Episode Details

Small decisions in the resus room can save minutes; badly designed systems can waste thousands of hours. In the April 2026 St Emlyn’s round-up, Iain Beardsell and Simon Carley move between both ends of that spectrum, from external haemorrhage control and chest drains before CT to ED crowding, clinician productivity and the reflex to solve safety problems with more mandatory training.

There is also new evidence on smoking cessation in the emergency department and HI-PEITHO, a randomised trial of catheter-directed thrombolysis for higher-risk pulmonary embolism.

In this podcast:

• A practical escalation approach to external haemorrhage control: why accurate direct pressure still matters, when to escalate, and why a tourniquet should not automatically be the first intervention.

• Chest drains before trauma CT: when physiological compromise makes drainage necessary and when inserting one first may simply delay definitive imaging.

• How Stevan Bruijns’ idea of a cognitive bridge can help clinicians explain ED crowding to colleagues who do not experience the problem themselves.

• Why asking how many patients per hour a clinician sees can be misleading if staffing, crowding, IT, physical environment and workflow are ignored.

• Jesse Spurr’s challenge to healthcare’s instinct to respond to errors with another training module, and why systems thinking may identify more useful solutions.

• What a systematic review tells us about smoking cessation interventions in the ED, including the difference between behavioural advice alone and interventions incorporating nicotine replacement therapy.

• The HI-PEITHO trial of ultrasound-facilitated catheter-directed fibrinolysis plus anticoagulation for intermediate-high-risk pulmonary embolism, and why the composite outcome and balance of benefit and harm need careful interpretation.

• Why putting a major trauma patient straight onto a portable monitor, checking transfer oxygen and preparing equipment early can remove avoidable delays on the way to CT or theatre.

Links and resources

Read TTL Tip 8: External Haemorrhage Control

Read TTL Tip 9: Chest Drain Before CT? Think, Decide, Communicate

Read Explaining Emergency Department Crowding Using a Cognitive Bridge

Read Marching Backwards into the Future: Why Healthcare Needs Fewer Modules and More Systems Thinking

Read How Many Patients Should We See Per Hour?

Read Fit to Quit? The Trial Evidence for Smoking Cessation Interventions in ED

Read the Emergency Medicine Journal systematic review of ED smoking cessation interventions

Read the St Emlyn’s review of HI-PEITHO

Read the original HI-PEITHO trial in the New England Journal of Medicine

Read TTL Tip 10: Put the Trauma Patient Straight onto the Portable Monitor

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