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

New UK research reveals 3 types of moral injury in emergency medicine: loss of trust in others, self & authority. St Emlyn's journal club review of key findings.

Can children with abdominal pain, vomiting, or tenderness avoid CT? We review PECARN's latest insights into low-risk paediatric trauma.

Ourt review of a small Feasibility study on arterial line placement during ED cardiac arrest shows high success and improved ROSC. Is it time to rethink resuscitation monitoring?

In this emergency medicine toxicology blog, Gregory Yates takes us through a few recent papers on nitazenes, a group of (potent) synthetic opioids with high overdose potential.

Recognise and treat drug-induced hyperthermia fast. Learn how early sedation and rapid cooling can save lives in this ED-focused clinical review.

Can salbutamol relieve pain in renal colic? We review a phase II randomised controlled trial exploring intravenous salbutamol as an adjunct analgesic in the emergency department.

In this emergency medicine toxicology blog, Gregory Yates reflects on a recent EMCRIT podcast episode discussing serotonin syndrome, neuroleptic malignant syndrome (NMS), and other hyperthermic drug reactions. The post highlights the diagnostic importance of neuromuscular findings such as clonus, tremor, and hyperreflexia, as outlined in the Hunter criteria. It also critiques the limitations of relying solely on drug history and explores the inter-rater variability in neurological examinations for movement disorders. With real-world cases from Virchester, the piece underlines the risks of misdiagnosis — particularly the danger of using antipsychotics in the wrong toxidrome. The takeaway: thorough neurological assessment is crucial, and clinicians should be cautious when interpreting overlapping syndromes.

Review the top 11 trauma and resuscitation trials discussed at ICEM 2025. Expert summaries and critical appraisals from St Emlyn’s cover transfusion strategies, airway management, oxygenation, fibrinogen, and more.

Can you perform a life-saving thoracotomy without ICU, theatre, or specialist staff? A new study from Cape Town shows it's possible — and often successful — even in district hospitals facing high trauma burdens. Read our latest St Emlyn’s review 👇 #EmergencyMedicine #TraumaSurgery #FOAMed #GlobalHealth

Emergency care is more pressured than ever—but is compassion being lost in the chaos? This post explores the reality of compassion fatigue, the systemic and cultural barriers to empathy, and practical, evidence-based strategies to reconnect with patients in meaningful ways.

Emergency care is more pressured than ever—but is compassion being lost in the chaos? This post explores the reality of compassion fatigue, the systemic and cultural barriers to empathy, and practical, evidence-based strategies to reconnect with patients in meaningful ways.

Emergency departments (EDs) often seem to shift from calm to crisis in an instant. Why? This article explores ED crowding through the lens of complexity science and self-organised criticality, explaining how minor changes—like a few extra patients—can trigger disproportionate chaos. Using the sandpile analogy and concepts like power law distributions, we reveal why traditional linear models and static targets often fail to manage ED flow effectively. Instead, we offer a data-driven, systems-based approach: identifying tipping points, recognising early warning signs, and implementing proactive, anticipatory interventions. From real-time dashboards to weekly cycle planning and distributed decision-making, this article offers a practical guide for building resilience in emergency care. Learn how your ED can thrive in complexity, not just survive it.

The simplified BATT (sBATT) score offers a practical trauma triage tool for use in motor vehicle collisions where monitoring equipment may be unavailable. Derived from the original BATT score and validated on over 70,000 UK patients, the sBATT shows excellent performance in predicting early death using only observable signs. Ideal for lay responders, trapped patients, and low-resource settings, this novel tool could help guide early trauma care and emergency dispatch.