Hip fractures for older people are often severely painful. But, the common treatments like intravenous opioids can cause adverse effects like nausea and delirium. We discuss a new RCT that tests intravenous morphine vs. an ultrasound-guided block of the pericapsular nerve group (PENG), finding the PENG block to be a highly effective and safe alternative. We talk about the ten research priorities for paediatric emergency medicine distilled down by a mixed group of patients, carers, and healthcare professionals.

Paediatrics sticks around with a Delphi approach study that delivers another ten pressing research questions for better ways to procedurally sedate kids. And, from the North West of England, we hear about a trial of reflective practice (Balint) groups with protected clinical time for resident doctors in emergency medicine training.

• Refreshing the paediatric emergency medicine research priorities across the UK and Ireland
• Ultrasound-guided pericapsular nerve group block versus intravenous morphine for pain management in older adults with hip fractures: a randomised controlled trial in the emergency department
• Research priorities for paediatric procedural sedation in emergency medicine
• Qualitative study of reflective practice groups for emergency medicine resident doctors

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

What social dynamics can be observed in the administration of bystander CPR? New research from Korea shows a reluctance to assist when the patient and bystander were of different sex. In the UK, a five year review of knife crime involving children and young people looks for trends in the background of the 145 victims who passed away in that period. From France, we have a study looking at the geographic distribution of cardiac arrest events, and to finish there is a scoping review highlighting the value of access to good translation.

• We have recognised inequalities: now we must act
• Focusing on health inequalities in emergency care
• Impact of bystander and patient sex on cardiopulmonary resuscitation provision in out-of-hospital cardiac arrest
• Preinjury, injury and post-injury factors leading to death in children and young people who were victims of knife crime in England between 2019 and 2024: a review of the National Child Mortality Database
• Spatial clustering of out-of-hospital cardiac arrest in northern France and its association with social deprivation: a population-based registry study
• Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

This month, we start with a systematic review on smart ways to cut down unnecessary X-rays in kids with limb injuries. We also look at why subarachnoid haemorrhages get missed or diagnosed late, from both patient and doctor perspectives. A Best Evidence Topic (BET) review asks if simple haematoma blocks are as good as procedural sedation for resetting broken wrists. And finally, we dive into a UK study exploring what life is really like for early-career academic doctors in emergency care.

Read the highlights: Primary survey (https://emj.bmj.com/content/43/7)

• Interventions to reduce imaging in children with upper or lower extremity injuries: a systematic review and meta-analysis (https://emj.bmj.com/content/43/7/435)
• Prospective patient-reported reasons for delayed diagnosis of spontaneous subarachnoid haemorrhage (https://emj.bmj.com/content/43/7/390)
• Haematoma block versus sedation for manipulating distal radius fractures in the emergency department (https://emj.bmj.com/content/43/7/448)
• Balancing act of academic clinical fellows in UK emergency medicine: a qualitative study (https://emj.bmj.com/content/43/7/419)

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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 takes a look at fatalities in nightclubs across the UK in the last 15 years, based on media reporting and coroners' reports. It found that physical assault and overdoses of MDMA/ecstasy were the leading causes of deaths. Another paper, from Japan, addresses acute scrotum presentation. It set out to rate the use of the TWIST score and point-of-care ultrasound when identifying testicular torsion. Then here's a research paper from Australia looking at ways to avoid invasive diagnostic procedures when considering oesophageal perforation. And finally, a UK-wide study on the use of nasal-high flow asks: how widespread really is it?

Read the highlights: Primary survey

• Nightclub deaths in the UK: a retrospective observational study of media reports with coroner verification
• Evaluating the TWIST score and point-of-care ultrasound for paediatric testicular torsion
• Predictive criteria for oesophageal perforation in patients with pneumomediastinum: can invasive diagnostic modalities be avoided?
• Use of nasal high-flow in emergency departments: a four-nation UK-wide survey

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

Access to helicopter emergency services is improving in the UK, a recent study shows. But what impact is that access having? There's a paper for that too, with this episode declaring: "Helicopters for the win!" There's also research on the effect of epinephrine administration for out-of-hospital cardiac arrest in children - does the sequence of treatment affect the outcomes? And finally, how to fight back against spoofed survey responses when gathering data online.

Read the highlights: Primary survey

• Sequence of advanced airway management and epinephrine administration for paediatric patients with non-shockable out-of-hospital cardiac arrest
• Helicopter Emergency Medical Services attendance is associated with favourable survival outcomes in major trauma: derivation and internal validation of prediction models in a regional trauma system
• Access to physician-based Helicopter Emergency Medical Services in the UK: a service analysis in 2024
• Imposter participants and artificial intelligence: growing concerns in online surveys

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

This month we've got a few papers on dealing with smoking - and not smoking - in the emergency department. The episode starts off with a discussion of a paper on automating high-flow nasal oxygen, and the importance of titration of oxygen levels - critical for patients with COPD. Then there's a paper questioning, can nicotine replacement therapy in the ED really work? This is followed by a research paper addressing the gaps in tracking of vaping and substance use - should doctors be asking more about use of vapes? To finish off the episode there's an analysis of the shifting trends in ED attendance, with case complexity seeing a dramatic increase.

Read the highlights: Primary survey

• Automated titration of nasal high flow oxygen in the emergency department: a randomised controlled trial
• Emergency department interventions for smoking cessation: a systematic review and meta-analysis
• Assessment of vaping and substance use documentation in the emergency department and acute medical unit
• Shifting patterns in emergency department attendance: a time series analysis

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

What happens to an emergency department when staff go on strike? A new study published in EMJ examines this challenging scenario and its impact on patient flow. Another paper looks at the hybrid-warfare attack carried out in Lebanon, where exploding pagers caused a mass casualty incident, and what emergency departments can learn from managing that event. EMJ editor Prof. Richard Body adds some of his own reflections from the Ariana Grande concert terror attack in Manchester. Two more complex situations round out the list of papers for this episode, covering out-of-hospital cardiac arrest in pregnant patients, and magnet ingestion in children.

Read the highlights: Primary survey

• Prehospital resuscitative hysterotomy: a practice review
• The pager explosions: lessons learnt from a hybrid-warfare mass casualty incident
• What health systems should learn from the Lebanon pager attack
• Diagnosis and management of paediatric magnet ingestion: a systematic review of clinical practice guidelines
• Evaluating the impact of NHS strikes on patient flow through emergency departments

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.

"Should we be giving blood transfusions to patients with traumatic cardiac arrest?" EMJ editor Prof. Richard Body and associate editor Dr. Sarah Edwards talk through some original research on the value of blood transfusions in this difficult situation. Next is the new UNCORKED study from the Trainee Emergency Research Network (TERN), with some sobering statistics on the prevalence of emergency care carried out in non-standard treatment places across the UK. Then we move to a world of high-pressure injuries, often caused by industrial spraying equipment, where things on the surface aren't quite as they seem. The last paper returns to the theme of cardiac arrests, examining the predictive value of end-tidal CO2 usage. Read the highlights: Primary survey:

• The association of blood transfusion and sustained return of spontaneous circulation in blunt traumatic out-of-hospital cardiac arrest
• Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study
• Recognising high-pressure injection injuries to the hand: a practice review with guidance for emergency physicians
• Prognostic accuracy of end-tidal carbon dioxide in cardiac arrest: a systematic review and meta-analysis

The EMJ podcast is hosted by:

Prof. Richard Body, EMJ Editor-in-Chief, 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.