicine, blog content, upcoming conferences, and insightful research reviews. So, whether you're basking in the sun or sheltering from the rain, sit back and enjoy our latest insights into the world of emergency medicine. In this round-up of Month Year, we talk about a wide range of issues relating to emergency medicine, including nebulised ketamine for analgesia in the ED, risky intubations, presentation skills, more about the DOSE VF trial and analysis of the much-hyped PREOXI trial about preoxygenation before tracheal intubation. We're excited to announce our participation in two upcoming conferences. The Tactical Trauma Conference in Sweden this October promises to delve into pre-hospital emergency medicine, offering sessions from renowned speakers. It's a fantastic opportunity to learn and network, with flights to Sweden being relatively affordable. The event takes place just north of Stockholm, providing a chance to explore the beautiful city. In March next year, we look forward to the Incrementum Conference in Murcia, Spain. This is a significant event as emergency medicine has recently been recognized as a specialty in Spain. The conference will feature an impressive lineup of speakers from the FOMED world, including Scott Weingart, Ken Milne, Hany Malamatt, and Slim Resie , among others. Our very own Simon Carly will also be presenting. We'll be there to conduct interviews and gather exclusive content for our listeners. Thank you for joining us, please do like and subscribe wherever you get our podcasts.

  • Jul 31, 2024 · 15 min

    Ep 239 - Button Battery Ingestion with Francesca Steadman at PREMIER 2024

    In this podcast from the PREMIER conference 2024, Francesca Stedman, a consultant paediatric surgeon from Southampton Children's Hospital discusses the care of the child who has ingested a button battery. Button batteries are ubiquitous and come in various types and sizes. There are about 85 different kinds available or in use in the UK alone, found in everything from toys to hearing aids. The most notorious is the CR2032, which is about 20 millimeters in diameter and 3.2 millimeters thick. It contains lithium manganese oxide, and while its small size makes it convenient for electronics, it poses a significant risk if ingested. The danger with button batteries lies in their potential to cause severe injuries when lodged in the esophagus. They can cause necrosis, which is essentially tissue death, due to a strong alkaline substance produced by the battery. This substance acts like a potent oven cleaner, rapidly causing damage. The esophagus has three natural narrowing points where these batteries often get stuck, increasing the likelihood of injury. The situation becomes critical very quickly, often within two hours of ingestion. One of the most concerning aspects of these incidents is that button battery ingestions are rarely witnessed. Children might present with vague symptoms like drooling, difficulty swallowing, or even just being generally unwell. These can easily be mistaken for other common illnesses, leading to delays in diagnosis. In one particularly harrowing case, a child presented multiple times with symptoms of a respiratory infection, only for an x-ray to reveal a button battery lodged in the esophagus. By then, the damage was extensive. When ingestion is suspected, immediate action is crucial. Getting a chest x-ray is the first step, and if necessary, a lateral x-ray can confirm the presence of a button battery by revealing a characteristic double rim or halo sign. Pre-hospital measures can include giving honey or jam, depending on the child’s age, to help mitigate the damage. However, these should never delay getting the child to the hospital. Once at the hospital, the primary goal is to remove the battery as quickly as possible to prevent further injury. Depending on the location of the battery and available specialists, either ENT surgeons or paediatric surgeons may perform the removal. Post-removal care involves monitoring for complications like perforations or fistulas, which can develop days or even weeks later. In severe cases, these injuries can lead to life-threatening conditions, such as aorto-esophageal fistulas, which require immediate surgical intervention. In summary, button battery ingestion is a serious and often underappreciated risk. Even in homes where precautions are taken, accidents can happen. The key is quick recognition and action. As parents and caregivers, we need to be vigilant about keeping these small, dangerous objects out of children's reach. And if an accident does occur, immediate medical attention is essential to minimize the risk of serious injury. More details are available on the blogpost here.

  • Jul 24, 2024 · 11 min

    Ep 238 - Positive and Negative Predictive Values: Critical Appraisal Nugget

    In this St. Emlyn's podcast, Rick Body and Greg Yates, continue our exploration of diagnostic test accuracy, shifting our focus to positive predictive value (PPV) and negative predictive value (NPV). These concepts are vital for anyone preparing for exams or looking to enhance their application of diagnostic tests in clinical practice. While our last podcast discussion centred on sensitivity and specificity, PPV and NPV offer a different, arguably more clinically practical perspective on interpreting test results. Positive predictive value (PPV) and negative predictive value (NPV) are essential tools for understanding the effectiveness of diagnostic tests. PPV helps us determine the likelihood that a patient with a positive test result actually has the condition, whereas NPV helps us gauge the probability that a patient with a negative test result does not have the disease. These values are crucial for making informed clinical decisions, particularly when considering the prevalence of a condition in the population. Today, we’ll delve into these concepts, their practical applications, and why it's important to consider both PPV and NPV alongside sensitivity and specificity. You can find more about this on the St Emlyn's Blog and please don't forget to like and subscribe.

  • Jul 17, 2024 · 14 min

    Ep 237 - Hybrid Closed Loop Insulin Pumps with Nicola Trevelyan at PREMIER 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.

  • Jul 9, 2024 · 27 min

    Ep 236 - Occlusive Myocardial Infarction, ECGs and AI with Steve Smith

    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. In this special episode of the St Emlyn's podcast, we explore the concept of occlusive myocardial infarction (OMI) and its distinctions from ST elevation myocardial infarction (STEMI). Dr. Smith discusses his extensive work and experience in emergency medicine, spanning over three decades, and his development of Dr. Smith's ECG blog. The conversation dives into the limitations of traditional STEMI criteria and the benefits of adopting the OMI paradigm. Additionally, they discuss the revolutionary potential of artificial intelligence in ECG interpretation, particularly through the Queen of Hearts program developed in collaboration with Powerful Medical. Dr. Smith shares compelling studies and real-world applications demonstrating the efficacy of AI in diagnosing ECGs, ultimately offering a promising future for enhanced patient outcomes. 00:00 Introduction 01:43 Steve Smith's Journey in Emergency Medicine and ECGs 02:45 The Evolution of ECG Diagnosis: From STEMI to OMI 03:55 Challenges and Resistance to the OMI Paradigm 07:10 Key Indicators of Occlusive Myocardial Infarction 09:25 The Role of Artificial Intelligence in ECG Diagnosis 11:03 Development and Implementation of the Queen of Hearts AI 14:28 Clinical Studies and Real-World Applications 21:10 Future Prospects and Final Thoughts A comprehensive blog post with references is available here

  • Jul 2, 2024 · 16 min

    Ep 235 - Eating Disorders in the Emergency Department with Anna Kyle at PREMIER 2024

    In this episode of the St Emlyn's podcast, Iain Beardsell introduces a talk by Anna Kyle, a consultant paediatrician from Somerset, delivered at the Premier conference in June 2024. Anna explores the complexities of assessing and managing eating disorders in young patients, including young adults. Highlighting the critical nature of eating disorders, she notes a 90% increase in admissions over five years and emphasizes the deadly risks, particularly anorexia nervosa with its 10% lifetime mortality rate. Kyle provides detailed guidance on recognizing symptoms, conducting risk assessments, and the importance of a thorough medical evaluation. She also touches on the MEAD guidance for managing eating disorders, stressing effective communication with patients and their families, and the critical role of empathy and support throughout the treatment process. 00:00 Introduction to the Podcast 01:03 The Deadly Nature of Eating Disorders 02:23 Medical Complications of Eating Disorders 05:08 Cardiovascular and Other Systemic Effects 07:22 Risk Assessment and MEAD Guidance 10:23 Communication and Management Tips 15:24 Conclusion and Final Thoughts Comprehensive notes can be found here