Background It's pretty well agreed that management of blood pressure is really important in neurological injury. We usually think about this in terms of brain injury, but the general teaching is that the same applies to spinal cord injury too. It's neurological tissue and connected to the brain, so it makes sense. It's something we've talked about a lot on St Emlyn’s over the years, in the context of traumatic brain injury (TBI), stroke, and post–cardiac arrest care.

Video from the perimortem c-section at Incrementum in 2025. #FOAMed @stemlyns

If you have worked an ED shift over the last year, you will almost certainly have faced this dilemma: an ambulance crew arrives with an elderly, frail, confused patient who needs a Majors space. But with no room available, and increasing pressure to release the crew, a trade-off becomes inevitable. What happens next currently defines the quality and safety landscape of emergency care - and reveals the tussle between…

TTL tip 4 is about getting your CODE RED instructions right, by developing the right mindset about what you want to achieve and why.

Background For as long as I can remember emergency and critical care clinicians have debated the optimal induction agent for tracheal intubation in the critically ill. When I started my anaesthetic placements I uswed only two drugs for an RSI, Thiopentone and Suxamethonium. Anything else was considered 'fancy' amongst the older anaesthetists. The cool kids were using Etomidate/Sux as an alternative, and as I wanted to move with the times, that became my go-to regime for many years.

This is a festive break from my usual offerings on emergency toxicology, although you will note I lapsed a bit with dextromethorphan. My last post was on the SNAP regimen in teenagers, and can be found here. I am currently recovering from pneumonia. It is not pleasant. Like Tiny Tim himself, I have been struggling with a cough. And if the information I give in ED is correct, it will be weeks before I feel better.

Check these five areas in penetrating trauma. Trauma Team Leader tips from @stemlyns #FOAMed

Patients are consulting AI more and more before attending ED. What does the research say, and how should clinicians respond? Some great advice on what to do when this happens.

How bad is hypotension in TBI? What's the real world impact in a high quality PHEM service. Rich Carden reviews a recent paper that helps us understand the impact. #FOAMed @stemlyns

Paracetamol poisoning is an uncommon, but not rare, event in children. The treatment of choice is NAC. Should we be giving them the SNAP protocol?

Top tips on using pelvic binxders in major trauma . Trauma Team Leader tips from @stemlyns #FOAMed #TTLtips

Check these five areas in penetrating trauma. Trauma Team Leader tips from @stemlyns #FOAMed

Edited by Prof. Simon Carley & Dr. Greg Yates Leading a trauma team is one of the most challenging and rewarding roles in emergency medicine. It’s a blend of clinical expertise, calm leadership, communication, and the ability to make decisions when the stakes are high. The Trauma Team Leader (TTLtips) Tips on St Emlyn’s explores what it really means to lead in trauma, through clinical insight, human factors, and team dynamics.

Autumn is here, and winter is on its way. In children with gastroenteritis, should we be prescribing take-home doses of ondansetron?

The 2025 Medical Training Review (MTR) is the most significant rethink of UK postgraduate medical education in decades. It calls for more flexible, inclusive, team-based training that recognises learning across all grades, not just numbered trainees. For emergency medicine, this may mean redesigning pathways to include SAS and LED doctors, refreshing the RCEM curriculum, and re-establishing supportive team structures. EM must lead the way in creating sustainable, flexible, and patient-centred training for the next generation.

The FiiRST-2 randomised trial compared fibrinogen and prothrombin complex concentrate with plasma in trauma patients needing massive transfusion. No significant benefit was found. Read our St Emlyn’s critical appraisal.

The NHS drowns in innovation whilst repair work goes unsupported. Why Bronson's Design as Repair framework matters for emergency medicine.

The SUPERB trial compared ultrasound-guided supraclavicular block with Bier block for distal forearm fracture reduction in the ED. Both provided excellent pain relief, with supraclavicular block noninferior and offering longer analgesia. Safe, feasible, and well-tolerated, this trial supports expanding regional anaesthesia options for emergency physicians managing upper limb injuries.

Learn more about innovations in Cardiac Arrest management: 3 quick hits to stay prepared and respond effectively in critical situations. @stemlyns #FOAMed

From St Emlyn's journal club: are we overtreating sepsis? US study finds 87% received unnecessary or overly broad antibiotics in ED.

The EVIDENCE trial asked if rapid transport with ongoing CPR improves survival in refractory out-of-hospital cardiac arrest. Results: no clear benefit over on-scene resuscitation.

Background Paediatric generalised convulsive status epilepticus (GCSE) are some thing we see a fair amount of in Virchester. Many are a result of febrile seizures, but as we are a tertiary centre we see the full range of causes presenting to PED. Seizures that fail to stop spontaneously within five minutes are much less likely. to terminate without treatment and may lead to progressive neuronal injury, worsening outcomes, and, in some cases, death.

A recent trial of alternatives to commercial Calcium Gluconate gel in HF burnsBottom line - buy the proper stuff

How we transformed emergency medicine by 2038: AI, virtual EDs, and culture change. A powerful retrospective for healthcare leaders.

A review of intra-arrest stellate ganglion block for refractory cardiac arrest. Could this novel technique improve ROSC rates? Critical appraisal of scoping review. @stemlyns #FOAMed