St Emlyn's podcast and blog

Is post-induction hypotension harmful in traumatic brain injury? How bad is hypotension in TBI? What's the real world impact in a high quality PHEM service. Rich Carden reviews a recent paper that helps us understand the impact. #FOAMed @stemlyns

How bad is hypotension in TBI? What's the real world impact in a high quality PHEM service. #FOAMed @stemlyns

Make it SNAPpy! Paracetamol overdoses in teenagers Paracetamol poisoning is an uncommon, but not rare, event in children. The treatment of choice is NAC. Should we be giving them the SNAP protocol?

Make it SNAPpy! Paracetamol overdoses in teenagers

Paracetamol poisoning is an uncommon, but not rare, event in children. The treatment of choice is NAC. Should we be giving them the SNAP protocol?

TTL tips 2: Get the best from your pelvic binders! Top tips on using pelvic binxders in major trauma . Trauma Team Leader tips from @stemlyns #FOAMed #TTLtips

Top tips on using pelvic binxders in major trauma . Trauma Team Leader tips from @stemlyns #FOAMed #TTLtips

TTL tips 1: Check these FIVE areas (and more) in Penetrating Trauma. Check these five areas in penetrating trauma. Trauma Team Leader tips from @stemlyns #FOAMed

TTL tips 1: Check these FIVE areas (and more) in Penetrating Trauma.

Check these five areas in penetrating trauma. Trauma Team Leader tips from @stemlyns #FOAMed

Introducing the Trauma Team Leader Tips (TTL Tips) Series Edited by Prof. Simon Carley & Dr. Greg Yates Leading a trauma team is one of the most challenging and rewarding roles in emergency medicine. It’s a blend of clinical expertise, calm leadership, communication, and the ability to make decisions when the stakes are high. The Trauma Team Leader (TTLtips) Tips on St Emlyn’s explores what it really means to lead in trauma, through clinical insight, human factors, and team dynamics.

An introduction to our TTLtips series. How to be a better trauma team leader. #FOAMed @stemlyns

Gastroenteritis in children: should we be sending them home with ondansetron? Autumn is here, and winter is on its way. In children with gastroenteritis, should we be prescribing take-home doses of ondansetron?

Gastroenteritis in children: should we be sending them home with ondansetron?

Autumn is here, and winter is on its way. In children with gastroenteritis, should we be prescribing take-home doses of ondansetron?

What does the Medical Training Review mean for Emergency Medicine training in the UK? The 2025 Medical Training Review (MTR) is the most significant rethink of UK postgraduate medical education in decades. It calls for more flexible, inclusive, team-based training that recognises learning across all grades, not just numbered trainees. For emergency medicine, this may mean redesigning pathways to include SAS and LED doctors, refreshing the RCEM curriculum, and re-establishing supportive team structures. EM must lead the way in creating sustainable, flexible, and patient-centred training for the next generation.

What does the Medical Training Review mean for Emergency Medicine training in the UK?

The 2025 Medical Training Review (MTR) is the most significant rethink of UK postgraduate medical education in decades. It calls for more flexible, inclusive, team-based training that recognises learning across…

Factors in the Initial Resuscitation of Patients With Severe Trauma – The FiiRST-2 Trial

The FiiRST-2 randomised trial compared fibrinogen and prothrombin complex concentrate with plasma in trauma patients needing massive transfusion. No significant benefit was found. Read our St Emlyn’s critical…

Design as repair: what Emergency Medicine can learn (and why it is so hard) The NHS drowns in innovation whilst repair work goes unsupported. Why Bronson's Design as Repair framework matters for emergency medicine.

The NHS drowns in innovation whilst repair work goes unsupported. Why Bronson's Design as Repair framework matters for emergency medicine.

SUPraclavicular Block for Emergency Reduction of Upper Limb Injuries Versus Bier Block (SUPERB Trial) The SUPERB trial compared ultrasound-guided supraclavicular block with Bier block for distal forearm fracture reduction in the ED. Both provided excellent pain relief, with supraclavicular block noninferior and offering longer analgesia. Safe, feasible, and well-tolerated, this trial supports expanding regional anaesthesia options for emergency physicians managing upper limb injuries.

The SUPERB trial compared ultrasound-guided supraclavicular block with Bier block for distal forearm fracture reduction in the ED. Both provided excellent pain relief, with supraclavicular block noninferior and offering longer analgesia. What do you currently do?

Cardiac arrest: three quick hits Learn more about innovations in Cardiac Arrest management: 3 quick hits to stay prepared and respond effectively in critical situations. @stemlyns #FOAMed

Acute behavioural disturbance (ABD) is a high-stakes presentation in emergency medicine, often requiring rapid pharmacological sedation. While haloperidol has long been a go-to antipsychotic, recent evidence suggests olanzapine may offer similar efficacy with fewer side effects.

JC: Are we overtreating suspected sepsis with broad-spectrum antibiotics? From St Emlyn's journal club: are we overtreating sepsis? US study finds 87% received unnecessary or overly broad antibiotics in ED.

JC: Are we overtreating suspected sepsis with broad-spectrum antibiotics?

From St Emlyn's journal club: are we overtreating sepsis? US study finds 87% received unnecessary or overly broad antibiotics in ED.

Stay or go? Should we Move Patients with Refractory Out-of-Hospital Cardiac Arrest to Hospital? The EVIDENCE Trial The EVIDENCE trial asked if rapid transport with ongoing CPR improves survival in refractory out-of-hospital cardiac arrest. Results: no clear benefit over on-scene resuscitation.

The EVIDENCE trial tested expedited intra-arrest transport vs extended on-scene CPR for refractory OHCA. Did faster hospital transfer improve outcomes?

JC: Ketamine or Midazolam as first choice for Paediatric Status Epilepticus? St Emlyn’s Background Paediatric generalised convulsive status epilepticus (GCSE) are some thing we see a fair amount of in Virchester. Many are a result of febrile seizures, but as we are a tertiary centre we see the full range of causes presenting to PED. Seizures that fail to stop spontaneously within five minutes are much less likely. to terminate without treatment and may lead to progressive neuronal injury, worsening outcomes, and, in some cases, death.

Can ketamine improve seizure control in children with status epilepticus? We critically review the Ket-Mid trial and discuss what. it means for UK emergency practice.

Hydrofluoric acid burns: stay on brand! A recent trial of alternatives to commercial Calcium Gluconate gel in HF burnsBottom line - buy the proper stuff

Acute behavioural disturbance (ABD) is a high-stakes presentation in emergency medicine, often requiring rapid pharmacological sedation. While haloperidol has long been a go-to antipsychotic, recent evidence suggests olanzapine may offer similar efficacy with fewer side effects.

Looking Back from 2038: How We Fixed Emergency Medicine How we transformed emergency medicine by 2038: AI, virtual EDs, and culture change. A powerful retrospective for healthcare leaders.

How we transformed emergency medicine by 2038: AI, virtual EDs, and culture change. A powerful retrospective for healthcare leaders.

JC: Intra-arrest Stellate Ganglion Block A review of intra-arrest stellate ganglion block for refractory cardiac arrest. Could this novel technique improve ROSC rates? Critical appraisal of scoping review. @stemlyns #FOAMed

A JC review of intra-arrest stellate ganglion block for refractory cardiac arrest. Could this novel technique improve ROSC rates? Critical appraisal of scoping review. @stemlyns #FOAMed

JC: When helping hurts – moral injury and the erosion of trust for UK emergency responders New UK research reveals 3 types of moral injury in emergency medicine: loss of trust in others, self & authority. St Emlyn's journal club review of key findings.

JC: When helping hurts – moral injury and the erosion of trust for UK emergency responders

New UK research reveals 3 types of moral injury in emergency medicine: loss of trust in others, self & authority. St Emlyn's journal club review of key findings.

Evaluating the PECARN Abdominal Trauma Rule in the grey zone…. Can children with abdominal pain, vomiting, or tenderness avoid CT? We review PECARN's latest insights into low-risk paediatric trauma.

Evaluating the PECARN Abdominal Trauma Rule in the grey zone….

Can children with abdominal pain, vomiting, or tenderness avoid CT? We review PECARN's latest insights into low-risk paediatric trauma.

Arterial Line Placement During Cardiac Arrest: The ED experience. Ourt review of a small Feasibility study on arterial line placement during ED cardiac arrest shows high success and improved ROSC. Is it time to rethink resuscitation monitoring?

Our review of a small Feasibility study on arterial line placement during ED cardiac arrest shows high success and improved ROSC. Is it time to rethink resuscitation monitoring?

Emergency toxicology insights on nitazenes.

JC: Illicit Drug Induced Hyperthermia: A Time-Critical Toxicological Emergency Recognise and treat drug-induced hyperthermia fast. Learn how early sedation and rapid cooling can save lives in this ED-focused clinical review.

JC: Illicit Drug Induced Hyperthermia: A Time-Critical Toxicological Emergency

Recognise and treat drug-induced hyperthermia fast. Learn how early sedation and rapid cooling can save lives in this ED-focused clinical review.

JC: Salbutamol for Analgesia in Renal Colic – Worth a Puff or a Painful Disappointment? Can salbutamol relieve pain in renal colic? We review a phase II randomised controlled trial exploring intravenous salbutamol as an adjunct analgesic in the emergency department.

Can salbutamol relieve pain in renal colic? We review a phase II randomised controlled trial exploring intravenous salbutamol as an adjunct analgesic in the emergency department.

When things get exciting: Thoughts on the recent EMCRIT episode on serotonin syndromes. In this emergency medicine toxicology blog, Gregory Yates reflects on a recent EMCRIT podcast episode discussing serotonin syndrome, neuroleptic malignant syndrome (NMS), and other hyperthermic drug reactions. The post highlights the diagnostic importance of neuromuscular findings such as clonus, tremor, and hyperreflexia, as outlined in the Hunter criteria. It also critiques the limitations of relying solely on drug history and explores the inter-rater variability in neurological examinations for movement disorders. With real-world cases from Virchester, the piece underlines the risks of misdiagnosis — particularly the danger of using antipsychotics in the wrong toxidrome. The takeaway: thorough neurological assessment is crucial, and clinicians should be cautious when interpreting overlapping syndromes.

Emergency toxicology insights on differentiating serotonin syndrome from NMS and stimulant toxicity. A commentary on the latest EMCRIT podcast, including diagnostic challenges and clinical examination reliability.

Top 10 trauma/resus papers for IFEM 2025 Review the top 11 trauma and resuscitation trials discussed at ICEM 2025. Expert summaries and critical appraisals from St Emlyn’s cover transfusion strategies, airway management, oxygenation, fibrinogen, and more.

Review the top trauma and resuscitation trials discussed at ICEM 2025. Expert summaries and critical appraisals from St Emlyn’s cover transfusion strategies, airway management, oxygenation, fibrinogen, and more.

Emergency Centre Thoracotomy in South Africa. Can you perform a life-saving thoracotomy without ICU, theatre, or specialist staff? A new study from Cape Town shows it's possible — and often successful — even in district hospitals facing high trauma burdens. Read our latest St Emlyn’s review 👇 #EmergencyMedicine #TraumaSurgery #FOAMed #GlobalHealth

Emergency Centre Thoracotomy in South Africa.

Can you perform a life-saving thoracotomy without ICU, theatre, or specialist staff? A new study from Cape Town shows it's possible — and often successful — even in district hospitals facing high trauma burdens. Read our latest St Emlyn’s review 👇…

Is there still room for compassion in emergency care? Emergency care is more pressured than ever—but is compassion being lost in the chaos? This post explores the reality of compassion fatigue, the systemic and cultural barriers to empathy, and practical, evidence-based strategies to reconnect with patients in meaningful ways.

Is there still room for compassion in emergency care?

Emergency care is more pressured than ever—but is compassion being lost in the chaos? This post explores the reality of compassion fatigue, the systemic and cultural barriers to empathy, and practical, evidence-based strategies to reconnect…

Emergency Centre Thoracotomy in South Africa: Real-World Insights from District-Level Hospitals

Emergency care is more pressured than ever—but is compassion being lost in the chaos? This post explores the reality of compassion fatigue, the systemic and cultural barriers to empathy, and practical,…

Self-Organised Criticality: Why your ED is like a Sand Pile Emergency departments (EDs) often seem to shift from calm to crisis in an instant. Why? This article explores ED crowding through the lens of complexity science and self-organised criticality, explaining how minor changes—like a few extra patients—can trigger disproportionate chaos. Using the sandpile analogy and concepts like power law distributions, we reveal why traditional linear models and static targets often fail to manage ED flow effectively. Instead, we offer a data-driven, systems-based approach: identifying tipping points, recognising early warning signs, and implementing proactive, anticipatory interventions. From real-time dashboards to weekly cycle planning and distributed decision-making, this article offers a practical guide for building resilience in emergency care. Learn how your ED can thrive in complexity, not just survive it.

Emergency departments (EDs) often seem to shift from calm to crisis in an instant. Why? This article explores ED crowding through the lens of complexity science and self-organised criticality, explaining how minor changes—like a few extra patients—can trigger disproportionate chaos.

Derivation and Validation of the Simplified Bleeding Audit Triage Trauma (sBATT) Score The simplified BATT (sBATT) score offers a practical trauma triage tool for use in motor vehicle collisions where monitoring equipment may be unavailable. Derived from the original BATT score and validated on over 70,000 UK patients, the sBATT shows excellent performance in predicting early death using only observable signs. Ideal for lay responders, trapped patients, and low-resource settings, this novel tool could help guide early trauma care and emergency dispatch.

Derivation and Validation of the Simplified Bleeding Audit Triage Trauma (sBATT) Score

The simplified BATT (sBATT) score offers a practical trauma triage tool for use in motor vehicle collisions where monitoring equipment may be unavailable. Derived from the original BATT score and validated on…