The St.Emlyn’s Podcast

Last year we were honoured to bring Kat Evans to Manchester to talk at the #stemlynsLIVE conference. We've covered emergency medicine in South Africa before on the blog, but there is no substitute to hearing about it from someone who actually works there.

Understanding P Values: A Comprehensive Guide for Clinicians Welcome to St Emlyn's blog, where we delve into the complex world of P values—a crucial element in medical research. For emergency medicine clinicians, understanding P values is essential for interpreting study results and applying them effectively in clinical practice. This post aims to demystify P values and enhance your critical appraisal skills. What Are P Values? P values are a measure of the probability that an observed difference could have occurred just by chance if the null hypothesis were true. The null hypothesis generally states that there is no difference between two treatments or interventions. Thus, a P value helps us determine whether the observed data is consistent with this hypothesis. The Null Hypothesis and Significance Testing To grasp P values fully, we start with the null hypothesis. In any trial, we begin with the premise that there is no difference between the treatments being tested. Our goal is to test this null hypothesis and ideally disprove it, a process known as significance testing. When we calculate a P value, we express the probability of obtaining a result as extreme as the one observed, assuming the null hypothesis is true. For instance, a P value of 0.05 suggests a 5% chance that the observed difference is due to random variation alone. The Magic of 0.05 The threshold of 0.05 has become a benchmark in research. A P value below this threshold is often considered statistically significant, while one above is not. However, this binary approach oversimplifies statistical analysis. The figure 0.05 is arbitrary and does not imply that results just above or below this threshold are vastly different in terms of practical significance. Clinical vs. Statistical Significance Distinguishing between statistical significance and clinical significance is crucial. A statistically significant result with a very small P value may not always translate into clinical importance. For example, a large study might find that a new treatment reduces blood pressure by 0.5 millimetres of mercury with a P value of 0.001. While statistically significant, such a small reduction may not be clinically relevant. Conversely, a clinically significant finding might not reach the strict threshold of statistical significance, particularly in smaller studies. Therefore, it's essential to consider both the magnitude of the effect and its practical implications in clinical practice. The Fragility Index The fragility index is an alternative measure that addresses some limitations of P values. It calculates the number of events that would need to change to alter the study's results from statistically significant to non-significant. This index provides insight into the robustness of the findings. Surprisingly, even large trials can have a low fragility index, indicating that their results hinge on a small number of events. Moving Beyond 0.05 Recognizing the limitations of the 0.05 threshold, some researchers advocate for more stringent criteria, such as a P value of 0.02, particularly in large randomized controlled trials (RCTs). This approach aims to reduce the likelihood of false-positive results and improve the reliability of findings. However, it also raises the bar for demonstrating the efficacy of new treatments, which can be a double-edged sword. Multiple Testing and Bonferroni Adjustment A significant challenge in research is multiple testing. Conducting numerous statistical tests increases the probability of finding at least one significant result purely by chance. This issue is particularly relevant in exploratory studies where multiple outcomes are assessed. One method to address this problem is the Bonferroni adjustment, which adjusts the significance threshold based on the number of tests performed. While this approach helps control the risk of false positives, it can be overly conservative and reduce the power to detect true effects. Therefore, it should be used judiciously. Interim Analysis in Clinical Trials Interim analysis is a crucial aspect of clinical trials, allowing researchers to assess the effectiveness or harm of an intervention before the study's completion. However, performing multiple interim analyses can increase the risk of false-positive findings. To mitigate this risk, researchers use techniques like P value spending functions, which adjust the significance threshold for each interim analysis. Additionally, the number of interim analyses should be limited and pre-specified in the study protocol. This ensures that decisions to stop a trial early are based on robust evidence and not on arbitrary or opportunistic analyses. Effect Size and Confidence Intervals P values alone do not provide a complete picture of the study results. It's equally important to consider the effect size, which measures the magnitude of the difference between treatments. A small P value might indicate statistical significance, but without a substantial effect size, the clinical relevance of the finding remains questionable. Confidence intervals (CIs) complement P values by providing a range within which the true effect size is likely to lie. A 95% CI means that if the study were repeated multiple times, 95% of the calculated intervals would contain the true effect size. CIs offer valuable context for interpreting P values and understanding the precision of the estimated effect. Practical Tips for Interpreting P Values Understand the Null Hypothesis: Always start with a clear understanding of the null hypothesis and what the study aims to test. Look Beyond the P Value: Consider the effect size, confidence intervals, and clinical significance of the findings. Be Cautious with Multiple Testing: Recognize the increased risk of false positives with multiple comparisons and apply appropriate adjustments. Assess the Fragility Index: Use the fragility index to gauge the robustness of the study's findings. Consider Interim Analysis: Ensure that interim analyses are pre-planned and interpreted with caution to avoid bias. Question the Threshold: Remember that the 0.05 threshold is not a magic number. Interpret P values in the context of the study design, sample size, and practical implications. Conclusion P values are a fundamental aspect of medical research, but their interpretation requires a nuanced understanding. By considering the null hypothesis, clinical significance, effect size, and confidence intervals, we can make more informed decisions based on the data. As emergency medicine clinicians, our goal is to apply research findings judiciously to improve patient care. We hope this deep dive into P values has clarified their role and limitations in research. Remember, the journey to mastering statistical concepts is ongoing, and continuous learning is key. If you have any questions or thoughts, please share them in the comments below. Happy appraising, and stay curious!

St. Emlyn's January Roundup: Key Insights and Innovations Hello and welcome to the St. Emlyn’s Podcast. I’m Simon Carley, joined by Rick Body. Today, we’re bringing you our January roundup, sharing the most intriguing and impactful content we've covered this month. From reflecting on 2018 to exploring new guidelines and innovations in emergency medicine, we have a lot to discuss. Let’s dive in! Reflecting on 2018: Transformational Reads and Achievements As we started January, we reflected on 2018, a year filled with significant achievements and insights. One standout discussion was our review of key books that left a lasting impact. A personal favorite of mine is "Why We Sleep" by Matthew Walker. This book has been transformational for me, influencing how I live and advise others on health, well-being, and performance. The insights on sleep’s importance in education, creativity, and overall health are profound. Rick, did anything from our 2018 review resonate with you? Rick Body: Absolutely, Simon. The variety of books we discussed was impressive. It was enlightening to hear about others' achievements in 2018 and their goals for 2019. This exercise really focused my mind on what I hope to achieve this year. Goals for 2019: Innovations and Personal Aspirations As we moved from reflections to aspirations, we set our sights on exciting projects for 2019. One major highlight is the AI incubator for emergency care. This initiative aims to support academic careers and foster partnerships between data and industry to enhance medical technologies. It’s an exhilarating time for advancements in emergency care. Rick is incredibly busy with groundbreaking work, particularly in diagnostics in Manchester. His research and speaking engagements are making waves in the medical community. For more details on these projects, check out the blog where all the information is comprehensively covered. New Year’s Resolutions: Insights from Liz Crowe We explored New Year’s resolutions with Liz Crowe, who offered a fresh perspective on well-being and resolutions. Instead of focusing on all-or-nothing goals, Liz suggests starting small and seeking rewards rather than punishments. This approach makes significant lifestyle changes more manageable and sustainable. Committing to resolutions publicly or with a friend can enhance accountability and success. Rick, do you have any New Year’s resolutions? Rick Body: It’s challenging to pinpoint one or two, but Liz’s advice on avoiding binary thinking is crucial. Recognizing progress rather than dwelling on setbacks can make a big difference. Tetanus Guidelines: New Insights and Practical Applications In January, we delved into updated tetanus guidelines, highlighting significant changes. Previously, a single booster in your early 20s was deemed sufficient, but the new guidelines recommend a 10-year booster. This change stems from the recognition that immunity wanes over time. Interestingly, point-of-care testing is now available to detect active tetanus immunization, allowing for more tailored booster decisions. These updates are crucial for emergency physicians to ensure compliance with current standards and provide optimal patient care. The blog post simplifies these guidelines, making them accessible and easy to understand. Excellence in Emergency Medicine: Claire Richmond’s Contributions We featured Claire Richmond, a hero in the emergency medicine community. Claire, who works with Sydney HEMS, delivered an inspiring keynote at the St. Emlyn’s live conference. Her talk focused on excellence, performance, training, and development in retrieval medicine. She emphasized the importance of honesty, feedback, and continuous improvement. For those aspiring to achieve self-actualization in emergency medicine, Claire’s insights are invaluable. We’ve shared the video and podcast of her talk, and we highly recommend checking them out. Prognosticating Cardiac Arrest Outcomes: Dan Horner’s Research Another highlight of January was Professor Dan Horner’s discussion on serum neurofilament light chains, a promising tool for prognosticating cardiac arrest outcomes. This research, stemming from the TTM trial, suggests that these biomarkers can provide early predictions about patient outcomes. Early identification of patients likely to have poor neurological outcomes can significantly impact family discussions, treatment decisions, and overall management. This research is groundbreaking and holds potential for future clinical applications, although it’s not yet ready for immediate practice. Celebrating Evidence-Based Medicine: Critical Appraisal E-Book We’re incredibly proud of our journal club series at St. Emlyn’s, which advocates for evidence-based medicine. This series highlights the latest research, making it accessible and understandable. To celebrate the contributions over the past year, we’ve compiled an e-book available for free download. This resource is a testament to our commitment to advancing medical knowledge and practice. Pre-Medication for Ketamine Sedation: Exploring New Research One of the intriguing studies we covered this month examined pre-medication with midazolam or haloperidol for ketamine sedation. The randomized control trial suggested that pre-medication could reduce complications like abnormal behaviors and emergence phenomena. However, it also increased recovery time, requiring more resources and nursing time. While the findings are interesting, they haven’t convinced us to change our current practice. However, it’s essential to stay informed about such research to make informed decisions in clinical practice. HEMS and Traumatic Cardiac Arrest: Evaluating Outcomes We also discussed the role of HEMS in improving outcomes for traumatic cardiac arrest. The study from the UK highlighted the high-level interventions provided by HEMS teams. However, it raised questions about the overall impact on patient survival. Of the 263 patients attended, only seven survived, and all had achieved ROSC before HEMS arrival. This data suggests that while HEMS interventions are critical, their direct impact on survival needs further evaluation. This topic is sure to spark debate, and we appreciate the transparency of HEMS services in sharing their data and encouraging open discussions. Looking Ahead: Plans for the Future As we wrap up January, we’re excited about the plans for the coming months. Simon is heading to Jeddah for a significant event, and we’re considering hosting another St. Emlyn’s live conference and teaching course. We’re exploring innovative formats for medical conferences and welcome your ideas on how we can make these events even more impactful. Support St. Emlyn’s: Keeping Education Free and Accessible Since 2012, we’ve funded the blog and podcast out of our own pockets, but as our audience has grown, so have the costs. If you find our content valuable, please consider making a small donation or subscribing for regular contributions. Your support helps us keep St. Emlyn’s free and accessible to all. Thank you for your time and continued support. Stay tuned for more updates, and as always, enjoy your emergency medicine practice and take care!

In this episode of the St. Emlyn's podcast, Rick Body and Charlie Reynard discuss an influential research project conducted by Dr. Reynard during his academic foundation program. The paper, titled 'Optimizing Antiplatelet Utilization in the Acute Care Setting,' explores decision-making under clinical uncertainty, specifically in emergency medicine for suspected acute coronary syndromes (ACS). Through systematic reviews and decision tree modeling, the research evaluates the benefits and risks of various antiplatelet therapies, such as Ticagrelor and aspirin versus Clopidogrel and aspirin. The findings reveal that Ticagrelor and aspirin are often more beneficial for patients with a greater than 8% probability of ACS, while Clopidogrel holds little to no place in current practice. The discussion opened up new questions about dynamic risk prediction and the importance of modeling to inform clinical decisions. 00:00 Introduction to the Podcast 00:26 Charlie's Research Background 00:52 Overview of the Research Paper 01:17 Decision Making Under Uncertainty 03:05 Systematic Reviews and Data Collection 03:46 Building the Decision Tree Model 04:48 Results and Key Findings 08:07 Implications for Clinical Practice 09:19 Future Directions and Conclusion

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. 

A Deep Dive into December: The Best of St. Emlyn’s Blog and Beyond Welcome to the St. Emlyn’s Podcast! I’m Simon Carley, and today we’re going to journey through December 2018. This month has been filled with intriguing discussions, significant insights, and top-notch blogs from a variety of experts. As we wrap up the year and get ready to welcome 2019, it’s the perfect time to reflect on the key topics that have shaped our discussions around Christmas and the New Year. Tribalism in Healthcare with Ross Fischer First up, we have an insightful contribution from Ross Fischer, a key member of the St. Emlyn’s team and a Pediatric Surgeon based in Sheffield. Ross has delved into the topic of tribalism in healthcare, a subject we've explored previously but which remains ever relevant. Tribalism refers to the formation of groups or 'tribes' based on common beliefs and cultures, which significantly influences our behaviour and treatment approaches in healthcare. Ross's blog revisits a remarkable presentation by Vic Brazil at SMACC Gold in 2014, highlighting how tribalism drives our interactions and behaviours within the medical field. In healthcare, tribes often form around specialities – emergency physicians, surgeons, anaesthetists, etc. While having a strong group identity can be positive, it can also lead to unhealthy competition and misunderstandings. For example, emergency physicians might unfairly label surgeons as uncooperative, which is not only untrue but also counterproductive. Ross's extensive experience across various medical cultures has given him a unique perspective on this issue. His blog emphasizes the importance of recognizing and mitigating tribalism to foster better cooperation and ultimately improve patient care. Some strategies he suggests include using personal names during referrals, face-to-face communication, being supportive rather than critical when things go wrong, organizing social events across specialities, and calling out tribalism in casual conversations. Conservative Management of Chest Trauma Next, I’ve put together a blog on the conservative management of chest trauma, inspired by several presentations I've done this year on torso trauma. The increasing body of evidence suggests that not all chest injuries, such as hemothoraces and small pneumothoraces, require invasive intervention. Reflecting on my early days in emergency medicine, we operated under the strict guideline that any pneumothorax or hemothorax warranted a chest drain. However, advances in imaging technology, like whole-body CT scans, have revealed that many small pneumothoraces and hemothoraces were previously undetected and thus untreated without significant complications. Recent studies, including a substantial observational study by Walker, support the safety of conservative management for many of these cases. This shift in practice aligns with our experiences here in Virchester, where we often opt to observe rather than immediately intervene with chest drains, even in ventilated patients. The evidence is still evolving, but it’s encouraging to see data supporting less invasive approaches. Intensive Care Insights with Dan Horner Dan Horner, Professor of Emergency Medicine at Virchester West, has shared three exceptional posts from our time at the Intensive Care Society conference in London. The interface between emergency medicine and ICU is a critical area, and Dan’s insights are invaluable for anyone interested in this field. One standout topic from the conference was Tom Evans' presentation on exercise physiology. Though I missed it, the demonstration with Olympic rowers on stage, showcasing their lactate levels, was reportedly phenomenal. This type of hands-on demonstration highlights the extraordinary resilience and adaptability of human physiology, insights that are crucial for both emergency and intensive care practitioners. In addition to exercise physiology, Dan and I covered the continuum of patient care from the roadside to critical care, emphasizing the importance of effective handovers and collaborative work with paramedics. Our discussions included the zero point survey, ATMIST handovers, and the significance of follow-ups to ensure paramedics receive feedback on their patients' outcomes, all crucial elements for improving patient care and professional practice. FemInEM Conference Highlights with Natalie May Natalie May wrapped up our review of the FemInEM conference, emphasizing the multifaceted nature of medicine. The themes of passion, role models, organization, consistency, persistence, mentorship, and leadership were central to the conference discussions. FIX19, the upcoming FemInEM event, promises to continue this tradition of exploring how medical professionals can impact not just clinical outcomes but also their own lives, colleagues, and the broader community. HIV Management in Emergency Medicine Gareth Roberts, a recent addition to our consultant team in Manchester, provided a comprehensive review of HIV management from an emergency physician’s perspective. His blog focuses on post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), critical areas for emergency physicians to master. With the ongoing changes in HIV treatment and prevention, understanding the nuances of PEP and PrEP is vital. Gareth also touches on the rise of chemsex and its implications for emergency medicine, emphasizing the need for awareness and appropriate management strategies for patients involved in these practices. Trauma Laparotomy: A Decade of Data Rich Cardens explored the intriguing findings from his PhD research on trauma laparotomy. Despite significant advancements in trauma care over the past decade, the mortality rate for trauma laparotomy has remained unchanged. This surprising discovery prompts a deeper investigation into the factors influencing these outcomes. Rich's research compares data from the JTTR military registry and the Royal London Hospital, highlighting the need for a comprehensive trauma emergency laparotomy audit. Understanding why mortality rates haven't improved could lead to better strategies and practices in trauma care. Game of Thrones Mortality Study For a lighter, yet still educational note, Janos Byan Beethar found an entertaining yet insightful study in the Injury Prevention Journal. This study analyzed the mortality of characters in Game of Thrones, a bit of fun that doubles as a critical appraisal exercise. With over half of the 330 characters meeting untimely deaths through injury, burns, or poisoning, the study offers a unique way to engage with epidemiological concepts and cause-effect associations. Interestingly, the study also suggests that characters who change allegiances have a higher survival rate – perhaps a subtle hint at the importance of adaptability in both fictional and real-world scenarios. Looking Ahead to 2019 As we close out December, it’s clear that 2018 has been a year of growth, learning, and exciting developments here at St. Emlyn’s. From addressing tribalism in healthcare to exploring conservative management strategies for chest trauma, and from the latest insights in intensive care to the evolving field of HIV management, our blogs have covered a wide range of critical topics. We look forward to continuing this journey in 2019, bringing you the latest research, discussions, and insights in emergency medicine. Whether through our blogs, podcasts, or live events, we aim to foster a community of continuous learning and professional growth. Stay connected with us on Twitter, Facebook, the blog, and the podcast. We’re here to support you in your practice and to ensure you stay at the forefront of emergency medicine. Here’s to another great year with St. Emlyn’s!

St Emlyn's November 2018 Review: Key Highlights and Insights Hello and welcome to the St Emlyn's Podcast and blog. I'm Simon Carley, and I'll be guiding you through the exciting topics and developments we've covered on the blog in November 2018. From leadership insights to groundbreaking medical research, this month has been incredibly informative. Let's dive into the highlights! Leadership Insights from the FIX Conference We begin our review in New York, where Natalie May attended the FIX (FeminEM) Conference. In her second post about this event, Natalie explores profound themes, particularly around leadership and motivation in the medical field. Key Takeaways on Leadership and Motivation Jennifer Walthall's talk emphasized the importance of acting within the system to drive change. When joining an organization that may not align with your values, you can either work within the system to improve it or fight from the outside. Walthall advocates for influencing change from within, suggesting that once embedded, you can effectively drive improvements. Lara Goldstein's session on leadership identified four critical attributes of a good leader: Listening: Truly understanding your team. Recognizing the Impact of Small Actions: Little things add up. Conflict Management: Not everyone will like you, and that's okay. Gratitude, Kindness, and Decency: Core values that should guide every leader. Natalie's detailed reflections on the FIX Conference are a must-read for those interested in these themes. Attending FIX in 2019 should be on your list if possible! POLAR Trial: New Insights into Hypothermia Post-Brain Injury Dan Horner analyzed the POLAR trial in one of our journal club posts. The POLAR trial is a significant randomized control trial investigating the effects of hypothermia in the early stages after a brain injury. This study follows the Eurotherm trial, which explored hypothermia's role in patients with severe brain injuries in the ICU. What the POLAR Trial Reveals The POLAR trial involved 511 patients with severe brain injuries, randomized to either hypothermia (cooling to 33-35°C) or maintaining normothermia for 72 hours. Despite strong pathophysiological evidence supporting hypothermia, the trial found no significant difference in outcomes after six months. Initial results suggest that routine hypothermia for early-stage brain injury might not be beneficial, but long-term data follow-up is crucial. This trial, published in JAMA, is essential reading for anyone involved in emergency medicine or critical care. The Case for Whole Blood Transfusion in Trauma: Insights from Zaf Qasim Zaf Qasim, a former Manchester trainee now making waves in the US, contributed an enlightening post on the use of whole blood in trauma resuscitation. This approach, which makes intuitive sense—replacing lost whole blood with whole blood—contrasts with the UK practice of separating blood into components for transfusion. Advantages of Whole Blood Transfusion Zaf argues that whole blood could simplify and improve trauma care, reducing the time and complexity of reconstituting blood components in the body. Although not yet standard in the UK, this method is gaining traction in places like London HEMS and various European centers. As data continues to emerge, this could revolutionize trauma care, harkening back to practices from the Second World War and Vietnam. Challenging the Use of "Sexy" in Clinical Medicine Natalie May returns with a provocative post challenging the use of the term "sexy" in clinical medicine, especially in resuscitation-related specialties. Often used to describe procedures or equipment, this term can inadvertently perpetuate gender biases and undermine professionalism. Redefining Professional Language Natalie, supported by her husband Oli May's humorous yet insightful critique, urges us to reconsider such language. The term "sexy" in a medical context is not a compliment and can contribute to a culture that sexualizes women in the workplace. This reflection is especially relevant for departments striving to maintain professionalism and inclusivity. Understanding Cognitive Load Theory with Nick Smith In the realm of medical education, Nick Smith's debut blog post introduces us to cognitive load theory. As a clinical educator in Manchester, Nick explores how intrinsic, extrinsic, and germane cognitive loads affect learning and teaching. Applying Cognitive Load Theory in Medical Education Nick's post is a valuable resource for educators aiming to optimize their teaching strategies. By understanding and managing cognitive load, we can create more effective and supportive learning environments for our trainees. This post is part of a broader series on educational theories that are crucial for medical educators. Elective Experience in South Africa: Lessons from Claire Bromley Medical student Claire Bromley shares her transformative elective experience at Mitchell's Plain with the BAD EM team. Working with leaders like Katya Evans and Craig Wylie, Claire's reflections offer deep insights into the challenges and rewards of emergency medicine in South Africa. Bridging UK Training with South African Realities Claire highlights the stark differences between UK and South African healthcare systems, particularly the intense workload and resource constraints in the public sector. Her experience underscores the importance of preparation, respect, and adaptability for anyone considering working in a different health economy. Promoting Diversity in the Emergency Department Natalie May's final post for November reflects on promoting diversity and inclusivity in the emergency department. She emphasizes that the ED is unique in its diversity, seeing patients from all walks of life. Embracing and Understanding Diversity Natalie advocates for a broader understanding of diversity beyond ethnicity, including gender, disability, and sexual orientation. Her insights are essential for ED professionals committed to providing equitable care and fostering an inclusive environment. Learning in the Social Age: Embracing Medutainment I had the pleasure of discussing "Learning in the Social Age" at the Emerge 10 conference in Scotland. This presentation, supported by a blog post, explores how the internet and social media are transforming medical education. The Impact of Medutainment We are now competing on a global scale as educators, with learners accessing information from various sources worldwide. This shift necessitates embracing new methods of engagement, ensuring our teaching remains relevant and impactful. Beyond ALS: Innovations in Cardiac Arrest Management We wrapped up November with a highlight from St Emlyn's Live, featuring Salim Rezaie from the RebelEM blog and podcast. Salim's presentation on "Beyond ALS" challenges us to rethink cardiac arrest management, focusing on advanced techniques and evidence-based practices. Advancing Cardiac Arrest Protocols Salim's talk covers crucial aspects such as minimizing shock pauses, effective adrenaline administration, and optimizing IV/IO access. For anyone serious about improving their ALS skills, this blog, podcast, and accompanying videos are indispensable resources. Looking Ahead November was a whirlwind of activity and learning at St Emlyn's, and we have plenty more in store for December. As we approach the holiday season, we hope you find time to explore these posts and integrate their lessons into your practice. Thank you for being part of the St Emlyn's community, and we look forward to continuing this journey of learning and improvement together.

This podcast was recorded at the Intensive Care Society State of the Art meeting in London 2018. Simon Carley interviews Prof Peter Brindley on the interface of technology, humans and humanity in critical care. The audio was recorded live and at the venue so there is a fair bit of background noise, but we hope that this does not distract from a wide ranging and fascinating podcast.  

Five strategies to improve your resuscitations. 1. Zero point survey 2. Peer review 3. 10 in 10 4. Hot debriefs 5. Fly the patient You can read about these strategies, watch the video and learn about the background on the St Emlyn's blog here https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/ 

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/