Code status conversations, and attitudes towards asthma: September 2025 Primary Survey

"What is your understanding of your father's illness?" This is the kind of question that may be posed by emergency clinicians in the context of end-of-life care. But as a survey of Thai and American emergency departments finds, approaches to these conversations can be quite different globally. This episode also features another angle on end-of-life care, highlighting the persistent impact that deprivation has when it comes to likelihood of hospital conveyance. On a different subject, there is a qualitative study of the management of acute asthma presentations, seeking to find any marginal gains that may present a chance for optimisation. The fourth and final paper is about acute coronary syndromes in the emergency department, presenting some surprising statistics on length of stay. Read the highlights: September 2025 primary survey Deprivation is associated with hospital conveyance among patients who are terminally ill Are acute asthma presentations to the emergency department an opportunity for optimising long-term management? A qualitative study on beliefs and behaviours of healthcare professionals Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, 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 Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

A new paper on the challenging diagnosis of acute appendicitis has us wondering, can it be spotted with just a glance? The reality is never so simple. This episode we also discuss low-value overtesting, cardiac arrest trial consent, and patient discharge into police custody. As with many aspects of the ED, they each have a layer of legal pressure to consider.   Read the highlights: August 2025 primary survey   The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, 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 Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

The NHS plans to set up mental health emergency departments throughout England. A survey discussed this episode highlights the importance of mental health assessments, finding that nearly a quarter of suicide deaths in a one year period had come after hospital or emergency department contact. Another survey raises the question, "How well is your ED prepared for a major incident?" and the statistics do not inspire confidence. Two more papers in this episode offer potential bulwarks against burnout of ED staff: global health outreach work, and self-rostered rotas. But there may be some downsides to watch out for too. Finally, a look at pulse oximetry for testicular torsion diagnosis. Read the highlights: July 2025 Primary Survey Contact with emergency departments and hospitals in England before suicide death: a retrospective cohort study Global health experience of staff working in UK emergency care: a reflexive thematic analysis A survey of major incident preparedness in English type 1 emergency departments In emergency settings, does the use of testicular pulse oximetry aid diagnosis of testicular torsions? Investigating the impact of self-rostering on EM trainee wellbeing and recovery: a national survey The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, 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 Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Can salbutamol be used be used to relieve pain in renal colic patients? Starting off this month's episode, a randomised trial seeks to find the answer. Then a topic of interest for anyone seeing patients with a phobia of needles, namely a study comparing coolant spray with topical anaesthetic cream for reducing pain from intravenous cannulation. Next, randomisation is a necessary tool for many trials, but what if you want something that's less high-tech, and more high-street? That's right, scratch cards! And finally, fear of not making the right decision dominates when it comes to  paramedic conveyance to the paediatric emergency department. "We just take them in," "parents know best," and "if only they could talk" are some of the revealing quotes found in the study wrapping up this month.   Read the highlights: June 2025 Primary Survey Salbutamol for analgesia in renal colic: a prospective, randomised, placebo-controlled phase II trial Comparison of the effects of vapocoolant spray and topical anaesthetic cream (lidocaine–prilocaine) on pain of intravenous cannulation: a randomised controlled trial Letter: Allocation concealment using scratchcards in an emergency department drug trial Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, 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 Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

A new survey has found that less than one third of end-of-life patients in Irish emergency departments have their own room. This is only one of the shortcomings found in end-of-life care, explored in two papers to start this episode. Following on from that is a comparison of video and direct laryngosocopy for intubation outcomes. There's also a "Best Evidence" review of the use of nasal clips for stopping nosebleeds, an approach which appears likely to offer advantages over the hands or inventive tongue-depressor contraptions. The finish up this month's episode, there's a return to a topic previously visited one year ago - the RCEM guidelines on cannabinoid hyperemesis syndrome. A study from Wales follows up on the adherence to this guidance. Read the highlights: May 2025 Primary Survey Dying matters in the emergency department Emergency clinician perceptions of end-of-life care in Irish emergency departments: a cross-sectional survey Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials Use of nasal clips as first aid for anterior epistaxis Awareness and management of cannabinoid hyperemesis syndrome among staff in emergency departments in Wales The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, 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 Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Trauma and paediatrics are the themes for this month's collection of papers. Starting off is a review of the effectiveness of prehospital ultrasound in detecting lung injury, with some surprising statistics. Next is a letter on the topic of self-presentation by paediatric patients with major trauma, which is thankfully a rare occurrence. The third paper looks at prehospital testing of trauma patients for  low fibrinogen levels, a condition which can lead to worse bleeding, increased transfusions, and higher mortality. The final paper discusses the worrying topic of delayed presentation with testicular pain, a phenomenon which leads to significantly lower salvage rates. This can arise from lack of information or embarrassment, particularly in younger males.   Read the highlights: April 2025 Primary Survey   Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis Identifying the walk-in wounded: paediatric major trauma patients self-presenting to a paediatric major trauma centre Comparison between point-of-care international normalised ratio, COAST, TICCS and truncated FibAT scores to rule in clinically significant hypofibrinogenaemia in the prehospital setting Experiences and perceptions of acute testicular pain, with a focus on reasons for delayed presentation to hospital: a qualitative evidence synthesis   The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, 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.

Advance clinical practitioners (ACPs) can have a big role to play in the emergency department, but their career paths are not always well understood. This episode features three papers from the journal which begin to address that - a census survey of over 1000 ACPs, a qualitative study on their experiences in emergency care, and a commentary on how to improve ACP training. There is also a paper from Canada discussing considerations to be made for patients living with dementia, as well as their care partners who may be accompanying them to the hospital. A bit of a curveball to close out, with a review on hidradenitis suppurativa, a challenging skin condition which can take years for a diagnosis.   Read the highlights: March 2025 Primary Survey   Care for older adults living with dementia in the emergency department: a systematic review and meta-synthesis of care partner roles and perspectives Emergency medicine advanced clinical practitioners: an English workforce census A qualitative study exploring the experiences of advanced clinical practitioner training in emergency care in the South West of England, United Kingdom How can we improve on advanced clinical practitioner training? Diagnosis and management of hidradenitis suppurativa: a review for the emergency clinician   The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, 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.

Another packed issue of the journal this month, and a podcast to match. Starting off with the Editor's Choice paper, on the important topic of sex and gender disaggregation in emergency medicine trials. Sex and Gender Equity Reporting (SAGER) guidelines were introduced in 2016 but poor adherence is still found in current publications. Next is a paper with high seasonal relevance, addressing the sensitivity and specificity of multiplex lateral flow tests for Flu A, Flu B and COVID 19. There's also a randomised controlled trial on nebulised corticosteroids for asthma exacerbation, and to finish, a question few might think to ask - can intradermal injection of sterile water offer pain relief to renal colic patients?   Read the highlights: February 2025 Primary Survey   Sex and gender reporting in UK emergency medicine trials from 2010 to 2023: a systematic review Sex and gender reporting in scientific papers now strongly recommended by the Emergency Medicine Journal Multiplex lateral flow test sensitivity and specificity in detecting influenza A, B and SARS-CoV-2 in adult patients in a UK emergency department  Nebulised high-dose corticosteroids as add-on therapy for adults with asthma exacerbation: a randomised controlled trial Best evidence topic report: can intradermal sterile water injections provide effective pain relief in patients with renal colic?   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.

A special bonus podcast this time, on the perennial issue of crowding. Rick and Sarah are joined by Royal College of Emergency Medicine president Dr. Adrian Boyle, and EMJ's editor-in-chief Prof. Ellen Weber. They address recent evidence for crowding's harmful impact, the arm-twisting needed to shape policy, how it shapes patient confidence, and what the future of crowding looks like.   Links: Association between delays to patient admission from the emergency department and all-cause 30-day mortality Being a patient in a crowded emergency department: a qualitative service evaluation   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.

It's a celebration of qualitative research to start the new year, with a collection of papers offering new perspectives on emergency department issues. First is a pair of papers centred on the theme of pre-alerts to the emergency department. Setting the scene for a patient's arrival is a vital process, yet it can generate fear of criticism for getting the balance wrong, when it comes to over- and under-alerting. Following on is a paper taking a look at the human experience of working in the emergency department, and the war-like atmosphere that can be found there. This leads to the final paper on well-being interventions in the ED, with interviews having found real limitations to current approaches.   Read the issue highlights: January 2025 Primary Survey   How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments  It’s a battlefield! A thematic analysis of narratives shared in Cape Town emergency departments Well-being interventions for emergency department staff: ‘necessary’ but ‘inadequate’ – a phenomenographic study   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.