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

The EMJ podcast is hosted by:

Dr. 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 iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

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

The EMJ podcast is hosted by:

Dr. 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 iTunes (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

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

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) or Spotify (https://spoti.fi/3ufutSL) page.

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:

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) or Spotify (https://spoti.fi/3ufutSL) page.

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

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) or Spotify (https://spoti.fi/3ufutSL) page.

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:

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) or Spotify (https://spoti.fi/3ufutSL) page.

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?

Links:

• Understanding escalation area and corridor care in UK emergency departments (UNCORKED)

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) or Spotify (https://spoti.fi/3ufutSL) page.

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

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room)

Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study

Evaluation of the impact of artificial intelligence-assisted image interpretation on the diagnostic performance of clinicians in identifying pneumothoraces on plain chest X-ray: a multi-case multi-reader study 

On-scene times during ambulance assessment of suspected stroke patients across England from December 2021 to November 2022

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) or Spotify (https://spoti.fi/3ufutSL) page.

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

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

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) or Spotify (https://spoti.fi/3ufutSL) page.

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 indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound

Best Evidence Topic report: Is a CT head required for patients who present to the emergency department with a first seizure? 

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) or Spotify (https://spoti.fi/3ufutSL) page.