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 patients under immune checkpoint inhibitors presenting at the emergency department. Pini F, Grigoriu B, Lieveke A, et al

Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department. Blundell M, Gill R, Thanacoody R, et al

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.

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:

Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colombia study. Chu K, Kelly A, Kuan WS HEAD and HEAD-Colombia study groups, et al

Pain in the ED: does anyone manage it well? Wilson S, Dainty J, Quinlan J, et al

Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study. Guyader F, Violeau M, Guenezan J, et al

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.

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.

Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels. Warman P, Warman A, Warman R, et al

External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction. Cullen L, Greenslade JH, Stephensen L 2022 SAMIE study group, et al

High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation. Curran JM, Mergo A, White S, et al

Determination of a whole-blood single-test low-risk threshold for a point-of-care high-sensitivity troponin assay. Pickering JW, Hamill L, Aldous S, et al

RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments. Humphries C, Gillings M

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.

“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. 

Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study. Daniels J, Robinson E, Jenkinson E, et al.

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 feast of aortic papers this month, including a study on missed aortic dissection diagnoses and an analysis of coroners' reports. Rick runs through the findings of an interesting study from the Trainee Emergency Research Network (TERN), and Sarah finishes off with a paper on predicting adverse outcomes in elderly patients with orthopaedic trauma.

Articles discussed in this episode:

Ohle R, Savage DW, Caswell J, et al. Mortality and risk factors associated with misdiagnosis of acute aortic syndrome in Ontario, Canada: a population-based study.

Hodgson S, O'Mahony K, Nicholson J, et al. Thematic analysis of ‘Prevention of Future Deaths’ reports related to emergency departments in England and Wales 2013–2022. 

McLatchie R, Reed MJ, Freeman N on behalf of the DAShED investigators, et al. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome.

Isaac CJ, Moore L, Bérubé M, et al. Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study.

Related links:

RCEM Learning: Aortic Dissection podcast.

Trainee Emergency Research Network.

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 lot of drugs to be talked about this month, and a heap of randomised control trials to be covered too. Rick and Sarah talk though the combining of nitrous oxide and fentanyl for sedation, the environmental impact of analgesics, the efficacy of acute heart failure treatment with high-dose and low-dose nitrates, and more newly published work from the latest issue of the journal.

Articles discussed in this episode:

Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes

Environmental impact of low-dose methoxyflurane versus nitrous oxide for analgesia: how green is the ‘green whistle’?

High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial

Effect of intranasal sufentanil on acute post-traumatic pain in the emergency department: a randomised controlled trial

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.

What are the questions to ask when dealing with acute behavioural disturbance? Join Sarah and Rick this month for a discussion of this difficult presentation. They also explore the topics of reducing low-acuity attendance, taking NHS 111 online, and the impact of a health coaching intervention for potentially recurrent attendees.

Highlights of the January 2024 issue

Consensus on acute behavioural disturbance in the UK: a multidisciplinary modified Delphi study to determine what it is and how it should be managed

What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study

How could online NHS 111 reduce demand for the telephone NHS 111 service? Qualitative study of user and staff views

https://emj.bmj.com/content/41/1/51

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 via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, 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 page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 

Hear a summary of some of the best papers published in the December 2023 issue of the Emergency Medicine Journal. The podcast this month covers a trio of ultrasound papers addressing its use in the treatment of distal radial fractures, and thoracic and abdominal stab wound injuries. Featured also is a paper investigating the effectiveness of a predictive system for COVID-19 triage by telephone.

Read the highlights: https://emj.bmj.com/content/40/12/803 

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 via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, 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 page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 

Read the highlights: https://emj.bmj.com/content/40/11/741 

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 via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, 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 page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 

Thank you for listening!

Read the highlights: https://emj.bmj.com/content/40/10/687.

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 via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, 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 page (https://podcasts.apple.com/us/podcast/emj-podcast/id445358244). 

Thank you for listening!