197 episodes

St Emlyn's is the premier emergency medicine podcast from the UK. We cover evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.

The St.Emlyn's Podcast St Emlyn's Blog and Podcast

    • Health & Fitness
    • 4.8 • 48 Ratings

St Emlyn's is the premier emergency medicine podcast from the UK. We cover evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.

    Ep 195 - October 2021 Round Up

    Ep 195 - October 2021 Round Up

    Our round up of all the blog had to offer in October 2021. There's discussion about evidence based medine in the REST and CTCA for intermediate chest pain trials, more about cauda equina and highlights from the Paediatric Colloquium in Australia, as well as the good humoured chat.


    Please see the website for more information and don't forget to subscribe and rate the podcast (if you think it's any good).  

    • 31 min
    Ep 194 - August 2021 Round Up

    Ep 194 - August 2021 Round Up

    The round up of the St Emlyn's blog posts in August 2021, featuring discussion about therapeutic anticoagulation in hospitalised COVID-19 patients, non invasive ventilation vs usual care for critically hypoxic COVID-19 patients and the recent EMTA (Emergency Medicine Trainees Association) survey. Oh, and Simon's mid-life crisis. 

    • 17 min
    Ep 193 - June and July 2021 Round Up

    Ep 193 - June and July 2021 Round Up

    Iain and Simon discuss the best from the blog in June and July. There's COVID chat (of course). thunderstorm asthma, a glance into the future and much, much more. 

    • 29 min
    Ep 192 - May 2021 Round Up

    Ep 192 - May 2021 Round Up

    It's been a busy month on the blog with plenty for Iain and Simon to talk about. The Manchester Arena bombing, new guidelines for Anaphylaxis management, Adult Congenital Heart Disease, Calcium in Major Haemorrhage and Spontaneous Coronary Artery Dissection all get a mention alongside the usual witterings of two middle aged emergency physicians. 

    • 24 min
    Ep 191 - Adult Congenital Heart Disease in the ED: Part 2

    Ep 191 - Adult Congenital Heart Disease in the ED: Part 2

    This is the second in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.


    In this episode we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta. 

    • 36 min
    Ep 190 - Adult Congenital Heart Disease in the ED: Part 1

    Ep 190 - Adult Congenital Heart Disease in the ED: Part 1

    This is the first in a two part podcast series discussing Adult Congenital Heart Disease (ACHD) and how these patients may present to the Emergency Department (ED). Dr Sam Fitzsimmons, our guest on the podcast, is a Consultant in Adult Congenital Heart Disease at University Hospital Southampton. There is more information in this blog post.


    Look out for Part 2, which will be released next week, where we discuss Eisenmenger Syndrome, Transposition of the Great Arteries and Coarctation of the Aorta. 


    Background
    With advances in paediatric cardiac surgery, more and more patients with complex congenital heart disease are surviving to adulthood: in the 1950s you might expect a survival rate of about 10%, whereas now this is more like 85%. In fact, there are more patients in the adult congenital heart disease population than there are in the paediatric one (with 2.3 million adults vs 1.9 million children in Europe).


    Many patients with Adult Congenital Heart Disease are young and able to live a relatively normal life. This means that they can travel and take part in just the same sort of activities as those without ACHD. They may well turn up in your Emergency Department one day, regardless of whether you are a tertiary centre or a district general hospital (DGH).


    They are experts, and know their disease well, but this does not abstain you from a responsibility to know about them too! When these patients become unwell, they can go downhill very fast and you may not have the chance to discuss with them their exact lesion and its management.


    The anatomy and physiology of these patients is abnormal, so they may present in atypical ways, and may not respond to usual medical interventions: in fact, some of our usual treatments may even be harmful.


    However, starting with our usual 'ABC' approach is by far the best way to go, whilst gathering more information and contacting their specialist centre. Many patients will have their last clinic letter and ECG with them (which will also have the direct dial number of their specialist). And if they, or their relative, say there is something wrong you must believe them and do all you can to make sure they are fully investigated.


     



     


    The presence of scars may give you some clues as to the patient's underlying condition and previous surgical repairs. (BMJ 2016; 354: i3905)


     


    A General Approach



    Do your usual ABC assessment.

    Pay particular attention to the respiratory rate - this should be normal.

    Give oxygen if they look unwell.

    They should have a 'normal' blood pressure - any hypotension should be taken as abnormal and investigated.


    The Fontan Circulation



    This is not a condition in itself, but in fact the resulting circulation after a series of operations that could've been performed due to a number of different underlying conditions:


     


    Tricuspid Atresia

    Double Inlet Left Ventricle

    Atrio-ventricular Septal Defect – unbalanced

    Pulmonary Atresia

    Hypoplastic Left Heart Syndrome


    In essence these patients are born with a single functioning ventricle, that has to be utilised to supply the systemic side of the circulation, whilst the Fontan acts as a passive means of returning blood to the pulmonary circulation.


     


    It was first devised in the early 1970s by Dr Francis Fontan, so the majority of patients with this are in their mid thirties and younger.


    Potential reasons for admission to the ED - Fontan circulation
    1, Arrythmia
    As the patient is entirely dependent on their systemic ventricle to work optimally, any disturbance of the delivery into it is very poorly tolerated. Thus, any arrhythmia is life threatening, even a mild atrial tachycardia.


    These patients need to be returned to sinus rhythm as quickly as possible and the recommended method for this is DC cardioversion in expert hands.


    Fontan patients have an incredibly fragile circulation and any change in their respiratory physiology can be life threatening, especially if it increases t

    • 27 min

Customer Reviews

4.8 out of 5
48 Ratings

48 Ratings

TAGShanahan ,

Excellent podcast

Fantastic podcast for emergency physicians and clinicians interested in science and critical appraisal of medical evidence

docib ,

Top Podcast

But then I would say that......

Mark Dunham ,

Awesome resource - thanks

Great to see access improved to this ace resource by adding to the iTunes outlet.
Love your work: well informed and thought provoking.
Thanks!

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