In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift.

We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved.

We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before.

There’s a discussion about trauma units. Not the big centres. The places where most patients go. Fewer resources. Different pressures. The same expectations.

We talk about spinal cord injury and blood pressure targets. Numbers are useful. But they’re still just numbers.

And then corridor care. Not a new problem. But one we may have started to accept in ways that should make us uneasy.

We discuss:

• What the RSI trial actually showed — and what it didn’t • Why secondary outcomes should make you pause, not pivot practice • How and when to activate a massive haemorrhage protocol • Why early senior decision-making matters more than perfect diagnosis • What good trauma handover looks like — and why it often doesn’t happen • How trauma teams function differently in trauma units • The limits of blood pressure targets in spinal cord injury • Why corridor care is not just operational — but ethical

This is not a guideline episode. It’s a conversation about practice. About judgement. About the small decisions that shape outcomes long before the data catches up.

If you’re listening after a shift, you’ll recognise most of it.

If podcasts are part of how you learn, you can log your listening, reflect, and build CPD through MedPod Learn. It works across podcasts, not just this one.

As always, thanks for listening.

these ideas are tested in practice.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Shock is one of the most used words in emergency medicine. It’s also one of the most misunderstood.

In this episode, recorded at Trauma 2030 at the Royal College of Surgeons, I sit down with one of St Emlyn's own, Rich Carden — former emergency physician, now intensive care trainee and PhD graduate in trauma sciences — to explore what shock actually means beyond the blood pressure reading.

We discuss:

• Why shock is fundamentally about oxygen delivery and utilisation at a cellular level • The difference between pressure and perfusion • The concept of the “dose” of shock — magnitude and duration • Why haemorrhage may only be the first phase • How trauma patients transition between haemorrhagic, inflammatory, vasoplegic and septic states • The glycocalyx — and why losing it matters • The risks of early vasopressors in an empty system • Why doing the basics exceptionally well remains our best intervention

This is not a protocol episode. It’s a physiology conversation. A systems conversation. A reminder that restoring a number is not the same as restoring oxygen to mitochondria.

If you’re interested in pre-hospital and trauma systems thinking, do take a look at Tactical Trauma — spaces where these ideas are tested in practice.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

As always, thanks for listening.

What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work?

In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice.

This is not just about adding another shock. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.

We also discuss:

• The difference between refractory and recurrent VF — and why it matters

• What DSED and vector change actually do in physiological terms

• Why guidelines have been slow to move despite emerging evidence

• The role of antiarrhythmics, adrenaline, and sequence of care

• Practical considerations for introducing DSED into real systems

• What comes next — from smarter detection to post-arrest recovery

This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence.

• Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications

• Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation

• Timing matters — waiting too long to escalate may reduce the chance of success

• Current guidelines remain cautious, reflecting the balance between evidence and implementation risk

• Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care

Cardiac arrest survival remains low.

Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.

The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.