REBOA with Zaf Qasim

Simon and Zaf talk about the practicialities of REBOA and discuss whether it's ready for prime time in the UK.

Further reading

Alan Grayson on beyond ATLS at St Emlyn’s LIVE 2018

Alan Grayson takes us through his thoughts on ATLS. Is it really as terrible the #FOAMed world makes out?

Wellbeing for the broken with Liz and Iain. St Emlyn’s

This is the podcast that links to the following two posts on how to deal with some of the hardest events we have to deal with in emergency and critical care.

You can read more about the topic on the following two blogs.

https://www.stemlynsblog.org/wellbeing-for-the-broken-part-1-liz-crowe-for-st-emlyns/

https://www.stemlynsblog.org/wellbeing-for-the-broken-part-2-st-emlyns/

This is a tough listen so if you are affected by the content do chat through with colleagues. 

George Wills on Aortic Emergencies from #stemlynsLIVE

Back in late 2018 we gathered in Manchester for the inaugural #stemlynsLIVE conference. Our friend Dr George Wills gave a great talk on Aortic Emergencies.

All emergency physicians know that it's all to easy to miss an aortic catastrophe. Listen to George's wisdom on common pitfalls and top tips to make you a better emergency clinician.

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Also check out these excellent #FOAMed resources.

• 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

Clare Richmond on the Journey that Matters from #stemlynsLIVE

This podcast and presentation was recorded at the St Emlyn's LIVE conference in Manchester 2018. In this presentation Clare takes us through the rationale, principles, training and practice that we need in order to continually develop as prehospital and resuscitation practitioners.

You can read more from the event at http://www.stemlynsblog.org 

This is a great presentation for anyone interested in continually developing their own and their colleagues practice, delivered by someone who really knows what they are talking about and who works for one of the best developed resuscitation services in the world.

Clare is an Emergency Physician and specialist in Pre-Hospital Care and Retrieval medicine based in Sydney, with Royal Prince Alfred Hospital and Sydney HEMS. She has completed a fellowship in simulation based education, and enjoys training with “real” people - patients, bystanders and the other clinicians we come across as we treat our patients every day. She is a lecturer with the University of Sydney, and is involved in education for the NSW Institute for Trauma Injury Management. When Clare is not working on helicopters or training teams, she is studying yoga or hanging out with her puppy, Archie. 

November round up podcast 2018. St Emlyn’s

November was a busy month for the St Emlyn's team with a variety of blogs on conferences, EBM, philosophy and education. Here's the podcast and the links to the blogs mentioned in November.

Beyond ALS with Salim Rezaie at #stemlynsLIVE

Salim Rezaie from the REBEL EM podcast takes us through the optimal management of cardiac arrest and also explores some of the controversies and difficulties that make the difference to our patients. 

You can read a lot more about the background to this talk, see the evidence and watch the video on the St Emlyn's site. Just follow this link. https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/ 

Natalie May on the pursuit of excellence

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/

St Emlyn’s February 2018 blog and podcast round up.

Iain and Simon review the best of the blog from February 2018.

Simon Carley

St Emlyn’s January 2018 in review

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.

Review of 2017. St.Emlyn’s

Simon Carley January 1, 2018 0 Comments 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,…
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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…
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[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…
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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…
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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…
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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…
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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…
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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…
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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…
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@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

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Managing Perceived Devastating Brain Injured patients.

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/

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The Critical Care Reviews meeting and the ADRENAL Trial results. Jan 2017

Rob MacSweeney from the incredible Critical Care Reviews website joins Simon to talk about the forthcoming CCR meeting in Belfast and the news that the eagerly awaited ADRENAL trial will be releasing it's results this Friday.

Here's the link for the live stream at 0900 GMT on Friday 20th Jan https://www.youtube.com/watch?v=ZU5w9AIu83Q If that does not work on the day then head over to the CCR website for an updated link

Here's the link to the CCR website. http://www.criticalcarereviews.com

Below is the 'blurb' from the CCR website. The bottom line is that this is a unique and incredibly valuable event and there is still time to get there.

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Every year the Critical Care Reviews Meeting brings the chief investigators for the biggest and best critical care trials of the year to Belfast to discuss their work. The programme is put together throughout the year as these trials either near completion or are published, but we have three confirmed mega trials to open registration with:

• ADRENAL - Prof Bala Venkatesh (Brisbane) will discuss ADRENAL, ANZICS latest mega trial, investigating corticosteroids in septic shock.
• TRANSFUSE - Prof Alistair Nichol (Dublin / Melbourne) will discuss TRANSFUSE, another massive ANZICS RCT, examining the age of transfused red cells in the critically ill
• MACMAN - Dr Jean-Baptise Lascarrou (Nantes) will present the MACMAN trial, comparing direct laryngoscopy with video laryngoscopy in the ICU.
• ATHOS-3 - Dr Ashish Khanna (Cleveland) gives his perspective on the ATHOS-3 trial, evaluating angiotensin II in vasodilatory shock.
• BREATHE - Prof Gavin Perkins (Warwick) tackles the role of non-invasive ventilation to achieve liberation from invasive mechanical ventilation
• VAP-RAPID - Prof John Simpson (Newcastle) describes his trial investigating a biomarker-guided strategy for limiting antibiotics for ventilator-associated pneumonia
• ART - Prof Alexandre Cavalcanti (São Paulo) explains the ART trial, testing alveolar recruitment in ARDS
• SURVIVING SEPSIS CAMPAIGN - Prof Andrew Rhodes (London) will explore the latest version of the Surviving Sepsis Campaign, which was released in January
• JOHN HINDS TRAUMA LECTURE - Dr Sophie Wallace (Perth) delivers this honorary lecture, recalling events during a major incident on Mount Everest

The Meeting is getting increasingly popular and in 2017 sold out for the first time. If you haven't yet been, and are wondering what it's all about check out the promotional movie. In addition to the big trials, we also review the remaining major trials of the year, have talks on "how I manage..." specific conditions by these experts, and take a look at the dark arts of critical care research with some of the best trialists in the world. In addition, every delegate will receive a free copy of the "Critical Care Reviews Book 2018" summarising, critiquing and placing in context the best critical care trials of the year. If you are unluckily enough not to be able to make it, all talks will be recorded and made freely available online after the event. You can check out the previous talks here and last years book here

The Critical Care Reviews Meeting is a small, intimate event where you get the opportunity to meet the faculty, ask questions and have a beer with them. The famous "Informal Chat", held at the end of the day, guarantees this opportunity to ask some real questions and get some very interesting answers. Stay for dinner afterwards, overlooking the slipways where RMS Titanic and Olympic were built and launched. Year on year delegate feedback has been incredibly positive confirming this as one of the best meetings around. In 2017 delegates travelled from across Ireland, the UK, Europe, India, the USA and Australia. Don't wait too long before registering as numbers are limited and the meeting will sell out.

Critical Care Reviews is a not-for-profit organisation.

CAN 7 Relative risk, Absolute risk and NNT in 5 minutes

A critical appraisal nuggest on simple ways to understand the true effect of an intervention. Also see this more in depth podcast done with Iain Beardsell

http://ebem.podbean.com/2011/11/03/statistics-2/

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St Emlyn’s In Review - March 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.

Research Priorities in Emergency Medicine

This podcast links to a St.Emlyn's blog on the outcome of the James Lind Alliance research priority setting exercise.

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CAN 6 Retrospective and Prospective studies

Rick and Simon talk about the merits of prospective and retrospective studies

TTC NYC Round Up

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)

Handover part 2.

Part 2 of our podcasts on major trauma handovers. This follows on from the discussion at SMACC and is intended to operationalise the concepts we talked about then. This is aimed at a UK audience but should apply pretty much anywhere. So hands off, eyes open and listen in, here we go.

ED Handover in the resus room.

Whilst we were in Dublin at the SMACC conference we took the opportunity to get some great minds together on the subject of ED handover at the point between prehospital and hospital teams for the critically ill or injured patient in the resus room.

This is an area of some difficulty in many areas (prob shouldn't be, but it is) and we thought it would be fun and useful to get perspectives from both sides.

As ever, we are not here to be definitive and your service may have a fantastic model that works well. This podcast is to help you think about what you're doing and to consider whether it can be improved.

Doug Lynch is a retrieval doctor from Australia
Ashley Voss-Liebig is a flight nurse from Texas
Natalie May is a retrieval doctor from Sydney (Virchester Alumnus)
Rusty Carroll is a senior paramedic from Virchester and a great supporter of the ATACC group.

We don't have all the answers, but we do have the ideas.

In Virchester it can certainly be improved.....

Tell us what you think and keep an eye out for the blog post on the same subject coming soon.

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We need you to help set research priorities in EM. The James Lind Alliance wants your help.

The James Lind Alliance is working with the public and the Royal College of Emergency Medicine on an incredibly important research priority setting exercise. This podcast with Rick and Simon explains why and how you must get involved (please).

Blog post here http://stemlynsblog.org/john-lind-alliance-update-st-emlyns/

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LTC 2015 Day 2 Summary

Our summary of Day 2 of the excellent London Trauma Conference. A unique threesome from Nat, Simon and Iain.....

LTC 2015 Day 1 Summary

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.

Clinical Judgement for the Emergency Physician

My talk from the RCEM conference in Manchester 2015.

Linked blog post here. http://stemlynsblog.org/making-good-decisions-in-the-ed-rcem15/

Slides are here http://www.slideshare.net/simoncarley7/making-good-decisions-rcem-2015-manchester-wednesday

Have fun and enjoy your emergency medicine.

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Induction podcast. Back pain in the ED

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.

Details of the SMACC Run in Chicago!

Interested in taking part in the SMACC Run? Visit http://wp.me/p2DMH0-6uX for everything you need to know or visit www.bit.do/smaccrun and complete the online form. Don't forget to pre-order your SMACC merchandise!

LTC. Tim Draycott on Obstetric Trauma

Iain interviews the wonderful Tim Draycott on the management of the Obstetric patient with trauma.Tim is a consultant Obstetrician from Bristol and is a great speaker on this rather terrifying topic!

APLS 2015 updates for the management of the serious injured child. St.Emlyn’s

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,

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Ross Fisher and Natalie May discuss Paediatric Major Trauma at the London Trauma Conference

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.

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PS. If you ever get to hear him speak.... then do, he's awesome. Check this out.

Opiate overdose in the ED.

Simon and Iain debate how the management of opiate OD has changed in the ED.

Surely you're not still giving massive doses of naloxone IV and IM are you? Really? Maybe this will make you think again.

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Prof. Tim Harris joins St.Emlyn’s on Shock Assessment

Do you think you're awesome at assessing shock?

Think again!

The stupendous Prof Tim Harris (who St.Emlyn's loves) tells us that all is not quite as it seems.....

Listen, learn, be awesome.

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Problems in Early Pregnancy. Induction podcast with Nat and Iain at St.Emlyn’s

The number of patients seen in each ED with problems relating to early pregnancy in the UK is very variable - some hospitals have rapid referral pathways for patients who know they are pregnant. It's still worth thinking about early pregnancy problems though as all EDs see young women and many of these may not yet know that they are pregnant.

Our induction podcast covers our approach to women presenting to the ED

Nat and Iain :-)

Impact Brain Apnoea with Gareth Davies from London HEMS

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.

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London Trauma Conference: Day three round up.

It's prehospital and helicopter day at #LTC2014! Iain and guest podcaster Caroline Leech chat through the key points of the day.

Chest pain in the Emergency Department. Induction podcast at St.Emlyn’s

Iain and Simon discuss the dilemmas of dealing with the patient presenting with chest pain to the ED.

Blog post link here

Getting started in Emergency Medicine Research

The Challenge and Value of Research in Emergency Medicine: at DGINA 2014

Rick Body's talk from DGINA on the need for research in EM.

Check out the associated blog post at http://stemlynsblog.org

Smacc Chicago update

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 world

Button Battery ingestion in children

Simon and Nat with a linked podcast to the blog post on the ingestion of button batteries by children.
http://stemlynsblog.org/button-batteries/

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Code for Cash and Credibility

Simon and Iain discuss what might appear to be a rather dull subject, but it's not. Coding is a key to developing your department and also to secure the functions of UK emergency departments.

A great primer for everyone coming up to FCEM and to anyone interested in how Emergency Departments are funded in the UK.

Follow this link to the associated blog post http://stemlynsblog.org/show-money/

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Victoria Brazil on great presentations with St.Emlyn’s

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.

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Diffuse Axonal Injury with John Hell

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.

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Syncope. Induction podcast with St.Emlyn’s

This podcast is part of our induction series for new docs starting in UK emergency departments.

You can check out the full post and supporting materials over at the main St.Emlyn's website.

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Understanding Troponin Part 2. St.Emlyn’s

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, 2012

So, 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.

Rick

DOI: 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.

Exeter CEM conference with Adam Reuben

In addition to being generally awesome he is also the convener of this year's College of Emergency Medicine conference in Exeter from the 9th to the 11th of September 2014. There is still time to come and the program looks really good and features some fantastic presenters.

#AWESOME ALERT - CLIFF REID WILL BE THERE - YOU HAVE TO BE TOO!!!!

I'll be there with many others from St.Emlyn's so if you see me say hi.

You can see the program here

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Understanding Troponin Part 1. St.Emlyn’s

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

Induction to EM. Staying safe in your first job. St.Emlyn’s

If you're starting out in EM then it can be a scary time. Iain and Simon talk through some of the initial anxieties and ask what you need to know to be safe, sensible and super.

Archery in the ED. What can we do about targets? St.Emlyn’s

It is a little known fact that to be successful as an emergency physician in the UK it is vital to take a three month rotation in Archery. Archery is a key skill for us all dating back to Medieval times when we introduced the longbow into warfare. This devastating tool could cause panic in opposing forces, scattering them into many wide and ineffective directions. In short they were an effective tool to cause and disruption inthe opposition ranks whilst the noble English armies of old strode forward with their visions of the future. Soldiers trained using targets to hone their skills and to focus on the aim - meeting the target.

Of course these days we do not have real bows and arrows in the emergency department, but archery remains alive and well. In the modern NHS we still train our troops in archery, or at least in the principle aim of archery - to meet the target.

With our long history of target setting and target hitting it is therefore no suprise that we are world leaders in standards/targets/indicators....., whichever term you prefer in fact and it has to be said that a target culture in the NHS has been criticised widely, even being blamed for the exodus of trainees to Southern climes, but there is arguably more to it than that.

In last weeks episode we touched on new targets around trauma care in the UK and that raised many questions and opened a debate on twitter. This week we want to take those thoughts further and ask what we, as the archiest of arch archers across the entire NHS can do with these externally set targets.

What we forgot to say in the podcast is the absolute need to work alongside a short stay admissions unit under the ED umbrella. Without that you would really struggle to deliver safe and efficient care. We both work in units with short stay admission units that allow us to deliver safe diagnostic and therapeutic interventions to our patients.

So, with some trepidation Iain and I ask whether all targets are a bad thing....

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Trauma Team Leadership - the 30min CT target. St.Emlyn’s

Iain and Simon discuss the challenges of getting our trauma patients to the CT scanner within 30 minutes of arrival.

The 30 minute target is a UK standard, and we did not set it! All UK trauma centres are judged against the target and (rightly or wrongly) it has become a real issue for many centres.

We would be really be interested in what our International colleagues think about the target and the resultant strategies outlined by the team. There's more on this at the St.Emlyn's website.

As always, we'd love to hear your comments.

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Delving into the Number Needed To Treat, RRR and ARR. Why we love natural frequencies. St.Emlyn’s

Iain and Simon chat about how we can start to translate research findings in to natural frequency summaries that help clinicians and patients alike understand the value of therapeutic interventions.

The NNT site we mention is just fantastic. Visit them here http://www.thennt.com/
Great revision page here by the amazing LITFL crew http://lifeinthefastlane.com/education/ccc/risk-and-numbers-needed-to-treat/

The NNT for tranexamic acid is 67 not 50.

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SMACC Back-Back on What to believe and when to change.

Hopefully you will have already seen and listened to my SMACC talk on 'What to believe and when to change'. If not then please whizz over to the site now and have a listen. I really enjoyed exploring the uncertainties that exist around when we decide to adopt or abandon therapies.

My belief is that it's really difficult to define the perfect moment and that it's only in retrospect that we can define it.

Since appearing on the ICN network and St.Emlyn's, Scott Weingart, one of the best and most innovative clinicians I know has come back and argued for early adoption. You can check out his rationale on his site and see what you think.

I actually agree with many of the things he tells us, although he has confined himself to one side of the argument. In terms of a defence of early adoption he makes a good case, but like all debates there needs to be another side to the story, so sit back and listen to why we must reflect hard on the decisions we make in deciding what we do, why we do it, and most importantly when.

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