Emj Podcast

The atmosphere of the emergency department can be a hard thing to put into words, with intense emotions washing over patients and staff alike. This month we feature a poem, powerfully illustrating the drama and stress inside the ED bubble. One of the recurring sources of uncertainty for patients is the question, “How long until I’m seen, doc?”, and there’s a paper following up on that issue with a personalised approach. A framework that has been employed by NHS England, aimed at dealing with the problem, is Same Day Emergency Care (SDEC). The next paper finds there is a limited evidence on the impact of SDECs, as well as confusion around their definition. Another paper on the subject of patient flow shows that while digital solutions are promising, you can’t replace a streaming nurse for critical decisions. To finish the episode is a 10-year retrospective review on the use of blood in paediatric trauma, drawing on the data of the Trauma Audit Research Network. Read the highlights: October 2025 primary survey

"What is your understanding of your father's illness?" This is the kind of question that may be posed by emergency clinicians in the context of end-of-life care. But as a survey of Thai and American emergency departments finds, approaches to these conversations can be quite different globally. This episode also features another angle on end-of-life care, highlighting the persistent impact that deprivation has when it comes to likelihood of hospital conveyance. On a different subject, there is a qualitative study of the management of acute asthma presentations, seeking to find any marginal gains that may present a chance for optimisation. The fourth and final paper is about acute coronary syndromes in the emergency department, presenting some surprising statistics on length of stay. Read the highlights: September 2025 primary survey Deprivation is associated with hospital conveyance among patients who are terminally ill Are acute asthma presentations to the emergency department an opportunity for optimising l

A new paper on the challenging diagnosis of acute appendicitis has us wondering, can it be spotted with just a glance? The reality is never so simple. This episode we also discuss low-value overtesting, cardiac arrest trial consent, and patient discharge into police custody. As with many aspects of the ED, they each have a layer of legal pressure to consider.   Read the highlights: August 2025 primary survey   The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

The NHS plans to set up mental health emergency departments throughout England. A survey discussed this episode highlights the importance of mental health assessments, finding that nearly a quarter of suicide deaths in a one year period had come after hospital or emergency department contact. Another survey raises the question, "How well is your ED prepared for a major incident?" and the statistics do not inspire confidence. Two more papers in this episode offer potential bulwarks against burnout of ED staff: global health outreach work, and self-rostered rotas. But there may be some downsides to watch out for too. Finally, a look at pulse oximetry for testicular torsion diagnosis. Read the highlights: July 2025 Primary Survey Contact with emergency departments and hospitals in England before suicide death: a retrospective cohort study Global health experience of staff working in UK emergency care: a reflexive thematic analysis A survey of major incident preparedness in English type 1 emergency departments I

Can salbutamol be used be used to relieve pain in renal colic patients? Starting off this month's episode, a randomised trial seeks to find the answer. Then a topic of interest for anyone seeing patients with a phobia of needles, namely a study comparing coolant spray with topical anaesthetic cream for reducing pain from intravenous cannulation. Next, randomisation is a necessary tool for many trials, but what if you want something that's less high-tech, and more high-street? That's right, scratch cards! And finally, fear of not making the right decision dominates when it comes to  paramedic conveyance to the paediatric emergency department. "We just take them in," "parents know best," and "if only they could talk" are some of the revealing quotes found in the study wrapping up this month.   Read the highlights: June 2025 Primary Survey Salbutamol for analgesia in renal colic: a prospective, randomised, placebo-controlled phase II trial Comparison of the effects of vapocoolant spray and topical anaesthetic c

A new survey has found that less than one third of end-of-life patients in Irish emergency departments have their own room. This is only one of the shortcomings found in end-of-life care, explored in two papers to start this episode. Following on from that is a comparison of video and direct laryngosocopy for intubation outcomes. There's also a "Best Evidence" review of the use of nasal clips for stopping nosebleeds, an approach which appears likely to offer advantages over the hands or inventive tongue-depressor contraptions. The finish up this month's episode, there's a return to a topic previously visited one year ago - the RCEM guidelines on cannabinoid hyperemesis syndrome. A study from Wales follows up on the adherence to this guidance. Read the highlights: May 2025 Primary Survey Dying matters in the emergency department Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey Video laryngoscopy may improve the intubation outcomes in critically ill p

Trauma and paediatrics are the themes for this month's collection of papers. Starting off is a review of the effectiveness of prehospital ultrasound in detecting lung injury, with some surprising statistics. Next is a letter on the topic of self-presentation by paediatric patients with major trauma, which is thankfully a rare occurrence. The third paper looks at prehospital testing of trauma patients for  low fibrinogen levels, a condition which can lead to worse bleeding, increased transfusions, and higher mortality. The final paper discusses the worrying topic of delayed presentation with testicular pain, a phenomenon which leads to significantly lower salvage rates. This can arise from lack of information or embarrassment, particularly in younger males.   Read the highlights: April 2025 Primary Survey   Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis Identifying the walk-in wounded: paediatric major trauma patients self-

Advance clinical practitioners (ACPs) can have a big role to play in the emergency department, but their career paths are not always well understood. This episode features three papers from the journal which begin to address that - a census survey of over 1000 ACPs, a qualitative study on their experiences in emergency care, and a commentary on how to improve ACP training. There is also a paper from Canada discussing considerations to be made for patients living with dementia, as well as their care partners who may be accompanying them to the hospital. A bit of a curveball to close out, with a review on hidradenitis suppurativa, a challenging skin condition which can take years for a diagnosis.   Read the highlights: March 2025 Primary Survey   Care for older adults living with dementia in the emergency department: a systematic review and meta-synthesis of care partner roles and perspectives Emergency medicine advanced clinical practitioners: an English workforce census A qualitative study exploring the expe

Another packed issue of the journal this month, and a podcast to match. Starting off with the Editor's Choice paper, on the important topic of sex and gender disaggregation in emergency medicine trials. Sex and Gender Equity Reporting (SAGER) guidelines were introduced in 2016 but poor adherence is still found in current publications. Next is a paper with high seasonal relevance, addressing the sensitivity and specificity of multiplex lateral flow tests for Flu A, Flu B and COVID 19. There's also a randomised controlled trial on nebulised corticosteroids for asthma exacerbation, and to finish, a question few might think to ask - can intradermal injection of sterile water offer pain relief to renal colic patients?   Read the highlights: February 2025 Primary Survey   Sex and gender reporting in UK emergency medicine trials from 2010 to 2023: a systematic review Sex and gender reporting in scientific papers now strongly recommended by the Emergency Medicine Journal Multiplex lateral flow test sensitivity and s

A special bonus podcast this time, on the perennial issue of crowding. Rick and Sarah are joined by Royal College of Emergency Medicine president Dr. Adrian Boyle, and EMJ's editor-in-chief Prof. Ellen Weber. They address recent evidence for crowding's harmful impact, the arm-twisting needed to shape policy, how it shapes patient confidence, and what the future of crowding looks like.   Links: Association between delays to patient admission from the emergency department and all-cause 30-day mortality Being a patient in a crowded emergency department: a qualitative service evaluation   The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Editor, Leicester Royal Infirmary, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast iTunes (https://apple.co/4bfcMU0

It's a celebration of qualitative research to start the new year, with a collection of papers offering new perspectives on emergency department issues. First is a pair of papers centred on the theme of pre-alerts to the emergency department. Setting the scene for a patient's arrival is a vital process, yet it can generate fear of criticism for getting the balance wrong, when it comes to over- and under-alerting. Following on is a paper taking a look at the human experience of working in the emergency department, and the war-like atmosphere that can be found there. This leads to the final paper on well-being interventions in the ED, with interviews having found real limitations to current approaches.   Read the issue highlights: January 2025 Primary Survey   How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative explor

Subarachnoid haemorrhage is a diagnosis that can't be missed, but it is not a simple process to detect it. The first paper for discussion this month questions if a CT scan within 6 hours is sufficient for exclusion in patients with acute headache. Then there is a large-scale analysis of over 400 million ED visits in the USA, focussing in on the significant issue of self-harm in the homeless population. Next is a paper on a decision tool for suspected acute aortic syndrome, and to finish, a discussion on the change in ED culture around safety since the COVID pandemic.   Read the issue highlights: December 2024 Primary Survey   Articles discussed in this episode: Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study Suicide and self-injury-related emergency department visits and homelessness among adults 25–64 years old from 2016 to 2021 in the USA  Decision analytical modelling of strategies for investigating suspected acute aortic syndrome  Cultur

Upper limb injuries make up about three-quarters of the limb injuries to children seen in the emergency department. But when it comes to the elbow, just how good are clinicians at diagnosing based on radiography? The first paper this month is a study putting over 300 global participants to the test. There's also a practice review highlighting the concept of shared decision making with frail elderly patients, a discussion of biomarkers for aortic dissection detection, more on telephone triage, and an interesting questionnaire on patient experience. Read the issue highlights: November 2024 Primary Survey Articles discussed in this episode: Black and white: how good are clinicians at diagnosing elbow injuries from paediatric elbow radiographs alone? Person-centred decisions in emergency care for older people living with frailty: principles and practice Use of emergency departments by children and young people following telephone triage: a large database study The wisdom of elders: a new patient experience surve

There's a whole pile of blocks in this month's papers, with the first being a trial of Erector-Spinae Plane (ESP) blocks, not for rib fractures as you might expect but Hepato-Pancreato-Biliary (HPB) pain instead. Following on from that is a retrospective study comparing the resource utilisation of haematoma blocks, Bier’s blocks and procedural sedation for patients with forearm fractures. The next paper sets the performance of unassisted radiographers against those armed with artificial intelligence algorithms when diagnosing pneumothorax, and the results show an interesting demographic trend. Concluding the discussion topics this month is a letter regarding "on-scene time" for ambulances when assessing patients for suspected stroke - a situation where every minute counts. Read the issue highlights: October 2024 Primary Survey Articles discussed in this episode: EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room) Haematoma block is the most efficient technique for

Being fallible was one of the most valued characteristics in a consultant, according to new doctors going through their induction - that's the subject of the first paper this month. Next up is a study on the impact of noise on hospital staff, which includes some simple interventions with measurable impact. There's also a discussion on pain relief for rib fractures, and how frailty scores are linked to 30-day mortality in patients. Read the issue highlights: September 2024 Primary Survey Articles discussed in this episode: Qualitative study of new doctor induction and socialisation Reduced noise in the emergency department: the impact on staff well-being and room acoustics The RELIEF feasibility trial: topical lidocaine patches in older adults with rib fractures Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Social Media Edito

The recovery of laceration repair patients is the topic of this month's first paper, looking at behavioural disturbances in children following these difficult medical procedures. The second paper deals with pre-hospital use of tranexamic acid for trauma, and surfaces some demographic discrimination in its rates of application. Next there is an observational study which has developed a score for indirect signs of appendicitis on ultrasounds where the appendix is not visualised. Finishing off the episode is a "Best Evidence" report, dealing with the appropriate usage of CT scans on patients first presenting with a seizure.   Read the issue highlights: August 2024 Primary Survey   Articles discussed in this episode: Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes Evaluation of the prehospital administration of tranexamic acid for injured patients: a state-wide observational study with sex and age-disaggregated analysis Predictive values of indire

What might yawning and sneezing be signs of in a patient? This month's podcast features new RCEM and NPIS guidance on acute opioid toxicity, outlining a number of symptoms to stay alert to. Before getting to that there's a paper on bypassing hospitals for patients needing mechanical thrombectomy, a study on how austerity affected emergency admissions across a range of UK local authorities, and some research on the immune-related adverse affects that can arise in the ED amongst oncological patients. Read the issue highlights: July 2024 Primary Survey Articles discussed in this episode: Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study. Day J, Simmonds RL, Shaw L, et al Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017. Castro-Ávila AC, Cookson R, Doran T, et al Management and outcome of oncological p

How well do patients in the emergency department judge the severity of their situation? Some may fear the worst for any hospital visit, and others not realise that their lives are in danger. This month's first paper is a review of the accuracy of self-prognostication and its relation to admission, severity, and length of stay. Then there's a trio of publications on the challenges of pain in various forms. Starting with a study on the links between red flags in headache assessment, and serious secondary headaches. Next there is a letter, questioning how well pain management is done in the ED. To finish, a new scale has been developed to assess ultrasound-guided fascia iliaca block. Read the issue highlights: June 2024 Primary Survey Articles discussed in this episode: Can acutely ill patients predict their outcomes? A scoping review. Mols EM, Haak H, Holland M Safer@Home Research Consortium, et al Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colom

Should we be bringing preventative medicine into the emergency department, or is it just using up valuable time? Our first paper this month looks at the "Cessation of Smoking Trial in the Emergency Department (COSTED)" trial, which presents the case for opportunistic smoking cessation intervention. Next up is a topical research paper on interpreting CT scans with artificial intelligence, and how machine assessment measures up against experienced physicians. Then there's a trio of troponin papers, discussing high-sensitivity testing. The final paper this time is not a paper but a guideline from the Royal College of Emergency Medicine, setting out best practices for dealing with suspected cannabinoid hyperemesis syndrome. Articles discussed in this episode: Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial. Pope I, Clark LV, Clark A, et al Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection t

“Social distancing is a privilege,” is the core message underlying the first paper brought by Sarah to this month’s roundup, as it unpacks the stark differences in COVID-19 outcomes across the spectrum of racial and ethnic groups in the United States. A second paper examines the returning rates of COVID patients across a large group of emergency departments in Canada, and the factors at play there. The final topic is one of Rick’s favourites, focusing on troponin testing in ambulances. Articles discussed in this episode: Pandemic phase-related racial and ethnic disparities in COVID-19 positivity and outcomes among patients presenting to emergency departments during the first two pandemic waves in the USA. Khosla S, Del Rios M, Chisolm-Straker M, et al.  Characteristics and outcomes of patients with COVID-19 who return to the emergency department: a multicentre observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). Rosychuk RJ, Khangura JK, Ortiz SS, et al.  Perce