![The St.Emlyn’s Podcast](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg.jpg)
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A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn ’s team are all passionate educators and clinicians who strive to bring you the best evidence based education. Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles. St Emlyn’s is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians.
Episodes
![Ep 188 - India COVID19 wave in Spring 2021](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday May 06, 2021
Ep 188 - India COVID19 wave in Spring 2021
Thursday May 06, 2021
Thursday May 06, 2021
Simon joins Ankur Verma from Delhi, to talk about the impact of COVID in the latest wave devastating India.
![Ep 187 - March 2021 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Apr 11, 2021
Ep 187 - March 2021 Round Up
Sunday Apr 11, 2021
Sunday Apr 11, 2021
A discussion about all the latest from the St Emlyn's blog, including a hot off the press article about vaccine induced thrombocytopenic thrombosis and the new FRCEM revision guide.
Simon and Iain also talk about the latest results from the RECOVERY trial, Major Trauma Triage tools, cricothyroidotomy, thromboprophylaxis in COVID19 and the new Medical Licensing Assessment for medical students and the new St Emlyn's Undergraduate Curriculum
![Ep 186 - Assessing online medical education resources with Peter Brindley](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Apr 08, 2021
Ep 186 - Assessing online medical education resources with Peter Brindley
Thursday Apr 08, 2021
Thursday Apr 08, 2021
An audio review of a paper in the Journal of Intensive Care Medicine with two of the authors.
Assessing on-line medical education resources: A primer for acute care medical professionals and others
Peter G Brindley, Leon Byker, Simon Carley, Brent Thoma https://doi.org/10.1177/1751143721999949
![Ep 185 - February 2021 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Copy-of-Untitled-1_300x300.jpg)
Monday Mar 15, 2021
Ep 185 - February 2021 Round Up
Monday Mar 15, 2021
Monday Mar 15, 2021
Our regular podcast round up from February 2021. Iain and Simon highlight the key learning points from this month on the St Emlyn’s blog and podcast.
Topics discussed this month include tocilizumab in COVID19, TIA risk scores, new Emergency Care standards (targets) and TXA use in epistaxis. We also pay tribute to Dr Cliff Mann, former President of RCEM who sadly died this month.
Please remember to subscribe to the podcast on iTunes/Google Play and please do leave us some reviews and ratings there.
![Ep 184 - January 2021 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/January-2021-Podcast_300x300.jpg)
Saturday Feb 20, 2021
Ep 184 - January 2021 Round Up
Saturday Feb 20, 2021
Saturday Feb 20, 2021
Our regular round up of the best of the blog and podcast from January 2021 with Iain and Simon. The St Emlyn's blog posts from January 2021 are discussed, including plenty about Coronavirus as well as other topics relevant to anyone interested in Emergency Medicine and evidence based care.
![Ep 183 - Am I going to die? Communicating COVID-19 test results and risk (January 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Feb 18, 2021
Thursday Feb 18, 2021
Going into hospital as an emergency during the COVID-19 pandemic must be extremely scary for patients and their relatives. With no relatives allowed to visit and staff dressed in full PPE, the experience must be so much more unnerving than usual. Add to that the incredible worry about catching COVID-19 for those who don’t already have it; or the worry about what might happen for those who do. Will they pull through? Could this be the end?
I’m privileged to be co-leading the COvid-19 National DiagnOstic Research and evaluation programme (CONDOR), which involves a collaboration between amazing teams in Manchester, Oxford, Leeds, Newcastle, London and Nottingham. The programme evaluates diagnostic tests for COVID-19.
We’re extremely lucky to have two very experienced and proactive patient and public representatives as members of our steering committee: Graham Prestwich from Leeds and Val Tate from Oxford.
I recently spoke with Graham and Val to get their thoughts about how we, as clinicians, might effectively communicate with patients during the COVID-19 pandemic. They provide their important insights from a lay perpsective about what they would want from their clinician.
We cover everything from the challenges of communicating while wearing PPE to the way to answer important questions like, “Am I going to die?”, which many of us have, I’m sure, had to answer on a number of occasions over the past 12 months.
I hope that you enjoy the podcast. We realise that 25 minutes wasn’t long enough to cover everything we’d have liked to.We’d really like to know what you think. Are there things that we haven’t covered that you’d like us to? What are your experiences? We’d love you to share your thoughts in the chat!
Rick
![Ep 182 - COVID-19 vaccines update (January 2021)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Jan 17, 2021
Ep 182 - COVID-19 vaccines update (January 2021)
Sunday Jan 17, 2021
Sunday Jan 17, 2021
A vaccine update with Rick Body, Simon Carley, Pam Vallely, Paul Klapper and Charlie Reynard. Bringing RCEM, St Emlyn's and the University of Manchester together for the latest thoughts and wisdom on the vaccines that might get us out of this pandemic.
Moderna vaccine phase 3 trial - https://www.nejm.org/doi/full/10.1056/nejmoa2022483
Oxford vaccine phase 2/3 - https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)32466-1.pdf
Pfizer vaccine trial - https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
#vaccines #COVID19 #coronavirus
![Ep 181 - Christmas 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Christmas_Podcast_Round_Up_Cover6gdft_300x300.jpg)
Thursday Dec 17, 2020
Ep 181 - Christmas 2020 Round Up
Thursday Dec 17, 2020
Thursday Dec 17, 2020
A special festive edition of our round up podcast featuring six weeks of blog posts and plenty more besides.
From all at St Emlyn's we hope you have a very happy festive season and we cannot wait to talk to you again in 2021.
Take care,
Simon and all the team
![Ep 180 - Understanding COVID-19 testing with Professor Rick Body (October 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Nov 27, 2020
Friday Nov 27, 2020
Rick leads the FALCON and CONDOR studies that are currently evaluating COVID-19 studies in the UK. Nobody knows more about how we can practically use COVID-19 testing than Rick and in this podcast he takes us through what is available and how we might use it in the future.
A great listen and lots to learn.
![Ep 179 - October 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/October_Podcast_Round_Up_Coveraph4n_300x300.jpg)
Friday Nov 06, 2020
Ep 179 - October 2020 Round Up
Friday Nov 06, 2020
Friday Nov 06, 2020
A bumper edition of the podcast where Iain and Simon discuss TXA (twice), antibiotics in appendicits, VTE, Blood products in trauma, use of ultrasound in cardiac arrest and plasma in traumatic brain injury. Oh, and COVID19 (but not for long)...
An evidence based cornucopia of aural pleasure.
Please like and subscribe (as all podcasters seem to say).
Take care,
Iain
![Ep 178 - Surviving the Second Wave with Liz Crowe (October 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Oct 24, 2020
Ep 178 - Surviving the Second Wave with Liz Crowe (October 2020)
Saturday Oct 24, 2020
Saturday Oct 24, 2020
In this special edition of the podcast, Liz Crowe discusses with Iain how we can find contentment, despite the relentless nature of COVID19 and the impending second wave. She gives practical, realistic advice that everyone can consider and encourages us all to be kind to ourselves in these strange and difficult times.
![Ep 177 - September 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/September_Podcast_Round_Up_Cover6m0l2_300x300.jpg)
Tuesday Oct 20, 2020
Ep 177 - September 2020 Round Up
Tuesday Oct 20, 2020
Tuesday Oct 20, 2020
Welcome to our audio round up of everything on the blog during September.
It's been a relatively quiet on the blog post this month, but we chat through not only blogposts on the REMAP-CAP trial, TXA in Head Injury and the ISARIC COVID Risk prediction tool, but also the situation in the North of England and the recent RCEM Virtual Conference.
The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think. If you're interesed in learning more about Baysian thinking this Lesson Plan is a good place to start.
Take care,
![Ep 176 - JC: Can we give tranexamic acid (TXA) via the IM route? (October 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Oct 01, 2020
Ep 176 - JC: Can we give tranexamic acid (TXA) via the IM route? (October 2020)
Thursday Oct 01, 2020
Thursday Oct 01, 2020
Interview with Ian Roberts on the pharmacokinetic trial of intramuscular tranexamic acid.
Blog link here
![Ep 175 - August 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/August_Podcast_Round_Up_Cover7gvu4_300x300.png)
Thursday Sep 10, 2020
Ep 175 - August 2020 Round Up
Thursday Sep 10, 2020
Thursday Sep 10, 2020
Welcome to our audio round up of everything on the blog during August.
As the world continues to be in the grips of the Coronavirus pandemic there have been more papers looking at all aspects of this disease.
Simon reviewed the latest paper on Hydroxychloroquine and Charlie collated some of the top papers covering aspects from aerosol spread and use of CPAP to the effect on vulnerable groups and the effect on staff psychological health
It's not all COVID though. Sepsis is a condition we all want to be able to treat more effectively. Sadly there doesn't seem to be any encouraging news about the use of Vitamin C, Steroids and Thiamine in this latest RCT.
Many of the St Emlyn's group have special expertise in toxicology and Gareth wrote this incredibly informative post about the use of GBL. If you're not sure what "ChemSex" is then this post from a few years ago by Janos is worth a read.
The anonymously written "Look at what they make you give" post really struck a chord with readers, with an astonishing number of views. There are messages here for us all.
The numbers of Lesson Plans available continue to grow. We've had some great feedback following their use in induction. If tyou've not seen them yet, do have a look and let us know what you think.
![Ep 174 - June and July 2020 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Aug 01, 2020
Ep 174 - June and July 2020 Round Up
Saturday Aug 01, 2020
Saturday Aug 01, 2020
Our own version of Buy One Get One Free* this month, where you get a round up of two months of blog content.
Coronavirus continues to dominate the medical (and non-medical) headlines, and we discuss the two major results from the RECOVERY trial published recently, one positive and one not so (depending on who you talk to....). Simon also catches up with Roberto Cosentini, who you'll remember from the very powerful podcast at the beginning of the pandemic.
COVID isn't the only EBM circus in town though: we've reviewed HALT-IT and Simon has given a talk about the "Ten Top Trauma Papers" of the last year and Laura reviewed a paper looking at haloperidol for headaches.
We're having to think even harder about how we communicate in the ED, both for clinical care and to deliver education. Two ideas to help learning have been featured this month: The St Emlyn's Lesson Plans and "Background Learning".
Good luck to all those starting in Emergency Medicine, and a huge thank you to all those who are moving to other areas of medicine or other departments. It's been a curious few months...
Take care,
Iain
*It's actually Get One Free Get Another Free, but whose ever heard of that?
![Ep 173 - The St Emlyn's Lesson Plans](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/IMG_7114_300x300.jpg)
Thursday Jun 25, 2020
Ep 173 - The St Emlyn's Lesson Plans
Thursday Jun 25, 2020
Thursday Jun 25, 2020
We are delighted to introduce you to the "St Emlyn's Lesson Plans", which we hope will help structure some of your education sessions over coming months (and years).
Each lesson plan starts with a descrete learning outcome, to set the scene, as well as details of the RCEM curriculum item(s) that will be covered.
The first tasks are aimed at aquiring some background knowledge and can either be done as part of the session, or beforehand. These utilise the vast "FOAMed" resources (including, but not exclusively, those of St Emlyn's).
Our experience is that time constraints often mean that "background reading" isn't achieved before the session, so would encourage allowing time within it to complete these. They are designed to take about 30 minutes and occupy the first half of the session.
Everything you need for each lesson is included in the plan. We would recommend that each learner has an internet enabled device available (with headphones) to read and listen to the background material at their own pace.
The second half of the session should be facilitated by an expert. This can happen in person, but also online, via any of the interfaces that are now so familiar.
In many plans we have given some case examples, but it would be even better if learners can bring cases of their own for discussion. This element is very much within the control of the facilitator (who should been fully cogniscent of the contents of the knowledge section).
The session finishes off with a summary, this should emphasise again the most important learning points. To really embed the knowledge and skills the particiapants should be encouraged to reflect on what they have learned, and to even talk to thse who were unable to attend about what they missed.
For learners this also gives an opportunity to easily link teaching sessions to their portfolio.
You may want to record the "face-to-face" elements, so that those who were not present are able to access them when they can (and those that did can rewatch to refresh their learning).
Although these plans are designed for delivery in a single centre, there is absolutely no reason why regional (or even national) teaching could take place in this way. The recent COVID19 Journal Clubs have demonstrated beautifully how a group of learners can engage with an online panel.
We would be very happy to receive lessons plans to add to the collection. This is very much a collaborative effort.
Please let us know what you think of these lesson plans and if you are using them in your Department. We'd love to hear your ideas about how we can take medical education forward.
![Ep 172 - Dexamethasone and COVID - Show us the Data! (June 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Jun 19, 2020
Ep 172 - Dexamethasone and COVID - Show us the Data! (June 2020)
Friday Jun 19, 2020
Friday Jun 19, 2020
St Emlyn's three professors, Carley, Body and Horner* critically appraise the Press Release regarding Dexamethasone in the treatment of COVID-19.
What does this mean for the future of Evidence Based Medicine? Can we really start using a medication when the trial hasn't been peer reviewed and the full dataset not released?
The blog post by Josh Farkas, that is mentioned in the podcast, is here.
*Professor Simon Carley, Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in Adult and Paediatric Emergency Medicine at Manchester Foundation Trust, Professor Rick Body Professor of Emergency Medicine in Manchester and Honorary Consultant in Emergency Medicine at Manchester Foundation Trust. Professor Dan Horner, Professor of Emergency Medicine of the Royal College of Emergency Medicine and Consultant in Emergency Medicine and Intensive Care at Salford Royal NHS Foundation Trust.
![Ep 171 - May 2020 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Jun 13, 2020
Ep 171 - May 2020 Round Up
Saturday Jun 13, 2020
Saturday Jun 13, 2020
Lots to chat about on the podcast this month, and not just COVID! There's been blog posts about clots, troponin and even telly, as well as the Journal Club series.
Keep a look out for the new St Emlyn's Lesson Plans that we hope will help usher in a new era of medical education in a socially distanced world.
If you would like to donate to the fund in the memory Adel Aziz you can find the link here.
We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.
Take care
Iain
Podcast edited by Izzy Carley
PS You can find the Lesson Plans here. Still a work in progress, but as you've read these "shownotes" you deserve to have a sneak preview...
![Ep 170 - COVID-19 Journal Club #7 (June 2020)](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Jun 04, 2020
Ep 170 - COVID-19 Journal Club #7 (June 2020)
Thursday Jun 04, 2020
Thursday Jun 04, 2020
Welcome to our seventh webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.
The live event took place on Tuesday 26th May.
Today's panel will be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Ellie Hothershall (Consultant in Public Health), Prof Simon Carley and special guest Kelly Ann Janssens (Emergency Physician in Ireland) to discuss five papers about COVID-19 infection.
This will be the last weekly journal club, but we will be back with more EBM goodness very soon. Do let us know what you like to be included at stemlyns@gmail.com
References
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Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. N Engl J Med. Published online May 22, 2020. doi:10.1056/nejmoa2007764
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Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 2020. doi:10.1016/s0140-6736(20)31180-6
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Gray N, Calleja D, Wimbush A, et al. “No test is better than a bad test”: Impact of diagnostic uncertainty in mass testing on the spread of Covid-19. Published online April 22, 2020. doi:10.1101/2020.04.16.20067884
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Peyrony O, Marbeuf-Gueye C, Truong V, et al. Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019. Annals of Emergency Medicine. Published online May 2020. doi:10.1016/j.annemergmed.2020.05.022
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Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic – a systematic review. Acta Paediatr. Published online May 19, 2020. doi:10.1111/apa.15371
![Ep 169 - COVID-19 Journal Club #6 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/covid19-webinar-6_300x300.png)
Friday May 22, 2020
Ep 169 - COVID-19 Journal Club #6 (May 2020)
Friday May 22, 2020
Friday May 22, 2020
Welcome to our sixth COVID-19 Journal Club Podcast.
The panel was hosted by Rick Body and included Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Liz Crowe (Advanced Clinician Social Worker and PhD candidate in health staff wellbeing in Brisbane) to discuss four papers about COVID-19 infection. We were especially pleased to welcome Liz this week, which enabled us to focus on the important topics of grief, loss and communication during the COVID-19 pandemic.
References
![Ep 168 - COVID-19 Journal Club #5 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/webinarcover7298g_300x300.png)
Friday May 15, 2020
Ep 168 - COVID-19 Journal Club #5 (May 2020)
Friday May 15, 2020
Friday May 15, 2020
Welcome to our fifth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The live event took place on Tuesday 12th May at 11.00am BST (10.00am GMT).
The COVID-19 Journal Club Panel
Today’s panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Dan Horner, Dr Anisa Jafar, Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Lauren Westafer (Attending in Emergency Medicine and Co-Creator of the Foamcast blog and podcast) and Ellie Hothershall (head of undergraduate medicine at the University of Dundee and an expert in Public Health) to discuss six papers about COVID-19 infection.
![Ep 167 - Troponin Update and LoDED Study Review with Rick Body](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Wednesday May 13, 2020
Ep 167 - Troponin Update and LoDED Study Review with Rick Body
Wednesday May 13, 2020
Wednesday May 13, 2020
Over the last few years many of us in the UK have started to incorporate high-sensitivity troponin into the assessment of patients presenting with chest pain.
We have seen these samples taken at ever shorter intervals, aiming to discharge low risk patients safely, sooner from the Emergency Department (ED). This has been driven in part by the "Four Hour Emergency Access Target" as well as increased crowding in overwhelmed EDs.
In this podcast, internationally renowned researcher Prof Rick Body discusses the latest in troponin research and the recent LoDED study.
The Shownotes
The various organisations mentioned by Rick can be found here:
The Innovation Agency Webinar Series
The NHS Accelerated Access Collaborative
The CQUIN that will be implemented later this year (page 15 for the Troponin section)
The Draft NICE recommendations
![Ep 166 - COVID-19 Journal Club #4 (May 2020)](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Journal-Club-4-1_300x300.png)
Thursday May 07, 2020
Ep 166 - COVID-19 Journal Club #4 (May 2020)
Thursday May 07, 2020
Thursday May 07, 2020
Welcome to our fourth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.
The live event tool place on Tuesday 5th May at 11.30am BST (10.30am GMT).
The panel was again be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar (Academic Clinical Lecturer), Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Justin Morgenstern to discuss six papers about COVID-19 infection.
There will be another COVID 19 Journal Club next week (Tuesday 12th May at 11am).
References
Podcast edited from a live webinar by Izzy Carley
![Ep 165 - April 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/april_2020_300x300.jpg)
Sunday May 03, 2020
Ep 165 - April 2020 Round Up
Sunday May 03, 2020
Sunday May 03, 2020
It's been another busy month at St Emlyn's, with the publication of 15 blog posts and five podcasts, but there does seem to be an awful lot to talk about!
Of course there have been multiple posts and podcasts about COVID-19, and you can fiind all of these on our special St Emlyn's page. Highlights have included the three RCEM/St Emlyn's Webinars which we are delighted to host in podcast form.
It's not just been coronavirus though, we have also dipped out toes into exercise and nutrition, graphic design and horticulture!
Parts of the site have also undergone a bit of a redesign with the curriculum pages now easier to navigate to find that post to fioll an e-portfolio hole.
We hope you're finding all of our output useful. Please do subscribe to the website (in the top right hand corner) and rate our podcast on iTunes.
They'll be much more to come in May I am sure.
Take care
Iain
Podcast edited by Izzy Carley
![Ep 164 - COVID-19 Journal Club #3](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/covid19_podcasts_300x300.png)
Thursday Apr 30, 2020
Ep 164 - COVID-19 Journal Club #3
Thursday Apr 30, 2020
Thursday Apr 30, 2020
Welcome to our third webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The live event took place on Tuesday 28th April at 11am BST (10am GMT).
The panel was hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Dan Horner (RCEM Professor), Prof Pam Vallely (Professor of Medical Virology), Salim Rezaie (Emergency Physician and Founder of REBEL EM) and Prof Simon Carley (you know him…) to discuss five papers about COVID-19 infection. There will be another COVID 19 Journal Club next week (Tuesday 5th May at 11am).
Edited by Izzy Carley and Iain Beardsell
References
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Helms J. High risk of thrombosis in patients in severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine. April 2020:1-21. https://www.esicm.org/wp-content/uploads/2020/04/863_author_proof.pdf.
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Caputo ND, Strayer RJ, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID‐19 Pandemic. Acad Emerg Med. April 2020. doi:10.1111/acem.13994
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Garcia FP, Perez Tanoira R, Romanyk Cabrera JP, Arroyo Serrano T, Gomez Herruz P, Cuadros Gonzalez J. Rapid diagnosis of SARS-CoV-2 infection by detecting IgG and IgM antibodies with an immunochromatographic device: a prospective single-center study. April 2020. doi:10.1101/2020.04.11.20062158
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Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. April 2020. doi:10.1001/jama.2020.6775
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Metzler B, Siostrzonek P, Binder R, Bauer A, Reinstadler S. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. April 2020. doi:10.1093/eurheartj/ehaa314
![Ep 163 - COVID-19 Journal Club #2](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Webinar_300x300.png)
Saturday Apr 25, 2020
Ep 163 - COVID-19 Journal Club #2
Saturday Apr 25, 2020
Saturday Apr 25, 2020
Welcome to our second webinar on recent research about COVID-19, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn’s.
The panel was hosted by Rick Body. The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer), Dr Casey Parker and Prof Simon Carley (you know him…) to discuss six papers about COVID-19 infection.
The live event took place on Tuesday 21st April 2020
References:
Paper 1 (00:00) Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. April 2020. doi:10.1101/2020.04.10.20060558
![Ep 162 - Beyond the ED: COVID-19 and Critical Care with Dan Horner](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/COVID_and_ICU_300x300.png)
Wednesday Apr 22, 2020
Ep 162 - Beyond the ED: COVID-19 and Critical Care with Dan Horner
Wednesday Apr 22, 2020
Wednesday Apr 22, 2020
In this podcast, Dan and Iain talk about the clinical journey of a COVID-19 patient, beyond the ED, with insights from the critical care unit. There are some concepts here that we don’t have time to do full justice to in the podcast, so there is a comprehensive set of "show notes" and all the references at www.stemlynsblog.org/covid-19-and-critical-care
![Ep 161 - COVID-19 Journal Club #1](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/Journal_Club_300x300.png)
Wednesday Apr 15, 2020
Ep 161 - COVID-19 Journal Club #1
Wednesday Apr 15, 2020
Wednesday Apr 15, 2020
Professor Rick Body is joined by Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynolds (NIHR Clinical Research Fellow), Prof Pam Vallely (Professor of Medical Virology), Dr Anisa Jafar (Academic Clinical Lecturer) and Prof Simon Carley (you know him...) to discuss six papers about COVID-19 infection.
03:10 - Paper 1 – Guan et al. Clinical characteristics of Coronavirus disease 2019 in China. NEJM Feb 28 2020
https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
16:54 Paper 2 – Zou et al. Single Cell RNA-SEQ Data Analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-NCOV infection. Frontiers of Medicine. Mar 12 2020.
https://link.springer.com/content/pdf/10.1007/s11684-020-0754-0.pdf
21:43 Paper 3 – Gautret et al. Hydroxychloroquine and azithromycin treatment of COVID-19: Results of an open-label non-randomised clinical trial. International Journal of Antimicrobial Agents. 20 Mar 2020
https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub
25:25 Paper 4 – Cao et al. A trial of Lopinavir-Ritonavir in adults hospitalized with severe COVID-19. NEJM Mar 18 2020
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2001282
29:35 Paper 5 – Cui et al. Prevalence of venous thromboembolism in patients with severe Coronavirus pneumonia. Journal of Thrombosis and Haemostasis. Apr 9 2020 doi:10.1111/jth.14830
https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.14830
34:14 Paper 6 – Lynarts et al. Prediction models for diagnosis and prognosis of COVID-19 infection: systematic review and critical appraisal. BMJ. Apr 7 2020 BMJ 2020;369:m1328
![Ep 160 - March 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/march_300x300.jpg)
Sunday Apr 05, 2020
Ep 160 - March 2020 Round Up
Sunday Apr 05, 2020
Sunday Apr 05, 2020
Iain and Simon discuss Covid19 and more in this review of the best of the blog from March 2020.
![Ep 159 - Covid 19. Lessons from Sports and Exercise Medicinewith John Rogers and Nathan Lewis](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Thursday Apr 02, 2020
Thursday Apr 02, 2020
Simon interviews Dr John Rogers and Dr Nathan Lewis on respiratory infection prevention.
John a Sports and Exercise Medicine Consultant in Manchester. He is also Chief Medical Officer for British Triathlon and Visiting Professor in Sport & Exercise Medicine at Manchester Metropolitan University.
Nathan is lead performance nutrition scientist at the English Institute of Sport and at ORRECO.
These two academics take us through how sports science might be able to support our wellbeing during the Covid19 pandemic.
References
- Recommendations to maintain immune health in athletes https://www.tandfonline.com/loi/tejs20
- Probiotics https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006895.pub3/epdf/full
- Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/23840373/
- Vitamin C for prevention and treatment of pneumonia https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013134/full
- Vitamin C and common cold https://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold
- Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/27184276/
- Vitamin C and Infections https://pubmed.ncbi.nlm.nih.gov/28353648/
- Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage https://pubmed.ncbi.nlm.nih.gov/28515951/
![Ep 158 - Understanding Fear and Anxiety around COVID19 with Liz Crowe](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Mar 29, 2020
Ep 158 - Understanding Fear and Anxiety around COVID19 with Liz Crowe
Sunday Mar 29, 2020
Sunday Mar 29, 2020
The world is consumed by the Coronavirus pandemic, but how do we look after ourselves? Liz and Iain discuss some strategies to stay well over the coming weeks and months. Recorded on 25th March 2020.
![Ep 157 - ICU for the non-intensivist with Sarah Thorton](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Tuesday Mar 24, 2020
Ep 157 - ICU for the non-intensivist with Sarah Thorton
Tuesday Mar 24, 2020
Tuesday Mar 24, 2020
Simon chats to Sarah Thornton, consultant anaesthetist, intensivist and head of the NW school of anaesthesia on preparing to work in a critical care unit during the Covid-19 pandemic.
![Ep 156 - February 2020 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Friday Mar 20, 2020
Ep 156 - February 2020 Round Up
Friday Mar 20, 2020
Friday Mar 20, 2020
Iain and Simon chat about the current Corona pandemic and the blog in Feb 2020.
Iain remains positive, but Simon thinks the glass is half full. Time will tell who is right (though in truth there is a lot of common ground).
S
![Ep 155 - Covid-19 Podcast from Italy with Roberto Cosentini March 2020](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Saturday Mar 14, 2020
Ep 155 - Covid-19 Podcast from Italy with Roberto Cosentini March 2020
Saturday Mar 14, 2020
Saturday Mar 14, 2020
Dr Roberto Cosentini is an old friend of St Emlyn's who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid19 outbreak. He kindly found an hour to record a podcast with us on his experiences.
There are so many essential lessons in this podcast. Please share with clinical and non-clinical colleagues, as we need to plan NOW. Roberto is quite clear that if we don't train and get plans into place before the wave of cases hit us then both ourselves and our patients will suffer.
In the interest of speed I'm not going to summarise the whole podcast. You have to listen to it all yourself to see what's relevant to you. These are some of my take away messages.
- Divide your department into resp patients and non-resp patients
- Wear PPE and know how to use it
- You will need clinicians who do not usually work in ED. Train and orientate them now (before you need them).
- Most patients are hypoxic and this responds to O2 and CPAP. You're going to need a lot of CPAP and how that happens could be tricky. They found hoods the best (Ed - but how many of those do we have?).
- Although hypoxic, patients have good lung compliance.
- They regularly saw diurnal variation with many patients presenting in the early afternoon.
- It's emotionally exhausting. Prepare yourself and your team psychologically and support them during the pandemic. Roberto's department has an embedded psychologist.
- Health care worker infections were quite low (because they wore PPE for all resp cases).
- Flow through the department and onto wards is absolutely vital.
- Flow out the the main hospitals to other units that can rehabilitate is vital.
- Decisions for ICU level care were similar to normal (in his hospital)
We rarely declare one of our podcasts a 'must listen' but this is an exception. Please listen and share widely. Please think hard about the issues Roberto raises and PLEASE ACT NOW.
vb
S
How you can support St Emlyn's
- Join us for #stemlynsLIVE conference May 12th 2020
- 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
- Find out more about the MMU MSc in Emergency Medicine here.
- Download one of our FREE e-books here
![This image has an empty alt attribute; its file name is banner-pg-med-emergency-med.jpg](http://www.stemlynsblog.org/wp-content/uploads/2019/05/banner-pg-med-emergency-med.jpg)
![Ep 154 - January 2020 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Wednesday Feb 12, 2020
Ep 154 - January 2020 Round Up
Wednesday Feb 12, 2020
Wednesday Feb 12, 2020
Iain is back on the podcast with Simon to talk through the best of the blog from January 2020.
![Ep 153 - December 2019 Round Up](https://pbcdn1.podbean.com/imglogo/image-logo/321472/Front_image_jsmmsg_300x300.jpg)
Sunday Jan 19, 2020
Ep 153 - December 2019 Round Up
Sunday Jan 19, 2020
Sunday Jan 19, 2020
Our regular round up of the best of the blog from December 2019. Published a little late, largely because of Coronavirus issues and general business.
![Ep 152 - November podcast round up on St Emlyn's](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Monday Dec 23, 2019
Ep 152 - November podcast round up on St Emlyn's
Monday Dec 23, 2019
Monday Dec 23, 2019
The latest from the St Emlyn's blog
![Ep 151 - October 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Dec 07, 2019
Ep 151 - October 2019 Round Up
Saturday Dec 07, 2019
Saturday Dec 07, 2019
Our regular review of the best of the blog from October 2019
![Ep 150 - REBOA with Zaf Qasim](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/REBOA_in_the_ED_9hr6db_300x300.jpg)
Thursday Nov 14, 2019
Ep 150 - REBOA with Zaf Qasim
Thursday Nov 14, 2019
Thursday Nov 14, 2019
Simon and Zaf talk about the practicalities of REBOA and discuss whether it's ready for prime time in the UK.
Introduction
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive technique designed to control hemorrhage in patients with life-threatening bleeding and offers a bridge to definitive surgical intervention. Here at St Emlyn’s, we are committed to exploring innovative solutions that enhance patient outcomes in emergency medicine. In this post, we delve into the essentials of REBOA, its clinical application, benefits, and challenges.
Understanding REBOA
REBOA involves the insertion of a balloon catheter into the aorta via the femoral artery. By inflating the balloon, we can occlude the aorta, thus controlling bleeding below the point of occlusion. This procedure is particularly useful in cases of non-compressible torso haemorrhage, where traditional methods of haemorrhage control are inadequate.
Indications and Contraindications
Indications:
- Hemorrhagic shock from pelvic fractures or abdominal bleeding.
- Trauma patients with signs of severe hemorrhage unresponsive to fluid resuscitation.
- As a temporary measure until surgical control of bleeding is achieved.
Contraindications:
- Patients with known aortic pathology (e.g., aortic dissection).
- Significant injury above the diaphragm.
- Prolonged transport times where REBOA may not be beneficial.
The Procedure
Preparation
Before performing REBOA, it is crucial to ensure that the patient is appropriately resuscitated and stabilized as much as possible. This includes securing the airway, ensuring adequate ventilation, and achieving initial hemodynamic stabilization.
Insertion and Inflation
- Vascular Access: Gain access to the common femoral artery using ultrasound guidance to minimize complications.
- Catheter Insertion: Insert the REBOA catheter through a sheath into the femoral artery. Advance the catheter under fluoroscopic or ultrasound guidance to the desired level in the aorta (Zone I: above the celiac artery for abdominal hemorrhage, Zone III: above the bifurcation of the iliac arteries for pelvic hemorrhage).
- Balloon Inflation: Inflate the balloon to occlude the aorta. This temporarily controls bleeding and allows time for definitive surgical repair.
Monitoring and Maintenance
Continuous monitoring of vital signs and catheter position is essential. The occlusion time should be minimized to reduce ischemic complications. Ideally, REBOA should serve as a bridge to definitive surgical intervention within 30-60 minutes.
Benefits and Challenges
Benefits
- Rapid Hemorrhage Control: REBOA can quickly control bleeding, buying crucial time for surgical intervention.
- Less Invasive: Compared to traditional open thoracotomy with aortic cross-clamping, REBOA is less invasive, reducing associated morbidity.
- Improved Survival Rates: Emerging evidence suggests that REBOA can improve survival rates in appropriately selected trauma patients.
Challenges
- Technical Expertise: REBOA requires specific training and expertise. Improper technique can lead to significant complications.
- Ischemic Complications: Prolonged aortic occlusion can lead to ischemia of distal organs and tissues, necessitating careful monitoring and timely deflation.
- Resource Intensive: REBOA demands resources such as fluoroscopy, ultrasound, and trained personnel, which may not be available in all settings.
Conclusion
REBOA represents a promising advancement in trauma care, offering a vital tool in the management of life-threatening haemorrhage, but it's utility in the Emergency Department is uncertain.
Further reading
![Ep 149 - September 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Nov 02, 2019
Ep 149 - September 2019 Round Up
Saturday Nov 02, 2019
Saturday Nov 02, 2019
Our regular round up of the best of the blog from September 2019. A fairly quiet month for us, but some great content including a fabulous video from Cliff Reid on the Zero Point survey and on a related resus note, the concept of the UK resuscitationist with Dan Horner.
![Ep 148 - CRASH-3](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Monday Oct 14, 2019
Ep 148 - CRASH-3
Monday Oct 14, 2019
Monday Oct 14, 2019
See more on the blog here https://www.stemlynsblog.org/jc-tranexamic-acid-txa-in-head-injury-the-crash-3-results-st-emlyns/
![Ep 147 - August 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Oct 06, 2019
Ep 147 - August 2019 Round Up
Sunday Oct 06, 2019
Sunday Oct 06, 2019
Our regular round up of the best and the brightest from the St Emlyn's blog. This is a round up of our August content.
![Ep 146 - European Resus Council meeting Slovenia 2019](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Oct 05, 2019
Ep 146 - European Resus Council meeting Slovenia 2019
Saturday Oct 05, 2019
Saturday Oct 05, 2019
A vox pop round up of the best of the ERC19 conference in Slovenia.
![Ep 145 - The UK Resuscitationist with Dan Horner at #stemlynsLIVE](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Friday Sep 27, 2019
Ep 145 - The UK Resuscitationist with Dan Horner at #stemlynsLIVE
Friday Sep 27, 2019
Friday Sep 27, 2019
Our latest podcast from the #stemlynsLIVE conference last year. Dan Horner talks on the concept and potential role of the UK Resuscitationist.
![Ep 144 - July 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_2_300x300.png)
Tuesday Sep 10, 2019
Ep 144 - July 2019 Round Up
Tuesday Sep 10, 2019
Tuesday Sep 10, 2019
The best from the blog and podcast in July 2019.
JC: Clot’s the Problem? Vena Cava filters in trauma patients. St Emlyn’s
Psychological performance in the resus room. Ashley Liebig at #stemlynsLIVE
JC: The Resuscitative Care Unit. St Emlyn’s
The great day paradox. St.Emlyn’s
All you need to know about Listeria. St Emlyn’s.
GI Emergencies – Chris Gray at #StEmlynsLIVE
Similar challenges, different approaches – Mass Casualty Incident training lessons from Pakistan. St Emlyn’s
![Ep 143 - The Future of Diagnostics with Rick Body](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Saturday Aug 31, 2019
Ep 143 - The Future of Diagnostics with Rick Body
Saturday Aug 31, 2019
Saturday Aug 31, 2019
Prof. Rick Body is an internationally recognised expert in diagnostic testing. In this podcast he takes us through diagnostics today and also the near future which may change almost everything.
You can read more and see the slides/video at http://www.stemlynsblog.com
![Ep 142 - Psychological performance in the Resus Room with Ashley Liebig](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Tuesday Jul 23, 2019
Ep 142 - Psychological performance in the Resus Room with Ashley Liebig
Tuesday Jul 23, 2019
Tuesday Jul 23, 2019
This talk focuses on how we can optimise our psychological performance in critical care situations, the type of situations that Simon describes as Time Critical, Information light. The Audio is available below, or watch the full presentation above.
Don't forget to watch the video on the St Emlyn's site http://www.stemlynsblog.org
vb
S
![Ep 141 - June 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Sunday Jul 14, 2019
Ep 141 - June 2019 Round Up
Sunday Jul 14, 2019
Sunday Jul 14, 2019
Here's our regular round up of the blog and podcast from June 2019.
Beyond ATLS https://www.stemlynsblog.org/beyond-atls-with-alan-grayson-at-stemlynslive-st-emlyns/
Traumatic Cardiac Arrest https://www.stemlynsblog.org/traumatic-cardiac-arrest-tca-podcast-with-prof-jason-smith-rn-st-emlyns/
The psychological impact of emergency medicine https://www.stemlynsblog.org/how-events-in-emergency-medicine-impact-doctors-psychological-well-being-st-emlyns/
Can we use IO aspirate for analysis https://www.stemlynsblog.org/jc-can-we-really-use-io-blood-for-analysis-st-emlyns/
Don't forget the Bubbles conference and site https://dontforgetthebubbles.com/
![Ep 140 - GI emergencies with Chris Gray at #stemlynsLIVE](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Thursday Jul 04, 2019
Ep 140 - GI emergencies with Chris Gray at #stemlynsLIVE
Thursday Jul 04, 2019
Thursday Jul 04, 2019
This is Chris's talk from #stemlynsLIVE on GI emergencies. Remember to check out the blog for the background, references and more.
![Ep 139 - May 2019 Round Up](https://pbcdn1.podbean.com/imglogo/ep-logo/pbblog321472/StEmlyns_base_3_300x300.png)
Friday Jun 21, 2019
Ep 139 - May 2019 Round Up
Friday Jun 21, 2019
Friday Jun 21, 2019
Our regular monthly round up, this month with Ian and Simon chatting through the best of the blog.
The power of peer review: https://www.stemlynsblog.org/smacc2019-the-power-of-peer-review/
Virtual reality in PED: https://www.stemlynsblog.org/jc-virtual-reality-for-distraction-from-paediatric-procedural-pain/
Wellbeing for the broken: https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlyns/
Traumatic cardiac arrest https://www.stemlynsblog.org/wellbeing-for-the-broken-part-3-the-podcast-st-emlhttps://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/
Should we cardiovert AF in the ED or wait? https://www.stemlynsblog.org/should-we-rapidly-cardiovert-af-in-the-ed-st-emlyns/
Prolonged field care in the ED https://www.stemlynsblog.org/prolonged-field-care-in-the-ed/
Keppra or Phenytoin for status epilepticus in kids https://www.stemlynsblog.org/jc-enter-sandman-which-agent-as-second-line-in-paediatric-status-epilepticus/