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.

There's a whole pile of blocks in this month's papers, with the first being a trial of Erector-Spinae Plane (ESP) blocks, not for rib fractures as you might expect but Hepato-Pancreato-Biliary (HPB) pain instead. Following on from that is a retrospective study comparing the resource utilisation of haematoma blocks, Bier’s blocks and procedural sedation for patients with forearm fractures. The next paper sets the performance of unassisted radiographers against those armed with artificial intelligence algorithms when diagnosing pneumothorax, and the results show an interesting demographic trend. Concluding the discussion topics this month is a letter regarding "on-scene time" for ambulances when assessing patients for suspected stroke - a situation where every minute counts.

Read the issue highlights: October 2024 Primary Survey Articles discussed in this episode:

EASIER trial (Erector-spinAe analgeSia for hepatopancreaticobiliary pain In the Emergency Room)

Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study

Evaluation of the impact of artificial intelligence-assisted image interpretation on the diagnostic performance of clinicians in identifying pneumothoraces on plain chest X-ray: a multi-case multi-reader study

On-scene times during ambulance assessment of suspected stroke patients across England from December 2021 to November 2022

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.