What might yawning and sneezing be signs of in a patient? This month's podcast features new RCEM and NPIS guidance on acute opioid toxicity, outlining a number of symptoms to stay alert to. Before getting to that there's a paper on bypassing hospitals for patients needing mechanical thrombectomy, a study on how austerity affected emergency admissions across a range of UK local authorities, and some research on the immune-related adverse affects that can arise in the ED amongst oncological patients.

Read the issue highlights: July 2024 Primary Survey

Articles discussed in this episode:

Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study. Day J, Simmonds RL, Shaw L, et al

Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017. Castro-Ávila AC, Cookson R, Doran T, et al

Management and outcome of oncological patients under immune checkpoint inhibitors presenting at the emergency department. Pini F, Grigoriu B, Lieveke A, et al

Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department. Blundell M, Gill R, Thanacoody R, et al

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.

How well do patients in the emergency department judge the severity of their situation? Some may fear the worst for any hospital visit, and others not realise that their lives are in danger. This month's first paper is a review of the accuracy of self-prognostication and its relation to admission, severity, and length of stay. Then there's a trio of publications on the challenges of pain in various forms. Starting with a study on the links between red flags in headache assessment, and serious secondary headaches. Next there is a letter, questioning how well pain management is done in the ED. To finish, a new scale has been developed to assess ultrasound-guided fascia iliaca block.

Read the issue highlights: June 2024 Primary Survey

Articles discussed in this episode: Can acutely ill patients predict their outcomes? A scoping review. Mols EM, Haak H, Holland M Safer@Home Research Consortium, et al

Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colombia study. Chu K, Kelly A, Kuan WS HEAD and HEAD-Colombia study groups, et al

Pain in the ED: does anyone manage it well? Wilson S, Dainty J, Quinlan J, et al

Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study. Guyader F, Violeau M, Guenezan J, et al

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.

Should we be bringing preventative medicine into the emergency department, or is it just using up valuable time? Our first paper this month looks at the "Cessation of Smoking Trial in the Emergency Department (COSTED)" trial, which presents the case for opportunistic smoking cessation intervention. Next up is a topical research paper on interpreting CT scans with artificial intelligence, and how machine assessment measures up against experienced physicians. Then there's a trio of troponin papers, discussing high-sensitivity testing. The final paper this time is not a paper but a guideline from the Royal College of Emergency Medicine, setting out best practices for dealing with suspected cannabinoid hyperemesis syndrome. Articles discussed in this episode: Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial. Pope I, Clark LV, Clark A, et al

Using an artificial intelligence software improves emergency medicine physician intracranial haemorrhage detection to radiologist levels. Warman P, Warman A, Warman R, et al

External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction. Cullen L, Greenslade JH, Stephensen L 2022 SAMIE study group, et al

High-sensitivity troponin testing at the point of care for the diagnosis of myocardial infarction: a prospective emergency department clinical evaluation. Curran JM, Mergo A, White S, et al

Determination of a whole-blood single-test low-risk threshold for a point-of-care high-sensitivity troponin assay. Pickering JW, Hamill L, Aldous S, et al

RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments. Humphries C, Gillings M

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.