Is tranexamic acid (TXA) useful in traumatic bleeding? A review of the PATCXH trial published in the NEJM.

This week I read a great article in the EMJ by Dan Horner and Rich Carden on new resuscitation targets. notably the use of diastolic blood pressure. DBP is the prime driver of coronary perfusion and thus successful resuscitation. Not only in cardiac arrest, but seemingly also in trauma. This blog (with their permission and review) outlines the main points from that article and links their thoughts on trauma to similar emerging evidence in cardiac resuscitation.

This month’s St Emlyn’s podcast wraps up Season 11 with a review of key emergency medicine topics. We cover new evidence on chest trauma management, intraosseous access safety, pediatric imaging updates, AI in medicine, toxic alcohol poisoning, and airway management. Plus, insights from major conferences like EUSEM 2024.

This blog post provides concise summaries of recent critical care trials, including HEMOTION, PREOXI, BLING III, CLASSIC, EVIDENCE, VICTOR, and PARAMEDIC-3. Each trial is examined for its key findings, strengths, limitations, and practical implications for clinical practice. The post aims to inform healthcare professionals about the latest evidence-based practices in critical care. #FOAMed

It’s a testament to Professor Lockey and the organizing committee’s efforts that Day 2 of LTC was perhaps even better attended than day one. The grand theater at the Royal Geographic Society was filled, with standing room only in the balcony area. Professor Karim Brohi is well known to anyone who has even a passing interest in trauma. His efforts through the Center for Trauma Sciences have really pushed forward our understanding of acute trauma resuscitation, in particular around bleeding and coagulation.

Explore the variability in maintaining prehospital anaesthesia for trauma patients in this comprehensive summary of a multinational survey. With insights into drug protocols, administration methods, and governance, the article highlights challenges and opportunities for standardisation in prehospital care. Ideal for clinicians and researchers aiming to optimise anaesthesia practices and enhance patient outcomes in emergency settings.

In this podcast, explore how Dr. Matt Hooper’s concept of "compassionate resuscitation" integrates palliative care principles into emergency medicine, focusing on quality end-of-life care for patients, families, and providers.

Emergency medicine demands constant practice, yet many clinicians experience skills fade due to lack of exposure. Nathalie Pattyn explores how this decline occurs, why it’s a systemic issue rather than an individual failure, and what changes are needed to maintain competency.

This article explores the impact of physician-led interprofessional pre-hospital teams on survival and mortality outcomes for critically ill and injured patients. Drawing on a systematic review and meta-analysis, it examines the evidence, evaluates key benefits, and critically appraises the limitations. The discussion highlights the potential of this model to enhance pre-hospital emergency care while addressing challenges in implementation across diverse healthcare systems. Essential reading for professionals in emergency and pre-hospital medicine.

The monthly update podcast from November 2024, including learning culture, chest drains in haemothorax, arterial lines in cardiac arrest and bad behaviour.

Learn more about the Ten Second Triage tool in this interview recorded at Tactical Trauma 24.

YouTube video by Mike Christian

How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). This retrospective study explores time efficiency, injury severity, and patient outcomes, highlighting the role of HEMS in delivering critical care to severely injured patients in remote locations.

Understand the impact of the sub30 study on ECMO CPR, and compare its results with other international studies of ECPR

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Intraosseous (IO) access is essential in prehospital emergency care when intravenous access is challenging. A Danish retrospective cohort study of over 5,000 patients found fewer than five cases of osteomyelitis, no osteonecrosis or compartment syndrome, and no complications in children. Despite a high mortality rate (60% at 180 days) potentially underestimating long-term risks, the study's robust design supports IO access as a generally safe and effective procedure in critical care situations.

Does early exercise after blunt chest trauma make a difference? Find out when we review the ELECT trial. #FOAMed @stemlyns

Day 1 review from the London Conference 2024 with Zaf Qasim. Also check out our podcasts from the same conference on our podcast channel. #FOAMed

This retrospective study explores the link between intra-arrest arterial blood pressure (IBP) and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Analysing data from 80 patients attended by the East Anglian Air Ambulance, it found that higher diastolic blood pressure (DBP) during CPR significantly increased the likelihood of ROSC. A DBP threshold of 35 mmHg was identified as optimal. The findings highlight the potential of haemodynamic monitoring to guide resuscitation efforts, moving beyond uniform protocols to tailored, goal-directed approaches. While promising, further research is needed to validate its integration into standard prehospital care practices.

GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns Greg Yates takes through a paper reporting overdoses in US practice.

GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns

In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety.

Uncover the truth about alcohol poisoning. Find out how toxic alcohols can be ingested accidentally or intentionally and the serious consequences they can have with a focus on Emergency medicine management. #FOAMed @stemlyns

A podcast with some of the highlights from the London Trauma Conference 2024

In October, I had the opportunity to give a talk on the ethics of Artificial Intelligence at the EUSEM Congress in Copenhagen. My focus was on the ethical implications of AI for emergency care, a topic that's becoming increasingly relevant as advances in AI accelerate. Below is a rundown of some of the key points I covered, touching on where we are now, where we might be headed, and the ethical questions we can’t ignore along the way.

Uncover the truth about alcohol poisoning. Find out how toxic alcohols can be ingested accidentally or intentionally and the serious consequences they can have, with a focus on Emergency medicine mana...

In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety.

Explore key takeaways from the DAS 2024 meeting, including airway management in obstetrics, ethics of training, challenges in critical care, and international practices. Insights tailored for emergency and anaesthesia professionals.

Uncover the truth about alcohol poisoning. Find out how toxic alcohols can be ingested accidentally or intentionally and the serious consequences they can have, with a focus on Emergency medicine mana...

Traditionally, large-bore chest tubes have been standard for managing haemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and few...

Creating a learning culture in the emergency department (ED) is crucial for enhancing patient care and team resilience. This approach prioritizes psychological safety, continuous improvement, open com...