The St.Emlyn’s Podcast

The SMACC (Social Media and Critical Care) Conference in Chicago brought together healthcare professionals and thought leaders from around the world. The St Emlyn's team, comprising Iain Beardsell, Simon Carley, Rick Boddy, and Natalie May, participated in various workshops and sessions, sharing their experiences and insights. This blog post captures the essence of the conference, highlighting key learning outcomes and the vibrant community spirit.

Simon Carley kicked off the day with a workshop titled "Gambling with the Evidence," focusing on practical applications of evidence-based medicine (EBM). Unlike traditional EBM sessions that often dwell on statistics and literature reviews, this workshop emphasized how to translate evidence into clinical practice. Simon, alongside Rick Boddy, Rob McSweeney, Ken Milne, and Rory Spiegel, explored how healthcare professionals manage the overwhelming volume of evidence and integrate it into their practice.

Key takeaways included strategies for storing and accessing evidence efficiently, influencing colleagues with evidence-based practices, and the importance of critical skepticism. The workshop stressed the responsibility of individuals to thoroughly understand the evidence before implementing changes in clinical settings. This session underscored the necessity of a balanced approach to adopting new practices, ensuring they are rooted in a comprehensive understanding of available evidence.

Natalie May joined other prominent figures in the FOAM (Free Open Access Meducation) community for the "Brew Your Own FOAM" session. Alongside Salim Rezé, Rob Rogers, Haney Malamarts, and others, Natalie discussed the creation of blogs, podcasts, and other educational resources. The session, likened to an Apple bar, provided an informal yet informative platform for attendees to engage with experienced content creators.

Participants gained insights into the technical and creative aspects of producing FOAM content. The session encouraged the sharing of knowledge and resources, emphasizing that a diverse range of voices and perspectives enriches the medical community. Natalie highlighted the importance of FOAM in democratizing medical education, making high-quality information accessible to a global audience.

Rick Boddy delved into the nuances of chest pain management and cardiology in his workshops. The morning session on evidence-based medicine included discussions on the values and outcomes in clinical trials, particularly concerning stroke and thrombolysis. Rick emphasized the varying perspectives of patients, doctors, and policymakers, stressing the importance of considering these viewpoints when evaluating clinical outcomes.

The afternoon's emergency cardiology workshop, featuring experts like Steve Smith and Louise Cullen, focused on chest pain pathways. The session covered a range of topics, from ECG interpretation to chest pain algorithms. Rick noted the growing interest in high-sensitivity troponins and the need for tailored chest pain pathways that cater to specific local populations. The discussion also addressed the challenges of implementing standardized pathways and the importance of trusting the evidence.

Simon Carley also participated in a workshop titled "Getting Creative," which explored creative communication methods in the medical field. The workshop featured three sessions: Michelle Johnson on writing, Grace Slyo on visual presentations, and Rob Rogers on podcasting. Michelle Johnson, a skilled writer, guided participants through the art of crafting compelling narratives, particularly for blog posts. She emphasized the power of language and the importance of clear, concise communication.

Grace Slyo's session focused on improving visual communication, offering tips on graphic design and effective presentation techniques. She provided valuable resources and exercises to help participants enhance their visual storytelling skills. Rob Rogers concluded the workshop with practical advice on creating engaging podcasts, covering everything from content creation to technical aspects. Simon found the workshop incredibly valuable, noting that these skills are essential for effective knowledge dissemination in the medical community.

Natalie May attended the SMACC mini session on pediatric critical care, where experts discussed managing critically ill children in emergency and intensive care settings. The session opened with Fran Lockey and Phil Hyde addressing pediatric airway and breathing management. They emphasized the importance of simple airway maneuvers and two-handed bag-valve-mask ventilation, debunking the myth that intubation is always necessary.

Lisa McQueen provided a poignant presentation on children in shock, referencing the case of Rory Staunton, a child who tragically died from sepsis after being discharged from the emergency department. The session highlighted the critical role of thorough reassessment and face-to-face evaluations in pediatric care. The importance of vigilance in monitoring children's progress before discharge was a key message.

Iain Beardsell shared his experience from the pre-hospital care workshop, led by Carol Harbig from Greater Sydney Hems. The workshop featured a range of topics and speakers, providing an in-depth look at pre-hospital emergency medicine. The highlight of the day was a presentation by Ashley Leibig, who delivered a powerful talk on the emotional challenges faced by pre-hospital care providers and the importance of peer support.

Iain emphasized the value of visualization and mental rehearsal in preparing for high-stress situations. The workshop underscored the importance of practicing difficult scenarios mentally to ensure readiness when faced with real-life emergencies. This approach helps clinicians develop a clear action plan, reducing the likelihood of hesitation or error during critical moments.

One of the standout features of the SMACC Conference is its holistic approach to medical education. The conference not only covers clinical and technical topics but also addresses the emotional and psychological aspects of healthcare. Ashley Leibig's talk, reminiscent of Liz Crowe's impactful presentations, reminded attendees of the need for compassion and self-care in a field often dominated by high-stakes decision-making.

The conference provided ample opportunities for networking and community building. The St Emlyn's team noted the importance of connecting with peers, sharing experiences, and learning from each other. The collaborative spirit of the FOAM community was palpable, with participants eager to exchange ideas and support one another in their educational endeavors.

As the day drew to a close, the St Emlyn's team prepared for their presentations at the conference. The anticipation and nerves were palpable, reflecting the high regard in which the opportunity to speak at SMACC is held. The team emphasized the importance of thorough preparation, including practicing presentations and ensuring all details are in order.

The St Emlyn's team encouraged attendees and followers to engage with them, highlighting the value of these interactions in enriching the conference experience. They looked forward to meeting new people and deepening connections within the medical community.

The SMACC Conference in Chicago provided a rich and varied learning experience for the St Emlyn's team. From evidence-based medicine to pediatric critical care and pre-hospital medicine, the workshops offered valuable insights and practical knowledge. The conference also underscored the importance of creative communication, emotional resilience, and community support in the medical field.

For those unable to attend, the St Emlyn's team hopes this blog post offers a glimpse into the vibrant and dynamic environment of SMACC. The team is committed to sharing the knowledge and experiences gained at the conference, contributing to the broader medical community's growth and development.

As always, the St Emlyn's team encourages feedback and engagement from their readers. Whether you're interested in evidence-based medicine, FOAM, pediatric care, or any other topic, there's something for everyone in the rich tapestry of SMACC. Stay tuned for more updates and insights as the conference continues to unfold.

Managing Back Pain in the Emergency Department: A Comprehensive Overview

In the emergency department (ED), back pain, particularly lower back pain without a traumatic cause, is a common and complex presentation. This condition can range from benign to life-threatening, requiring a thorough and systematic approach to ensure accurate diagnosis and effective management.

Back pain patients often come with preconceived notions, especially when they seek pain relief. However, it's crucial to avoid jumping to conclusions, as back pain can result from various underlying issues, including serious conditions like ruptured abdominal aortic aneurysms (AAA) or infections. Therefore, clinicians should avoid hastily labeling cases as "musculoskeletal" without thorough evaluation.

1. Broad Differential Diagnosis:

2. Pain Chronology and Characteristics:

3. Multi-System Evaluation:

Ruptured Abdominal Aortic Aneurysm (AAA):

Neoplastic Disease:

Infectious Causes:

Cauda Equina Syndrome (CES):

Imaging:

Laboratory Tests:

Once serious conditions are ruled out, management focuses on non-specific, likely musculoskeletal back pain. This involves patient education, mobilization, and appropriate pain management.

Patient Education and Mobilization:

Pain Management:

Controversial Treatments:

For chronic pain patients, management focuses on a multidisciplinary approach, involving pain specialists, physiotherapists, and primary care providers. The goal is to manage the physical, psychological, and social aspects of chronic pain.

Collaborative Care:

Non-Pharmacological Interventions:

In conclusion, managing back pain in the ED requires a comprehensive, systematic approach. Clinicians must prioritize ruling out serious conditions, use appropriate diagnostic tools, and provide effective pain management and patient education. Collaboration with primary care and pain specialists is essential for managing chronic pain, ensuring a holistic approach to patient care. By following these guidelines, healthcare professionals can provide compassionate, evidence-based care, leading to better patient outcomes and a more efficient emergency department.

Barbra Backus joins Rick Body to discuss the origin, development and future of risk scores for ED patients with possible acute coronary syndromes. Two researchers at the top of their game, and  authors of the HEART and MACS scores.

Welcome to the St. Emlyn's induction podcast recap, where we dive deep into the management of asthma in the emergency department. Asthma is a prevalent condition that emergency medical professionals encounter frequently. This blog post will provide a detailed step-by-step guide to managing patients presenting with asthma, including case presentation, assessment, treatment, and discharge planning. Whether you're a seasoned practitioner or new to emergency medicine, this guide aims to enhance your understanding and improve patient outcomes.

Imagine you're in the resuscitation room when you're alerted about an incoming patient. A 30-year-old female with a history of acute severe asthma is being brought in. She's a smoker, consuming 20 cigarettes a day, and has had a history of hospital admissions, including an ICU stay a few years ago. As she is wheeled in, you notice she is short of breath with audible wheezing. This initial presentation provides critical information for immediate action.

Upon the patient's arrival, it's crucial to make a rapid assessment. Conducting an ABC (Airway, Breathing, Circulation) assessment is essential to confirm the diagnosis and gauge the severity of the asthma attack. Given the patient's severe condition, it's vital to start treatment immediately while continuing your assessment.

1. High-Flow Oxygen: Administer high-flow oxygen to improve oxygen saturation levels.

Assessing the severity of asthma is critical to guiding further treatment. The British Thoracic Society provides guidelines that classify asthma into mild, moderate, acute severe, and life-threatening categories.

1. Mild Asthma: Patients might experience mild dyspnea but can generally manage with minimal intervention.

In cases of severe or life-threatening asthma, continuous management and close monitoring are paramount.

Administering nebulizers continuously can help manage severe bronchoconstriction. Use salbutamol and ipratropium bromide back-to-back to provide relief.

Steroids play a crucial role in managing asthma by reducing inflammation. Administer oral steroids (1-2 mg/kg of prednisolone) or intravenous steroids if oral administration is not feasible.

Consider intravenous bronchodilators like salbutamol if nebulized drugs are ineffective. Prepare IV salbutamol early to ensure it's available when needed.

Magnesium sulfate can be considered in severe cases. Although recent studies suggest it might not significantly impact, it is relatively safe and may benefit a small subgroup of patients.

If the patient's condition does not improve with initial treatments, advanced interventions may be necessary.

Engage with critical care colleagues early if the patient requires intensive care or ventilation. Ventilating an asthmatic patient is complex and requires experienced personnel.

1. Ketamine Infusion: Ketamine can act as a bronchodilator and is used in managing severe asthma.

It's vital for less experienced doctors to seek senior help when managing severe asthma cases. These patients require the most experienced care available.

For patients showing improvement, careful discharge planning is essential to prevent relapse and ensure ongoing management.

1. Stability: Ensure the patient is stable for at least 6-8 hours after initial treatment.

Natalie May from St. Emlyn's emphasizes the importance of advising patients to return if they have any concerns, even after leaving the hospital. Ensuring patients have their therapy and understand their treatment plan is crucial for safe discharge.

In summary, managing asthma in the emergency department requires a systematic approach:

1. Rapid Assessment: Quickly assess the severity using ABC and confirm the diagnosis.

Asthma management in emergency settings is challenging but manageable with the right approach and timely interventions. Always prioritize the patient's safety and seek senior support when needed.

For more detailed information, refer to the British Thoracic Society guidelines and explore additional induction podcasts available on iTunes. Staying updated with the latest research and best practices is essential for improving patient outcomes in asthma management.

• British Thoracic Society Guidelines

• Asthma management

By following these guidelines and staying informed, healthcare professionals can effectively manage asthma in emergency settings, ensuring the best possible outcomes for their patients.

Asthma is a common condition frequently encountered in emergency departments. Managing patients presenting with asthma, particularly those with severe symptoms, requires a systematic and prompt approach. This guide will focus on the initial assessment and management steps for a patient presenting with severe asthma in the emergency department, providing detailed insights into immediate actions and the rationale behind them.

Consider a typical scenario in the resuscitation room. You receive an alert about a 30-year-old female with a history of acute severe asthma. This patient, a smoker who consumes 20 cigarettes a day, has previously been admitted to the ICU for asthma-related issues. She is brought in, visibly short of breath and with an audible wheeze.

This initial presentation is critical for immediate action. Recognizing the signs of severe asthma and understanding the patient's history sets the stage for effective management.

Upon the patient's arrival, a rapid assessment is essential. Conducting an ABC (Airway, Breathing, Circulation) assessment helps confirm the diagnosis and determine the severity of the asthma attack. Given the patient's severe condition, simultaneous assessment and treatment are necessary.

Administer High-Flow Oxygen: The first step is to administer high-flow oxygen. This intervention aims to improve the patient's oxygen saturation levels, which is crucial for stabilizing their condition.

Start Nebulizers: Administer a combination of 5 mg of salbutamol and 500 mcg of ipratropium bromide. These medications help relax the bronchial muscles and reduce bronchospasm. If the patient remains symptomatic, additional doses can be given without hesitation.

Listen to the Chest: A quick auscultation of the chest can confirm the presence of wheezes and rule out other conditions, such as a tension pneumothorax. This step ensures that the treatment plan is appropriate and targeted.

Assessing the severity of asthma is crucial for guiding treatment decisions. The British Thoracic Society's guidelines classify asthma into mild, moderate, acute severe, and life-threatening categories based on specific clinical criteria.

Mild Asthma: Patients with mild asthma may experience mild dyspnea and can usually manage with minimal intervention.

Moderate Asthma: This category is characterized by a peak flow more than 50% of predicted or best, moderate symptoms, and manageable with proper medication at home.

Acute Severe Asthma: Patients in this category have a peak flow below 50%, respiratory rate over 25, heart rate over 110, or an inability to complete sentences. Immediate and aggressive treatment is required.

Life-Threatening Asthma: This is marked by a peak flow less than 33%, low oxygen saturation below 92%, silent chest on auscultation, cyanosis, and signs of exhaustion. These patients require urgent and intensive intervention.

For patients with severe or life-threatening asthma, continuous management and close monitoring are essential.

Administering nebulizers continuously can help manage severe bronchoconstriction. Salbutamol and ipratropium bromide should be given back-to-back to provide maximum relief.

Steroids are crucial in managing asthma by reducing inflammation. Administer oral steroids, such as 1-2 mg/kg of prednisolone, or intravenous steroids if oral administration is not feasible. While steroids do not provide immediate relief, they help reduce the underlying inflammation and prevent future exacerbations.

Consider intravenous bronchodilators like salbutamol if nebulized drugs are ineffective. Prepare IV salbutamol early to ensure it is available when needed.

Magnesium sulfate can be considered in severe cases. Although recent studies suggest it might not significantly impact, it is relatively safe and may benefit a small subgroup of patients. However, it should not delay other critical treatments.

If the patient's condition does not improve with initial treatments, advanced interventions may be necessary.

Engage with critical care colleagues early if the patient requires intensive care or ventilation. Ventilating an asthmatic patient is complex and requires experienced personnel.

Ketamine Infusion: Ketamine can act as a bronchodilator and is used in managing severe asthma.

CPAP: Continuous Positive Airway Pressure (CPAP) can be used in cases of severe air trapping and respiratory distress.

It is vital for less experienced doctors to seek senior help when managing severe asthma cases. These patients require the most experienced care available.

For patients showing improvement, careful discharge planning is essential to prevent relapse and ensure ongoing management.

Stability: Ensure the patient is stable for at least 6-8 hours after initial treatment.

Follow-Up: Arrange follow-up with a general practitioner or asthma nurse within a few days.

Medication Review: Ensure the patient has access to their inhalers and understands their use.

Safety Netting: Advise the patient to return if symptoms worsen, even if they are already on their way home.

Natalie May from St. Emlyn's emphasizes the importance of advising patients to return if they have any concerns, even after leaving the hospital. Ensuring patients have their therapy and understand their treatment plan is crucial for safe discharge.

In summary, managing asthma in the emergency department requires a systematic approach:

Rapid Assessment: Quickly assess the severity using ABC and confirm the diagnosis.

Immediate Treatment: Administer high-flow oxygen and nebulizers without delay.

Continuous Management: Use back-to-back nebulizers, steroids, and consider IV bronchodilators and magnesium sulfate.

Advanced Interventions: Engage critical care and consider additional therapies like ketamine and CPAP.

Discharge Planning: Ensure the patient is stable, arrange follow-up, review medications, and provide safety netting advice.

Asthma management in emergency settings is challenging but manageable with the right approach and timely interventions. Always prioritize the patient's safety and seek senior support when needed.

By following these guidelines and staying informed, healthcare professionals can effectively manage asthma in emergency settings, ensuring the best possible outcomes for their patients.

Asthma is a common, chronic respiratory condition that often presents acutely in emergency departments. Managing a severe asthma attack requires immediate and decisive action to prevent life-threatening complications. This guide will walk you through the first command in the management of severe asthma: recognizing the severity of the condition and initiating appropriate treatment promptly.

Picture yourself in the resuscitation room when you receive an alert about a patient en route to the hospital. The patient is a 30-year-old female with a history of acute severe asthma. She is a 20-a-day smoker and has had previous hospital admissions, including a stay in the Intensive Care Unit (ICU) a few years ago. Upon her arrival, she is visibly short of breath with an audible wheeze.

Upon the patient's arrival, it is critical to make a rapid assessment and initiate treatment simultaneously. The goals are to confirm the diagnosis, assess the severity of the asthma attack, and begin interventions that can stabilize the patient.

Airway: Ensure the airway is clear. Asthma patients typically do not have airway obstructions, but it is crucial to check for any foreign bodies or swelling that might complicate the condition.

Breathing: Assess the patient's breathing. Look for signs of respiratory distress, such as rapid breathing, use of accessory muscles, and the presence of wheezing. Measure oxygen saturation using a pulse oximeter.

Circulation: Check the patient's heart rate and blood pressure. Asthma can cause tachycardia and hypertension due to the stress of breathing difficulties.

Administer High-Flow Oxygen: The first and most crucial step is to administer high-flow oxygen. This intervention aims to improve the patient's oxygen saturation levels. Use a non-rebreather mask to deliver a high concentration of oxygen (usually 15 liters per minute).

Start Nebulizers: Administer bronchodilators through a nebulizer. Begin with 5 mg of salbutamol and 500 mcg of ipratropium bromide. These medications help to relax the bronchial muscles and reduce bronchospasm, facilitating easier breathing. If the patient remains symptomatic, additional doses can be administered without hesitation.

Listen to the Chest: Perform a quick auscultation of the chest to confirm the presence of wheezes and rule out other conditions such as a tension pneumothorax. The presence of bilateral wheezing supports the diagnosis of an asthma exacerbation.

Assessing the severity of the asthma attack is essential for guiding treatment decisions. The British Thoracic Society classifies asthma into mild, moderate, acute severe, and life-threatening categories based on specific clinical criteria.

Mild Asthma: Patients with mild asthma may experience mild dyspnea and can usually manage with minimal intervention.

Moderate Asthma: Characterized by a peak flow more than 50% of predicted or best, moderate symptoms, and manageable with proper medication at home.

Acute Severe Asthma: Patients in this category have a peak flow below 50%, respiratory rate over 25, heart rate over 110, or an inability to complete sentences. Immediate and aggressive treatment is required.

Life-Threatening Asthma: Marked by a peak flow less than 33%, low oxygen saturation below 92%, silent chest on auscultation, cyanosis, and signs of exhaustion. These patients require urgent and intensive intervention.

For patients with severe or life-threatening asthma, continuous management and close monitoring are essential.

Administering nebulizers continuously can help manage severe bronchoconstriction. Salbutamol and ipratropium bromide should be given back-to-back to provide maximum relief. This approach ensures that the bronchodilators maintain their effect, reducing airway resistance and improving airflow.

Steroids play a crucial role in managing asthma by reducing inflammation. Administer oral steroids, such as 1-2 mg/kg of prednisolone, or intravenous steroids if oral administration is not feasible. While steroids do not provide immediate relief, they help reduce the underlying inflammation and prevent future exacerbations.

Consider intravenous bronchodilators like salbutamol if nebulized drugs are ineffective. Prepare IV salbutamol early to ensure it is available when needed. Intravenous administration allows the...