The St.Emlyn’s Podcast

Rick and Kirstin delve deeper into the world of Novel Oral Anti Coagulants.

In this episode of the St Emlyn's podcast, host Natalie May interviews Karim Brohi, a vascular and trauma surgeon from London, during the London Trauma Conference. Brohi shares crucial insights from his talk on arterial dissection in trauma, highlighting the distinction between dissection and false aneurysms, the importance of early recognition and intervention in ischemic limbs, and the necessity of a robust interventional radiology team in trauma centres. Brohi emphasizes the critical need for rapid decision-making to improve functional outcomes, debunking traditional timelines for intervention, and advocates for simplified, impactful communication in medical presentations.   00:00 Introduction and Welcome 00:34 Understanding Arterial Dissection in Trauma 01:23 Key Points on Ischemic Limb Recognition 02:12 Clinical Practice and Pulse Assessment 03:14 Time Sensitivity in Treating Ischemic Limbs 04:14 Role of Interventional Radiology 05:16 Effective Communication in Medical Talks 06:05 Conclusion and Contact Information

Revolutionizing Emergency Medical Response: An Inside Look at the GoodSAM App Welcome to the St Emlyns blog! Today, we dive deep into an innovation that's poised to transform emergency medical care: the GoodSAM app. I had the privilege of sitting down with Mark Wilson, a consultant neurosurgeon, pre-hospital care practitioner, and the driving force behind this groundbreaking technology. Our conversation took place at the London Trauma Conference, where Mark shared insights into the motivation, development, and future of GoodSAM. The Birth of GoodSAM: Addressing a Critical Need Mark Wilson's journey with GoodSAM began through his work with London's Air Ambulance. During his time there, he observed a significant number of patients with head injuries experiencing periods of apnea before medical professionals could arrive. Often, these patients would suffer from hypoxic brain injuries rather than direct trauma to the brain. This observation sparked an idea: what if there was a way to reduce secondary brain injuries by ensuring that airways were kept open during the critical moments before emergency services could reach the patient? The problem was clear—there simply weren’t enough trained individuals present at the scene of these emergencies to maintain open airways. Inspired by the thought that "you’re never more than five meters away from a spider," Mark and his team theorized that, especially in urban areas like London, you’re likely never more than a few hundred meters away from a trained medical professional. Developing GoodSAM: From Concept to Reality Turning this idea into a functioning application required technical expertise and collaboration. Enter Ali Gorgony, a tech developer from Imperial College, who played a crucial role in bringing GoodSAM to life. Together, they conceptualized and built the app, creating a platform that connects individuals in need of immediate medical assistance with nearby responders. GoodSAM features two primary versions: the Alert app and the Responder app. The Alert app is designed for the general public, while the Responder app is for medical professionals such as doctors, nurses, and paramedics. Once a responder downloads and registers on the app, they are ready to assist in emergencies. The app uses advanced technology to triangulate the responder's location via beacons rather than GPS, ensuring minimal battery drain. How GoodSAM Works: Saving Lives One Alert at a Time When someone in distress uses the Alert app, it automatically dials 999 (or the local emergency number in other countries) and simultaneously notifies the three nearest responders. The responder’s phone emits a distinct siren sound, alerting them to the emergency. If they are available to help, they can quickly respond; if not, the next closest responder is notified. This system ensures that someone capable of providing immediate assistance, such as maintaining an open airway or performing CPR, can reach the patient as quickly as possible. A standout feature of GoodSAM is its defibrillator registry, which currently includes over 12,000 defibrillators. Users can upload pictures of fixed defibrillators in public places, adding to a comprehensive map that responders can access during emergencies. Ensuring Safety and Reliability: Governance and Verification The integrity of GoodSAM's responder network is paramount. To ensure that only qualified individuals are registered, responders must upload identification and, if applicable, their GMC number. This information is verified before they are approved to respond to alerts. Additionally, institutions like London’s Air Ambulance and various ambulance services in the UK and Australia can register, allowing their staff to be verified under the institution’s approval. GoodSAM's governance model is designed to maintain high standards and trust within the community. By verifying the identities and qualifications of responders, the app mitigates the risk of unqualified individuals responding to emergencies. The Bigger Picture: Integrating with Emergency Services Mark envisions a future where GoodSAM is fully integrated with emergency services' computer-aided dispatch (CAD) systems. This integration would enable automatic alerts to responders based on 999 calls, even if the GoodSAM Alert app hasn’t been used. This seamless connectivity would ensure even faster response times and potentially save more lives. Addressing Legal Concerns: The Good Samaritan Act One of the key concerns for medical professionals considering using the GoodSAM app is indemnity. Mark emphasizes that responding through GoodSAM is akin to performing a Good Samaritan Act. The UK does not currently have a formal Good Samaritan law, unlike parts of the US and Australia, but such legislation is expected to be introduced soon. This law will further protect responders, making it even more challenging for legal action to be taken against them for providing assistance in emergencies. Sustainability and Social Enterprise: A Model for Good GoodSAM operates as a not-for-profit social enterprise. Everything discussed so far is free for users—alerting, responding, and usage by ambulance services. The only potential costs arise from integrating with CAD systems, which require development on the part of ambulance services. The altruistic nature of GoodSAM ensures that its primary goal remains to save lives and improve emergency response times. Spreading the Word: How You Can Help Mark's call to action is clear: the more people who download and use the GoodSAM app, the greater its impact. He encourages everyone, medical professionals and laypersons alike, to download their respective versions of the app. For responders, having the app on their phone means they can provide critical assistance during emergencies. For the general public, the Alert app can quickly connect them to nearby help, potentially saving lives. Conclusion: A Community Effort for Better Emergency Care The development and success of GoodSAM are a testament to the power of community and collaboration. From Mark Wilson's initial observations and ideas to the technical expertise of developers and the support of medical institutions, GoodSAM represents a collective effort to improve emergency medical care. By leveraging technology and crowdsourcing, this innovative app has the potential to make a significant difference in response times and patient outcomes. If you're inspired by the story of GoodSAM, I urge you to download the app, encourage your friends and family to do the same, and become part of a community dedicated to saving lives. Only good can come from this—literally.

Rick Body and Kerstin de Wit discuss the role of NOACs in clinical management. Part 1 addresses the basics, stuff you should know if you are prescribing these drugs. Part 1 tells us the good stuff, don't forget to listen to 2 and 3 in the next few weeks as not everything is perfect ;-) Check out the BLOG POST HERE vb R

Managing Early Pregnancy Problems in the Emergency Department Welcome to the St. Emelene's induction podcast. I'm Iain Beardsell, and I'm Natalie May. Today, we're discussing the management of early pregnancy problems in female patients presenting to the emergency department (ED). Some of you may rarely encounter these cases, while others may see them frequently. This podcast aims to provide a detailed guide on how to manage these patients effectively, optimizing our approach for better patient outcomes. Understanding Early Pregnancy Problems Early pregnancy problems can range from minor concerns to life-threatening emergencies. As emergency physicians, our primary goal is to identify and manage the worst-case scenarios promptly. In this post, we'll cover the following topics: Worst-case scenarios and initial steps History and physical examination Risk factors for ectopic pregnancy Diagnostic testing: urine vs. serum HCG Per vaginal (PV) examination: when to perform Management of threatened miscarriage Patient communication and support Worst-case Scenarios and Initial Steps In emergency medicine, we often think about the worst-case scenarios first. For early pregnancy problems, the most critical concern is an ectopic pregnancy. Ectopic pregnancies occur in about 1 in 100 pregnancies in the UK and can be life-threatening if not identified and treated promptly. Initial Steps When a young female patient presents with lower abdominal pain or spotting and is potentially pregnant, our first steps should include: Confirming pregnancy status: Use a urine pregnancy test initially. Assessing vital signs: Look for signs of hemodynamic instability, such as hypotension or tachycardia, which could indicate a ruptured ectopic pregnancy. Taking a detailed history: Understand the patient's symptoms, last menstrual period, and any previous gynecological issues. History and Physical Examination A thorough history and physical examination are crucial in managing early pregnancy problems. Here's what you need to focus on: History Last Menstrual Period (LMP): Helps estimate the gestational age. Symptoms: Type and location of pain, nature of bleeding, and presence of other symptoms like dizziness or shoulder pain. Previous Pregnancies: Gravida (number of pregnancies) and Para (number of completed pregnancies). Risk Factors: Previous ectopic pregnancy, pelvic inflammatory disease, and any surgeries or procedures involving the reproductive organs. Physical Examination Abdominal Examination: Look for tenderness, guarding, or rebound tenderness. Vital Signs: Monitor for signs of shock or hemodynamic instability. Pelvic Examination: In specific cases, to assess for cervical motion tenderness, adnexal tenderness, or masses. Risk Factors for Ectopic Pregnancy Understanding the risk factors for ectopic pregnancy can help identify patients who need urgent evaluation. Risk factors include: History of pelvic inflammatory disease (PID) Previous pelvic or abdominal surgery Use of intrauterine devices (IUDs) Previous ectopic pregnancy Assisted reproductive techniques like IVF Anatomical abnormalities of the fallopian tubes or uterus Endometriosis Use of the progesterone-only pill Diagnostic Testing: Urine vs. Serum HCG Determining the pregnancy status and ruling out ectopic pregnancy requires accurate diagnostic testing. Here's a comparison between urine and serum HCG tests: Urine HCG Test Sensitivity: About 96%, particularly when HCG levels are above 100. Specificity: High, meaning a positive result is reliable. Limitations: May give false negatives if HCG levels are very low, as seen in some ectopic pregnancies. Serum HCG Test Sensitivity and Specificity: Both close to 100%, making it the preferred test for confirming pregnancy and assessing HCG levels. Usage: Particularly useful when urine tests are negative but clinical suspicion remains high. When to Perform a Per Vaginal (PV) Examination The necessity of PV examinations in the ED can be debated. However, they are essential in specific situations: Retained Foreign Bodies: Such as condoms or tampons. Significant Vaginal Bleeding: Particularly in cases of suspected cervical shock due to retained products of conception. For other scenarios, PV examinations are best left to gynecology specialists who have the expertise and appropriate setting to perform these exams with the required sensitivity and specificity. Management of Threatened Miscarriage A threatened miscarriage involves vaginal bleeding in a pregnancy less than 24 weeks, with a closed cervical os. It is a common issue that can cause significant anxiety for patients. Here's how to manage these cases: Terminology Threatened Miscarriage: Vaginal bleeding with a closed cervical os. Inevitable Miscarriage: Open cervical os, indicating that miscarriage is likely to proceed. Complete Miscarriage: All products of conception have passed. Incomplete Miscarriage: Some products remain, requiring further management. Approach Assess Bleeding: Light bleeding can often be managed on an outpatient basis. Heavy bleeding requires immediate gynecological consultation. Provide Reassurance: Explain that early pregnancy bleeding is common and not necessarily indicative of a miscarriage. Pain Management: Offer analgesia, such as paracetamol or cocodamol, to manage discomfort. Follow-up: Arrange for follow-up with an early pregnancy assessment unit (EPAU) within 48 hours. Patient Communication and Support Dealing with early pregnancy problems can be distressing for patients. Effective communication and support are crucial. Tips for Communication Be Empathetic: Understand that this might be a significant and emotionally charged situation for the patient. Explain Clearly: Provide information about what is happening and what the next steps are. Avoid Definitive Statements: Unless certain, avoid saying that the patient has definitely miscarried. Offer Reassurance: Reiterate that early pregnancy complications are common and often not due to anything the patient did wrong. Psychological Support Acknowledge Emotions: Recognize the patient's feelings and provide support. Encourage Support Systems: Suggest involving family or friends for emotional support. Professional Help: Refer to counseling services if needed. Conclusion Managing early pregnancy problems in the ED requires a systematic approach, starting with identifying worst-case scenarios and performing appropriate diagnostic tests. Understanding the risk factors for ectopic pregnancy and knowing when to perform a PV examination are crucial. Providing compassionate care and clear communication can help support patients through what can be a distressing time. By optimizing our approach, we can ensure better outcomes for our patients and provide the best possible care in these challenging situations. Always consult senior colleagues when in doubt and follow local guidelines to ensure consistency and quality of care.

Understanding Impact Brain Apnea: A Revolutionary Insight into Trauma Care Today, we delve into a fascinating and crucial topic in trauma care: impact brain apnoea. We recently had the privilege of attending the London Trauma Conference and caught up with Dr. Gareth Davis, a leading figure in trauma care and pre-hospital emergency medicine in the UK. Dr. Davis shared his insights into impact brain apnoea, a phenomenon that, while not widely recognized, has significant implications for patient outcomes. The Unseen Danger: What is Impact Brain Apnoea? Impact brain apnoea refers to a sudden cessation of breathing due to a blow to the head. This phenomenon, although not commonly discussed, has been a subject of intrigue for trauma professionals for many years. Dr. Davis explained that this condition occurs when an impact to the brain stem interrupts normal breathing, potentially leading to severe consequences if not promptly addressed. This condition's significance lies in its subtlety and the challenges it poses in pre-hospital care. Many trauma incidents involve high-impact forces, such as car accidents, where a patient may suffer head injuries. Understanding the mechanics behind impact brain apnea can be the key to differentiating between minor and severe trauma cases, potentially saving lives. The Historical Context and Research Challenges The concept of impact brain apnoea isn't new, but it has been challenging to prove and widely accept due to a lack of concrete evidence. Gareth emphasized that the inconsistency in patient outcomes—where one individual might suffer severe consequences while another escapes with minor injuries—sparked curiosity among trauma specialists. Over time, through a combination of clinical observations and literature reviews, the medical community has started to piece together a more comprehensive understanding of this condition. A significant barrier in researching impact brain apnoea is the timing of medical intervention. Most pre-hospital care teams arrive at the scene minutes after an incident, often too late to observe the initial apnea phase. This delay makes it challenging to gather real-time data, leaving a gap in understanding the immediate physiological responses post-trauma. Physiological Mechanisms: The Dual Threat Dr. Davis highlighted two critical physiological responses following a head injury that contributes to the complexity of treating impact brain apnea: the immediate cessation of breathing and a subsequent catecholamine surge. Apnea and Hypoxia: The primary response is an apnea caused by the impact on the medulla oblongata, the brain's breathing control centre. This apnea leads to hypoxia (low oxygen levels) and hypercarbia (increased carbon dioxide levels), which can quickly deteriorate the patient's condition. Catecholamine Surge: Following the initial apnea, the body releases a significant amount of catecholamines—hormones like adrenaline—that flood the system. This response, while a natural reaction to stress, can be detrimental, especially when the heart is already struggling due to hypoxia. The combination of these factors can lead to traumatic cardiac arrest, a situation where the heart fails due to trauma-induced physiological stress rather than direct injury. Understanding these mechanisms is crucial for emergency responders. Recognizing the signs of impact brain apnea and addressing them promptly can be the difference between life and death. The Clinical Conundrum: Diagnosing and Treating Impact Brain Apnea One of the most challenging aspects of dealing with impact brain apnea is the clinical presentation. Patients may not exhibit obvious signs of severe trauma, such as external bleeding or visible injuries, making it difficult to diagnose based solely on physical examination. Gareth discussed the importance of thorough history-taking and observing indirect signs—akin to observing the "echo" of a particle, like in the Higgs boson analogy. The lack of direct evidence means clinicians often rely on a combination of observational data, patient history, and situational awareness. For example, if a patient presents with persistent hypotension without a clear source of bleeding, clinicians might consider central shock—a term used to describe shock due to central nervous system dysfunction rather than volume loss. The Role of Public Education and Pre-Hospital Care Gareth emphasized the crucial role of public education and pre-hospital care in managing impact brain apnoea. The public's ability to provide immediate aid, such as opening an airway and administering ventilatory support, can significantly affect outcomes. He pointed out that while there is a global trend to focus on chest compressions in cases of cardiac arrest, for patients with traumatic injuries, addressing airway and breathing is paramount. In London, initiatives like the GoodSAM app are helping bridge the gap by connecting trained responders with emergencies in real-time. This app allows people with medical training to provide critical first aid before professional services arrive, potentially mitigating the effects of impact brain apnea by ensuring the patient's airway is open and they are breathing adequately. Navigating the Future: Research and Education The conversation with Dr. Davis also highlighted the future directions for research and education. The medical community needs to invest more in understanding and validating the concept of impact brain apnea. This investment includes funding for clinical studies and fostering an environment where healthcare professionals can share their observations and experiences. Podcasts, blogs, and medical conferences are valuable platforms for disseminating information about new medical phenomena like impact brain apnea. Dr. Davis encouraged medical professionals to remain curious, continue their education, and be open to emerging concepts that may not yet have robust evidence but have practical significance in clinical settings. Key Takeaways and Clinical Pearls Recognition and Belief: Clinicians need to recognize and believe in the concept of impact brain apnea. Even if direct evidence is scarce, understanding the physiological mechanisms and potential clinical presentations can guide effective treatment. Focus on Airway and Breathing: In cases of traumatic injury, especially with suspected head trauma, the immediate focus should be on ensuring the airway is clear and the patient is breathing. This intervention can prevent the cascade of negative physiological responses that lead to traumatic cardiac arrest. Role of Bystanders and First Responders: Public education and the involvement of trained responders are critical. Tools like the GoodSAM app can play a significant role in ensuring timely intervention. Continuous Learning and Adaptation: The medical field must remain adaptive, incorporating new research findings and adjusting treatment protocols as more is understood about conditions like impact brain apnea. Conclusion Impact brain apnoea is a critical yet under-recognized phenomenon in trauma care. Through continued research, education, and public awareness, we can improve patient outcomes and provide better care in pre-hospital and clinical settings.   

Year in Review: Highlights in Emergency Medicine and Critical Care As we close out the year, St Emlyn's takes a moment to reflect on the significant events and advancements in the field of emergency medicine, critical care, and FOAMed (Free Open Access Medical Education). The past year has seen remarkable progress in research, education, and community engagement, with key studies reshaping our understanding and practices. Here's a look back at the highlights and what we can look forward to in the coming year. Key Research and Trials This year has been notable for the publication of several high-impact studies in emergency medicine and critical care. While some findings may have appeared negative at first glance, they have ultimately underscored the strengths of current practices. For example, trials on mechanical CPR devices, such as the Lucas device, showed no significant improvement in outcomes for out-of-hospital cardiac arrest patients. Similarly, research on starch solutions in sepsis concluded that these substances could be harmful, advocating for their discontinuation despite continued use in some clinical settings. The ARISE and ProCESS trials were particularly influential, examining the effectiveness of early goal-directed therapy in sepsis management. Although these studies did not demonstrate a significant advantage over standard care, they highlighted the high quality of usual treatment protocols, which have improved considerably over the past decade. The ANZICS trial also reported a significant decrease in sepsis mortality, further emphasizing the advancements in patient care. Additionally, the Targeted Temperature Management trial found no difference in outcomes between maintaining post-cardiac arrest patients at 33°C versus 36°C. This finding suggests that more aggressive temperature control may not be necessary, streamlining care protocols. The Role of FOAMed The FOAMed movement has revolutionized access to medical education, allowing healthcare professionals to stay updated with the latest research and discussions. Within hours of publication, new studies are analyzed and debated on various platforms, enhancing knowledge dissemination and critical appraisal. St Emlyn's, along with other prominent FOAMed resources like Life in the Fast Lane, has played a crucial role in this educational revolution. The emergence of new platforms, such as The Bottom Line, has provided additional avenues for high-quality content. The Bottom Line, in particular, offers concise, critical appraisals of literature from a British perspective, catering to a broad audience interested in emergency medicine and critical care. Noteworthy Blogs and Podcasts The past year has seen an increase in the quality and quantity of blogs and podcasts in the FOAMed community. Established sites like Resus.Me, EM Lyceum, and the SGM continue to provide valuable insights, while newer entries such as Broom Docs have brought fresh perspectives. Broom Docs, led by Casey Parker, is particularly noted for its thoughtful discussions on diagnostic tests and clinical judgment. Podcasts have also become an essential part of the FOAMed landscape. St Emlyn's own podcast has grown significantly, offering interviews with experts and discussions on a wide range of topics. Other notable podcasts include Foamcast, which presents a polished and well-structured approach to emergency medicine education, and the Rage podcast, known for its informal yet informative style. Conferences and the Evolution of Medical Education Conferences remain a cornerstone of professional development in emergency medicine and critical care. This year, St Emlyn's team members attended several notable conferences, including the EMS Gathering in Ireland, which featured innovative learning approaches like the "Puss Bus" for sepsis education and Pecha Kucha-style presentations. These events provided valuable opportunities for networking, knowledge exchange, and exploring new educational formats. A significant trend in conferences is the shift towards "Medutainment," which blends medical education with entertainment. This approach, inspired by platforms like TED Talks, emphasizes engaging and visually appealing presentations over traditional lecture formats. The move towards more dynamic and interactive sessions reflects the growing demand for high-quality, engaging content in medical education. Looking Forward to 2015 The upcoming year promises to be equally exciting for emergency medicine and critical care. The SMACC Chicago conference in June is highly anticipated, featuring a lineup of world-class speakers and sessions. Additionally, the College of Emergency Medicine's conference in Manchester is expected to be a major event, with an impressive list of speakers and topics. At St Emlyn's, we plan to continue expanding our content offerings. Our goal is to provide comprehensive coverage of key presenting complaints in the College of Emergency Medicine curriculum through our blog and podcast. We aim to deliver high-quality educational resources that not only inform but also inspire and engage our audience. Acknowledgements We would like to extend our heartfelt thanks to everyone who has supported St Emlyn's and the broader FOAMed community. Special thanks go to Mike Cadogan, whose behind-the-scenes work has been instrumental in maintaining many FOAMed platforms. We also appreciate the contributions of our guest writers and the entire Life in the Fast Lane team for their invaluable support. Conclusion The past year has been marked by significant advancements and enriching experiences in emergency medicine and critical care. The growth of FOAMed has democratized access to knowledge, allowing healthcare professionals to stay current with the latest research and best practices. As we look forward to 2015, we are excited about the opportunities for further growth and learning. We remain committed to providing high-quality, accessible education and fostering a supportive, informed community. We wish all our readers and listeners a happy and healthy holiday season. Whether you're spending time with family or working through the festive period, we hope you find joy and fulfillment in your work and life. Thank you for being part of our journey, and we look forward to another year of learning and growth together.

Key Insights from the London Trauma Conference: Training, Innovation, and Clinical Governance in Emergency Medicine Welcome to the St. Emlyn’s podcast summary of the London Trauma Conference. Over the past few days, experts in emergency medicine and pre-hospital care have shared valuable insights into the latest developments in our field. This blog post covers the highlights, focusing on effective training strategies, innovative practices, and crucial discussions on clinical governance. Quality Education in Pre-Hospital Care by Cliff Reid Cliff Reid’s session on delivering quality education in pre-hospital care was a standout. He emphasized that training for performance goes beyond knowledge acquisition. While understanding SOPs and the flip classroom approach are important, practical application is crucial. Key Training Techniques: Stress Exposure Training: Regularly exposing doctors to high-pressure situations to build resilience. Perturbation: Introducing distractions during simulations to test team stability, such as simulating patient vomiting or monitor failures during an RSI procedure. Cross-Training: Ensuring paramedics and doctors train together and are evaluated as a team. Cliff's insights highlight the necessity of training cohesive units to prepare effectively for real-world scenarios. Learning from Failures in Modern Forensic Pathology Professor Guy Ratti discussed modern forensic pathology, focusing on how clinical techniques are applied post-mortem to determine causes of death. The use of CT scans, angiography, and point-of-care toxicology testing has revolutionized post-mortem investigations, providing quicker and more detailed insights. Learning Points: Application of Clinical Techniques Post-Mortem: Using CT scans and angiography to identify trauma causes. Point-of-Care Toxicology Testing: Rapid results within 45 minutes that can guide future clinical decisions. For pre-hospital providers, understanding these techniques helps in learning from patients who couldn’t be saved, improving future care strategies. Clinical Governance: Striking the Right Balance Clinical governance was a key theme, with discussions on its importance and implementation. Effective governance structures are essential for ensuring consistent, high-quality care. Governance Highlights: Structured and Regular Feedback: Creating environments where teams feel comfortable receiving and acting on feedback. Balancing SOP Adherence and Flexibility: Recognizing situations where deviation from SOPs is necessary for patient care. The consensus was that governance must be tight enough to maintain standards but flexible enough to accommodate individual patient care nuances. Transporting and Transferring Difficult Patients A session dedicated to transporting and transferring difficult patients in the HEMS context provided practical advice and highlighted innovative approaches from international contingents. Patient Categories: Psychiatric Patients: Safe sedation with ketamine for acutely psychotic patients. Bariatric Patients: Innovative positioning techniques, such as using a vac mat for intubation. Infectious Disease Patients: Protocols for safely managing and transporting patients with infectious diseases. These insights are valuable for those working in diverse and challenging environments, ensuring patient safety and effective care during transfers. Afternoon Sessions: EMS Disasters and Quick Hits The afternoon sessions covered a range of topics, from emotional accounts of EMS disasters to rapid-fire discussions on current practices. EMS Disasters: Case Studies from Norway and Glasgow: Brave speakers shared their experiences, offering lessons on safety and crisis management. Quick Hits: Cervical Collars Debate: Discussing the efficacy and necessity of cervical collars, with evidence suggesting limited benefit but continued standard use. Pre-Hospital Blood Testing: Advocating for the feasibility and benefits of conducting blood tests in the pre-hospital environment. These sessions underscored the importance of staying updated with current debates and practices, continuously evaluating and improving methods. Innovation in Medical Technology: The GoodSAM App Mark Wilson’s presentation on the GoodSAM app showcased how technology can revolutionize emergency response. The app alerts trained responders to nearby cardiac arrests, potentially saving lives by reducing response times. Key Features: Free to Download: Available on both the App Store and Google Play. Community-Based: Encourages both medical and non-medical individuals to participate. This app exemplifies how digital innovation can enhance traditional emergency response mechanisms, making it a must-have tool for responders and a valuable resource for the community. Apnoeic Oxygenation During RSI Cliff Reid returned to discuss apnoeic oxygenation during RSI, a technique that can extend the safe apnea period and reduce the risk of desaturation during intubation. Practical Tips: Use of Nasal Oxygenation: Attach nasal specs to the patient in addition to mask ventilation. Simulation and Practice: Regular training to integrate this practice seamlessly into procedures. This straightforward yet effective technique can significantly improve patient outcomes during RSI, both in pre-hospital and hospital settings. Reflections and Future Directions The London Trauma Conference provided a wealth of knowledge, practical advice, and innovative ideas for improving emergency medicine and pre-hospital care. From advanced training techniques to embracing new technologies and refining clinical governance, the insights shared by experts like Cliff Reid, Guy Ratti, and Mark Wilson are invaluable. Key Takeaways: Emphasize team-based training and resilience-building techniques. Leverage modern forensic methods to learn from patient outcomes. Maintain structured yet flexible clinical governance. Implement innovative practices for transporting difficult patients. Stay updated with current debates and emerging technologies. We hope these insights inspire you to reflect on your practices and consider how you can integrate these ideas into your work. Keep pushing the boundaries of emergency medicine, and stay tuned for more updates and interviews from the St. Emlyn’s team. Keywords: London Trauma Conference, emergency medicine, pre-hospital care, clinical governance, forensic pathology, Cliff Reid, GoodSAM app, apnoeic oxygenation, cervical collars, blood testing, trauma training, EMS disasters, St. Emlyn’s.

London Trauma Conference Day 2: Comprehensive Summary Welcome back to the St. Emlyn’s blog. I'm Iain Beardsell, joined by Natalie May, here to recap the second day of the London Trauma Conference at the Royal Geographical Society in Kensington. The day was filled with insightful talks and valuable teaching points, which we’re eager to share with you. Elderly Trauma: Addressing Under-Triage The day began with Marius Reigns focusing on the challenges of elderly trauma. Reigns highlighted the growing number of elderly patients in emergency departments and the critical issue of under-triage. Studies indicate that almost 50% of elderly trauma cases are under-triaged, compared to about 20% in younger patients. This leads to missed opportunities to reduce morbidity and mortality. Reigns emphasized the need to recognize the unique factors in elderly trauma, including multiple medical conditions, medication use, and systemic disadvantages in trauma management. Pediatric Trauma: A Unique Approach Ross Fischer, a favorite at St. Emlyn’s, delivered an outstanding presentation on pediatric trauma. He stressed the importance of not managing pediatric trauma with the same principles as adult trauma. Children have different injury mechanisms and often require different management strategies. For example, splenic injuries in children are less likely to need surgical intervention compared to adults. Fischer called for more research in pediatric trauma, emphasizing the rarity of these cases and the need for collaborative efforts to determine best practices. He also highlighted the importance of simulation in maintaining skills, noting that emergency physicians might only see one or two cases of pediatric trauma annually. Obstetric Trauma: Critical Four-Minute Window Tim Draikot followed with a humorous yet insightful talk on obstetric trauma. He reiterated the critical four-minute window for resuscitation in traumatic maternal cardiac arrest, after which a paramortum C-section should be performed. Draikot emphasized that this procedure is vital for the survival of both mother and child. He stressed the importance of this cognitive protocol—looking at the clock and acting decisively. Draikot’s engaging style made this crucial message resonate, reminding us that swift action can save lives. Coaching Principles in Emergency Medicine Tom Evans, a pre-hospital physician and rowing coach, shared fascinating insights on applying coaching principles to emergency medicine. He discussed the importance of clear mental models, focused teamwork, and having a defined endpoint. Evans drew parallels between coaching an elite athlete and managing a trauma team, emphasizing the need to strive for excellence. He posed the thought-provoking question: "What is our Olympics?" Evans’ talk encouraged us to find our own goals and work towards giving 100% in our practice. The Future of ATLS: Evolving Beyond the Basics Matt Walsh challenged the current status of Advanced Trauma Life Support (ATLS) in his talk. He argued that ATLS should now be considered a basic rather than an advanced course. Walsh proposed the idea of creating local trauma courses tailored to specific systems and teams, incorporating the latest evidence from conferences and social media. This approach aims to improve patient care by adapting training to local needs and continuously updating it with current best practices. Afternoon Highlights: Forensic Pathology and Quick Hits The afternoon session featured the Peter Baskett Memorial Lecture by forensic pathologist Stephen Lead-Beater. Lead-Beater provided a unique perspective on trauma through post-mortem examinations, offering insights that can inform and improve clinical practice. His lecture was both enjoyable and enlightening, adding a valuable dimension to the conference. In the quick hits session, several key points were discussed: Cooling in Isolated Head Injuries: Currently, there's insufficient evidence to support this practice, but further research is anticipated. Calcium in Shocked Trauma Patients: It's advisable to consider calcium administration in hypovolemic patients, particularly those with calcium levels below 0.9 mmol/L. For massive transfusion protocols, administering 10 ml of 10% calcium chloride for every four units of blood is recommended. IO Access: While intraosseous (IO) access remains a vital option, especially for rapid sequence intubation (RSI), it's not the ultimate solution. The debate continues on whether IO can effectively deliver blood due to potential hemolysis issues. FAST Scanning: The role of FAST (Focused Assessment with Sonography for Trauma) scanning in stable patients is diminishing. Operator dependence and declining performance outside research centers are concerns. However, ultrasound's evolving role in assessing general shock remains significant. Social Media in Trauma Care: Connor Deasy highlighted the importance of social media in trauma care, with St. Emlyn’s receiving notable mentions for its contributions. Conclusion and Looking Ahead The second day of the London Trauma Conference has been immensely rewarding, offering a wealth of knowledge and practical insights. From the challenges of elderly and pediatric trauma to the critical timelines in obstetric emergencies, the talks have reinforced the need for continuous learning and adaptation in emergency medicine. As we look forward to day three, focusing on air ambulance work and pre-hospital care, we hope you’ve found these recaps useful. Follow the discussions on Twitter for real-time updates and join us again tomorrow for more highlights. Thank you for reading, and stay tuned for our next update from the London Trauma Conference. Take care and keep striving for excellence in your practice.

London Trauma Conference 2024: Day One Highlights Welcome to the St Emlyn's blog! I'm Iain Beardsell, and I'm Natalie May. We’re excited to share insights from the London Trauma Conference 2024, held in the glamorous heart of Kensington, London. This year’s conference has brought together national and international experts, offering a wealth of knowledge on trauma care. Here, we’ll take you through some of the key highlights from day one, hoping to give you a feel for the event and perhaps persuade you to join us for the remaining days. Karen Bray’s Dynamic Talk on Trauma Dissection One of the standout sessions was Karen Bray's talk on trauma dissection. Her dynamic presentation, complemented by stunning slides, provided numerous take-home messages. For those following us on Twitter, you might have seen some key points and visuals already. Karen’s discussion was particularly poignant given the recent tragic events in Australia involving Phil Hughes. Her ability to weave current events into her presentation added a layer of immediacy and relevance. We’ll delve deeper into her insights in a separate podcast, but suffice it to say, her talk was both enlightening and thought-provoking. Pediatric Trauma and Research Challenges Ian McConaughey addressed the perennial issue of pediatric trauma, emphasizing the inconsistencies in pre-hospital assessments. He pointed out the challenges due to the lower incidence of pediatric trauma compared to adults, which hampers research efforts. Ross Fisher from Sheffield built on this, discussing potential pathways to overcome these barriers in pediatric trauma research. In line with these discussions, Ian Bailey from Southampton raised critical points about the evolution of trauma surgery in the UK. He highlighted the need to attract young doctors to general and trauma surgery, questioning why this isn’t currently a structured career path. His candid approach to addressing these “elephants in the room” was refreshing and necessary for future improvements in trauma care. The Helmet Debate: To Mandate or Not? One of the liveliest sessions featured a debate between Mark Wilson and Karim Brohi on the use of cycling helmets. This debate sparked significant discussion on Twitter. The crux of the debate was whether making helmets mandatory would reduce cycling participation and thereby negate the overall health benefits. Ultimately, Karim won with the argument that helmets should remain a choice rather than a mandate, but the conversation is far from over. Impact Brain Apnea: A New Mechanism We also had a compelling discussion with Gareth Davies on impact brain apnea—a newly recognized mechanism where a head injury can temporarily stop breathing. This simple yet critical understanding could reshape how we manage head trauma in the initial stages. Stay tuned for an upcoming podcast where we’ll explore this topic further. Chris Moran on the Future of Trauma Care Professor Chris Moran, a leading figure in trauma care in England, provided an insightful talk on the progress of major trauma centers over recent years. He also addressed the contentious issue of whether the focus should shift from in-hospital care to pre-hospital phases or rehabilitation. Surprisingly, he advocated for greater emphasis on rehabilitation, sparking a gut reaction among many attendees. However, upon reflection, the audience began to see the merit in his argument. Rehabilitation, though less glamorous than pre-hospital interventions, plays a crucial role in patient recovery and long-term outcomes. Practical Insights on Chest Trauma and Rib Fractures Doug West, a cardiothoracic surgeon from Bristol, delivered a practical talk on chest trauma, particularly the management of rib fractures. He highlighted the disparity in practices across centers, with some performing rib fixation regularly and others not at all. This variation underscores the need for standardized protocols and further research. Tim Moll on Trauma in Motorsport Tim Moll gave an entertaining and informative presentation on trauma in motorsport, a field with a historically high injury rate. He focused on the unique challenges of managing injuries in this sport, emphasizing the importance of understanding the specialized gear and protocols involved. This talk was enhanced by the presence of John Hinds, a veteran motorsport doctor, who added his invaluable perspective. The Complex Relationship Between Shock and Blood Pressure Tim Harris’s session on shock was another highlight. He challenged the traditional view that blood pressure is a direct surrogate for shock, emphasizing instead that shock is defined by inadequate oxygen delivery to tissues. This nuanced understanding is critical for trauma team leaders in managing hypotensive patients more effectively. Looking Ahead: Day Two at the London Trauma Conference As we wrap up day one, we’re looking forward to another full day of insightful sessions. Tomorrow’s program includes talks focused on patients requiring special consideration—such as the elderly, pediatric trauma cases, and trauma during pregnancy. These sessions promise to provide valuable knowledge for tailoring trauma care to these vulnerable populations. Additionally, there will be master classes and breakaway sessions on remote critical care and core topics in trauma, as well as a full day dedicated to motorsport medicine. If you’re in the area, it’s not too late to join us. Turn up at the door, and you might find a space available. Engage with Us We’re the slightly tired but enthusiastic team running around Kensington, usually attached to our mobile phones or computers. If you see us, please say hello! We’d love to meet our listeners and readers. If you have any questions for the speakers, reach out to us, and we’ll try to include them in a special follow-up podcast. From the beautiful, Christmassy setting of Kensington, the St Emlyn’s team at the London Trauma Conference wishes you a good evening. We’ll be back with more updates tomorrow. Thank you for listening and following along.