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 patients: a systematic review and meta-analysis of randomised controlled trials
• Use of nasal clips as first aid for anterior epistaxis
• Awareness and management of cannabinoid hyperemesis syndrome among staff in emergency departments in Wales

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

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-presenting to a paediatric major trauma centre
• Comparison between point-of-care international normalised ratio, COAST, TICCS and truncated FibAT scores to rule in clinically significant hypofibrinogenaemia in the prehospital setting
• Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis

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

• 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 experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom
• How can we improve on advanced clinical practitioner training?
• Diagnosis and management of hidradenitis suppurativa: a review for the emergency clinician

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

• 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 specificity in detecting influenza A, B and SARS-CoV-2 in adult patients in a UK emergency department
• Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial
• Best evidence topic report: can intradermal sterile water injections provide effective pain relief in patients with renal colic?

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:

• 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) 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

• 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 exploration of pre-alert practice in UK ambulance services and emergency departments
• It’s a battlefield! A thematic analysis of narratives shared in Cape Town emergency departments
• Well-being interventions for emergency department staff: ‘necessary’ but ‘inadequate’ – a phenomenographic study

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:

• 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
• Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic

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?
• 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 survey for older patients could tell us how to fix our emergency departments for everyone
• Psychometric validation of a patient-reported experience measure for older adults attending the emergency department: the PREM-ED 65 study
• Diagnostic accuracy of alternative biomarkers for acute aortic syndrome: a systematic review

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.