MEM-EM: The Memorising Emergency Medicine Podcast

MEM-EM
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An educational podcast designed for Emergency Medicine. The primary goal of this project is to accelerate the learning curve and decrease the knowledge translation window for trainees. MEM-EM is designed to complement official resources to help people prepare for examinations in Emergency Medicine and to maintain knowledge during practice. Content is structured to follow the RCEM 2021 curriculum but will be useful for ACEM trainees in Australasia and also portfolio pathway candidates in the UK.

  1. 3D AGO

    Approach to ... High Lactate DDx

    The provided text explains that lactate is a vital metabolic fuel and carbon source for the heart and brain, rather than just a waste product of oxygen deprivation. Clinicians categorize lactic acidosis into two types: Type A, which stems from inadequate tissue oxygenation, and Type B, which occurs due to metabolic triggers like medications, toxins, or systemic diseases. The liver and kidneys are responsible for the vast majority of lactate clearance, and disruptions in these organs can lead to dangerous accumulation. In the emergency department, measuring these levels serves as a critical prognostic tool for identifying patients in "cryptic shock" who may appear stable but face a high risk of death. Effective resuscitation is often marked by the body's ability to normalize these levels, making lactate a key indicator for monitoring treatment success in severe illness. Consequently, understanding the nuanced causes of hyperlactatemia helps medical providers differentiate between benign temporary elevations and life-threatening physiological stress.

    14 min

  2. FEB 9

    Overview: NICE Sepsis Guideline Update for 2025.

    Executive Summary This briefing document synthesizes the NICE NG253 (2025) guidelines for the recognition, assessment, and early management of suspected sepsis in individuals aged 16 and over. The central shift in practice is the mandatory use of the National Early Warning Score 2 (NEWS2) for risk stratification in acute hospital settings, ambulances, and acute mental health facilities. Critical Takeaways: Risk Stratification: NEWS2 scores define risk levels: High Risk (\ge7), Moderate Risk (5–6), Low Risk (1–4), and Very Low Risk (0).The "Red Flag" Single Parameter: A score of 3 in any single NEWS2 parameter requires an urgent high-priority review by an FY2 or above to determine if the patient is at higher risk than the total score suggests.Antibiotic Timelines:Fluid Resuscitation: Initial bolus is now 250 ml (reduced from 500 ml) of isotonic crystalloid, with reassessment after every bolus up to a 1,000 ml limit.Peripheral Vasopressors: Now recognized for initial management of hypotension/shock if fluids fail, following consultation with critical care.

    16 min

  3. FEB 6

    Trauma Resuscitation In A Crisis

    The United Kingdom’s National Health Service has transitioned from a fragmented approach to a sophisticated regional network designed to deliver critically injured patients to the most appropriate level of care. This tiered architecture utilizes Major Trauma Centres as specialized hubs for severe injuries, supported by smaller units that stabilize patients and adhere to strict evidence-based clinical protocols regarding hemorrhage control and diagnostic imaging. The system increasingly addresses the unique challenges of "Silver Trauma," acknowledging that elderly patients often mask signs of shock and require more liberal use of advanced imaging. To maintain high standards, the network is underpinned by rigorous educational frameworks and a national registry that uses financial incentives to reward hospitals for achieving specific quality benchmarks and patient outcome goals.

    15 min

  4. FEB 6

    Why 110 Systolic is the New 90

    This strategic framework outlines the evolution and operational standards of major trauma services within the UK, specifically detailing how regionalized networks have significantly increased patient survival since 2012. The text focuses on the critical mechanism of Trauma Team Activation (TTA), advocating for a tiered response system that balances urgent multidisciplinary care with the efficient management of hospital resources. A primary theme is the necessity of adapting traditional protocols for "Silver Trauma" in elderly patients, whose physiological stability can mask life-threatening injuries, and for pediatric cases which require age-specific triggers. To optimize the "Golden Hour" of care, the source emphasizes non-technical leadership skills and the "hands-off" role of the team leader to maintain situational awareness. Ultimately, the framework serves as a guide for senior clinicians to utilize evidence-based triage and damage control resuscitation to ensure the most severely injured patients receive rapid, specialized intervention.

    18 min
  5. Manage, Administer, Lead: SLO 12

    FEB 2

    Manage, Administer, Lead: SLO 12

    Executive Summary Achieving Specialty Learning Outcome (SLO) 12 requires a transition from clinical competency to system leadership. This document synthesizes the RCEM CARES strategic framework (addressing system pressures) with the EMLEADER development programme (building personal capability). Critical Takeaways: Strategic Alignment: Operational decisions must align with the RCEM CARES pillars (Crowding, Access, Retention, Experience, Safety) to advocate effectively for resources and safety. The EMLEADER Mindset: Leadership is not a title but a practice. You must demonstrate proficiency across the programme's core domains: Leading Self, Leading Teams, and Leading Systems. Governance as Safety: Moving from "admin" to "assurance"—using incidents and complaints to drive the Quality Improvement (QI) agenda. Compassionate Leadership: Retention is a critical safety issue. Leadership must focus on staff wellbeing to maintain a functioning workforce.

    16 min
  6. Acing the QIAT

    JAN 30

    Acing the QIAT

    Executive Summary This briefing document provides a comprehensive guide to the Royal College of Emergency Medicine (RCEM) Quality Improvement (QI) assessment, a core component of the 2021 curriculum. Specialty Learning Outcome (SLO) 11, "Participate in and promote activity to improve the quality and safety of patient care," represents a fundamental shift from a single examination hurdle to a continuous, longitudinal assessment of QI and patient safety skills throughout training. Critical Takeaways: Continuous, Longitudinal Assessment: QI is no longer an isolated event but is "spiralled" through training, requiring evidence of engagement at every stage (Core, Intermediate, and Higher). This approach, supported by educational principles of "interleaving" and "spacing," embeds QI into daily practice and prevents post-exam disengagement.The Quality Improvement Assessment Tool (QIAT): The primary mechanism for recording and assessing annual QI activity is the QIAT, a standardized reporting form available on the Kaizen ePortfolio. A well-constructed QIAT is detailed, typically covering the equivalent of 7–8 pages.Focus on Methodology: The assessment has shifted from traditional audit to a focus on mastering and applying systematic QI methodologies, such as the Model for Improvement (MFI) with Plan-Do-Study-Act (PDSA) cycles. The emphasis is on demonstrating an understanding of the improvement journey.Broadened Project Scope: QI projects are no longer limited to narrow clinical topics. Projects addressing education, environmental sustainability, staff wellbeing, cost-saving, pre-hospital care, or overseas settings are now suitable, significantly expanding the range of available topics.Progressive Competency: Expectations evolve with the trainee's level of seniority. Core trainees focus on participation and understanding basic principles; Intermediate trainees progress to data analysis and evaluation of change; and Higher trainees are expected to demonstrate project leadership.Assessment and Sign-Off: The QIAT is reviewed annually by the trainee's Educational Supervisor (ES). For trainees in Higher Specialist Training (ST4-6), there is additional oversight to ensure standards are met, which for some transitional trainees involves a regional QI panel.

    13 min
  7. SLO 11: Mastering Quality & Safety Improvement in the ED

    JAN 26

    SLO 11: Mastering Quality & Safety Improvement in the ED

    Executive Summary Specialty Learning Outcome (SLO) 11 represents a fundamental shift in the Royal College of Emergency Medicine (RCEM) curriculum, moving away from a single examination hurdle to a continuous, longitudinal assessment of Quality Improvement (QI) and patient safety. Critical Takeaways: Continuous Assessment: QI is no longer an isolated event; it is "spiralled" through training, requiring evidence of engagement at every stage (Core, Intermediate, and Higher).Methodology Focus: The emphasis has shifted from simple audit to mastering QI methodologies (e.g., PDSA, Driver Diagrams) and understanding the "journey" of improvement.The Tool: The Quality Improvement Assessment Tool (QIAT) on Kaizen is the primary mechanism for recording and assessing this activity.Scope: Projects are no longer limited to clinical topics; they can cover education, environmental sustainability, wellbeing, or cost-saving.

    11 min

  8. JAN 22

    Procedure Visualisation: Sutures

    Acute wound management in the emergency department (ED) focuses on two primary goals: avoiding infection and achieving a functional, cosmetically acceptable scar. Effective management requires a deep understanding of the physiological phases of wound healing—hemostasis, inflammation, proliferation, and maturation. Practitioners must distinguish between wounds suitable for primary closure and those requiring secondary or delayed primary closure based on wound age, mechanism of injury, and patient-risk factors. Critical takeaways for the experienced practitioner include: Healing Dynamics: Wounds typically regain 80% of their original tensile strength by six weeks, though full maturation can take up to 180 days.The "Golden Period": Most clean, simple lacerations can be closed up to 12–18 hours after injury, with head/neck wounds extending to 24 hours due to high vascularity.Preparation is Paramount: Irrigation remains the most effective method for decreasing infection. Pressures of 5–8 PSI are ideal for most minor wounds.Suture Selection: Use the thinnest suture feasible (e.g., 6-0 for face, 4-0/5-0 for extremities). Deep dermal sutures should utilize absorbable materials like Polyglactin 910 to reduce surface tension.

    11 min
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About

An educational podcast designed for Emergency Medicine. The primary goal of this project is to accelerate the learning curve and decrease the knowledge translation window for trainees. MEM-EM is designed to complement official resources to help people prepare for examinations in Emergency Medicine and to maintain knowledge during practice. Content is structured to follow the RCEM 2021 curriculum but will be useful for ACEM trainees in Australasia and also portfolio pathway candidates in the UK.

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