The St.Emlyn’s Podcast

Iain and Simon discuss Covid19 and more in this review of the best of the blog from March 2020.

Simon interviews Dr John Rogers and Dr Nathan Lewis on respiratory infection prevention. John a Sports and Exercise Medicine Consultant in Manchester. He is also Chief Medical Officer for British Triathlon and Visiting Professor in Sport & Exercise Medicine at Manchester Metropolitan University. Nathan is lead performance nutrition scientist at the English Institute of Sport and at ORRECO. These two academics take us through how sports science might be able to support our wellbeing during the Covid19 pandemic.   References Recommendations to maintain immune health in athletes https://www.tandfonline.com/loi/tejs20 Probiotics https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006895.pub3/epdf/full  Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/23840373/ Vitamin C for prevention and treatment of pneumonia https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013134/full Vitamin C and common cold https://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold  Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/27184276/ Vitamin C and Infections https://pubmed.ncbi.nlm.nih.gov/28353648/ Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage https://pubmed.ncbi.nlm.nih.gov/28515951/      

The world is consumed by the Coronavirus pandemic, but how do we look after ourselves? Liz and Iain discuss some strategies to stay well over the coming weeks and months. Recorded on 25th March 2020.

Simon chats to Sarah Thornton, consultant anaesthetist, intensivist and head of the NW school of anaesthesia on preparing to work in a critical care unit during the Covid-19 pandemic.

Iain and Simon chat about the current Corona pandemic and the blog in Feb 2020. Iain remains positive, but Simon thinks the glass is half full. Time will tell who is right (though in truth there is a lot of common ground).   S

Dr Roberto Cosentini is an old friend of St Emlyn's who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid19 outbreak. He kindly found an hour to record a podcast with us on his experiences. There are so many essential lessons in this podcast. Please share with clinical and non-clinical colleagues, as we need to plan NOW. Roberto is quite clear that if we don't train and get plans into place before the wave of cases hit us then both ourselves and our patients will suffer. In the interest of speed I'm not going to summarise the whole podcast. You have to listen to it all yourself to see what's relevant to you. These are some of my take away messages. Divide your department into resp patients and non-resp patients Wear PPE and know how to use it You will need clinicians who do not usually work in ED. Train and orientate them now (before you need them). Most patients are hypoxic and this responds to O2 and CPAP. You're going to need a lot of CPAP and how that happens could be tricky. They found hoods the best (Ed - but how many of those do we have?). Although hypoxic, patients have good lung compliance. They regularly saw diurnal variation with many patients presenting in the early afternoon. It's emotionally exhausting. Prepare yourself and your team psychologically and support them during the pandemic. Roberto's department has an embedded psychologist. Health care worker infections were quite low (because they wore PPE for all resp cases). Flow through the department and onto wards is absolutely vital. Flow out the the main hospitals to other units that can rehabilitate is vital. Decisions for ICU level care were similar to normal (in his hospital) We rarely declare one of our podcasts a 'must listen' but this is an exception. Please listen and share widely. Please think hard about the issues Roberto raises and PLEASE ACT NOW. vb S     How you can support St Emlyn's Join us for #stemlynsLIVE conference May 12th 2020 Subscribe to the blog (look top right for the link) Subscribe to our PODCAST on iTunes Follow us on twitter @stemlyns PLEASE Like us on Facebook Find out more about the St.Emlyn’s team Find out more about the MMU MSc in Emergency Medicine here. Download one of our FREE e-books here Shortcode

Iain is back on the podcast with Simon to talk through the best of the blog from January 2020.

Our regular round up of the best of the blog from December 2019. Published a little late, largely because of Coronavirus issues and general business.

The latest from the St Emlyn's blog

St Emlyn's October 2019 Round-Up: Key Insights from Conferences and Research October 2019 was a bustling month for the St Emlyn's team, filled with important conferences, groundbreaking research, and engaging discussions in emergency medicine. This round-up covers the highlights, from tactical trauma insights to controversial trial results, providing a comprehensive overview of the month’s most significant developments. Tactical Trauma Conference in Sundsvall, Sweden The month started with the Tactical Trauma Conference in Sundsvall, Sweden, where Pete Hume, a colleague from Virchester, presented on the response to the Manchester Arena bombing. This tragic event, involving many pediatric casualties, posed significant challenges in managing a high volume of injured children. Pete’s presentation highlighted the crucial lessons learned during the response, emphasizing the importance of preparedness and efficient resource management. A standout talk at the conference was given by Geoff Yost, who discussed the 2017 Las Vegas shooting. A key takeaway from his presentation was the importance of utilizing bystanders during mass casualty incidents. Bystanders are often the first to respond, and their actions can significantly influence outcomes. This was exemplified by the recent London Bridge attack, where members of the public intervened using improvised weapons like a narwhal tusk. Pete also provided insights into leadership in crisis situations, a topic covered by Kate Pryor at the conference. Overall, the Tactical Trauma Conference underscored the need for collaboration with bystanders and the importance of effective leadership during emergencies. R.CEM Annual Scientific Conference in Gateshead The R.CEM Annual Scientific Conference, held in Gateshead at the end of October, brought together emergency clinicians, nurses, paramedics, and researchers to discuss the latest developments in emergency medicine. Chris Gray, a member of the St Emlyn's team, attended and shared his experiences through a series of blog posts. One of the most anticipated studies discussed at the conference was the NOPE PAX study on the use of tranexamic acid for treating nosebleeds. Although the results are not yet publicly available, the study is expected to provide valuable insights into this increasingly popular treatment. Another key study was the CAP-IT study, which focuses on the use of antibiotics in pediatric pneumonia—a topic of ongoing debate in the context of antibiotic stewardship. The conference also featured discussions on the CRASH-3 trial, particularly concerning the use of tranexamic acid in traumatic brain injury. Ian Roberts delivered a compelling presentation on the mechanisms of tranexamic acid and the significant differences in its use across various regions, including the UK, the US, and Australasia. The TERN Network and the TIRED Study A major highlight of the R.CEM conference was the presentation of the TIRED study, the first major project from the Trainees Emergency Research Network (TERN). Led by Dan Horner, the study surveyed the levels of fatigue among emergency physicians across the UK, using the Need for Recovery Score to assess recovery time after shifts. The study revealed concerning results, with emergency clinicians scoring an average of 73 on the Need for Recovery Score, significantly higher than the previous highest score of 55 recorded for Iranian miners. This suggests that emergency clinicians are under immense pressure, leading to high levels of fatigue. Interestingly, older clinicians had lower scores, indicating either greater resilience or better workload management. However, the study raises the controversial question of whether the job’s demands are causing some clinicians to leave the profession early. The TERN network is continuing to explore critical questions in emergency medicine, with upcoming studies on subarachnoid hemorrhage and the necessity of lumbar punctures. European Resuscitation Council Meeting in Slovenia The European Resuscitation Council meeting in Slovenia was another key event in October. The chain of survival—early recognition, CPR, defibrillation, and post-resuscitation care—was a major focus of the conference. While much attention is often given to post-resuscitation care, the most significant impact on survival comes from the early stages of the chain. The GoodSAM app, which allows trained responders to be notified of nearby emergencies, plays a crucial role in this early response. The app has already made a significant difference in several cases, including cardiac arrests. Another important discussion at the conference was the use of hypothermia in post-cardiac arrest care. Following the TTM1 trial, which suggested that hypothermia might not be as beneficial as once thought, some clinicians have stopped temperature management altogether. However, evidence presented at the ERC meeting indicates that this may have led to an increase in post-arrest mortality. The ongoing TTM2 trial aims to provide more clarity on the role of hypothermia in post-cardiac arrest care. Thromboprophylaxis in Lower Limb Immobilization Dan Horner’s study on thromboprophylaxis in lower limb immobilization is another significant piece of research published this month. The study, a systematic review, highlighted that the incidence of significant deep vein thrombosis (DVT) in patients with lower limb immobilization is around 2%, and anticoagulation almost certainly reduces this risk. However, the study also pointed out that there is no clear consensus on which risk stratification tool is best for identifying patients at risk of DVT. The GemNet guidelines from R.CEM are a solid option, but more research is needed in this area. The study also discussed the choice of anticoagulant, noting that while low-molecular-weight heparin is the most commonly used, the use of DOACs, such as rivaroxaban, is on the rise. As an emergency physician, the balance between preventing life-threatening complications like pulmonary embolism and avoiding significant bleeding events remains a critical consideration in patient care. Top 10 Papers from 2018-2019 The R.CEM Annual Scientific Conference also featured a presentation on the top 10 papers from the past year, covering a wide range of topics in emergency medicine. One key study explored whether early or delayed cardioversion should be performed in recent-onset atrial fibrillation, with the conclusion leaning towards not immediately intervening. Another study examined whether ventilation should continue during RSI (rapid sequence induction), with evidence suggesting that it should. The debate over cricoid pressure during RSI continues, with recent evidence indicating that it may not be necessary and could even be harmful in some cases. Magnesium in atrial fibrillation was also discussed, with the evidence supporting its use, particularly when combined with other treatments. The presentation also covered the use of vasopressors in hemorrhagic shock, with early evidence suggesting they might be beneficial, though more research is needed. Finally, the discussion touched on diagnosing pulmonary embolism in pregnancy using the YEARS score, a promising but still developing area of research. The CRASH-3 Trial: A Controversial Conclusion The CRASH-3 trial, focusing on the use of tranexamic acid in traumatic brain injury, has generated significant debate in the emergency medicine community. While the trial’s findings have already started to influence practice in the UK, the way the results were interpreted and publicized has been controversial. The debate centres around two main camps: one that argues the trial didn’t conclusively prove that tranexamic acid reduces mortality in traumatic brain injury and another that believes the evidence strongly suggests a benefit in certain subgroups. While not the final word on the subject, the CRASH-3 trial provides enough evidence to justify the use of tranexamic acid in specific scenarios. Looking Ahead As October ends and November begins, there’s much to look forward to. The Asian Conference of Emergency Medicine in India promises to be an exciting event, and the Resuscitology Conference in December is already sold out, with plans to run it again in 2020. Emergency medicine is more intense than ever, with record numbers of patients and some of the toughest days experienced in the field. Despite these challenges, the St Emlyn's team continues to provide exceptional care and remain at the forefront of emergency medicine research and practice. Thank you for following along with this month’s round-up. Stay tuned for more updates from St Emlyn's as we continue to explore, learn, and share the latest in emergency medicine.     4o