The St.Emlyn’s Podcast

About The St.Emlyn’s Podcast

A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn ’s team are all passionate educators and clinicians who strive to bring you the best evidence based education. Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles. St Emlyn’s is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians.

Publisher

St Emlyn’s Blog and Podcast

Category

education · health & fitness · science

Language

en

Explicit

No

First episode

2 Jun 2014

Latest episode

3 Oct 2026

Latest episodes

301 episodes in the feed.

1. 

   3 Oct 2026

   Ep 299 - Which patients with chest pain need a troponin?

   Chest pain that sounds like indigestion, feels mild or seems “atypical” can still be myocardial infarction. The difficult question is not whether troponin is useful, but which patients actually need testing — and how much weight we should give symptoms, cardiovascular risk factors and clinical judgement. Professor Rick Body looks at the evidence behind those decisions, drawing on his own research and other studies of patients with suspected acute coronary syndromes. He explores which clinical features genuinely change the probability of myocardial infarction, which are less useful than we might think, and how to balance the risks of missing MI against unnecessary investigation. In this podcast: Why “heavy” or “crushing” chest pain only modestly increased the probability of myocardial infarction in Rick’s study population. Why indigestion-like pain should not automatically reassure us, and why apparently “atypical” symptoms cannot safely exclude acute coronary syndrome. The diagnostic significance of associated features such as vomiting and, particularly, sweating observed by the clinician. Why dividing chest pain into “typical” and “atypical” presentations has limited discriminatory value. Why having no recognised hypertension, hyperlipidaemia, diabetes, smoking history or family history does not rule out acute myocardial infarction. How clinician gestalt does track with risk, but is not sufficiently reliable on its own to rule myocardial infarction in or out. Why none of this means testing everyone: Rick’s practical approach is to seek a convincing alternative explanation and use troponin when MI remains a plausible diagnosis that has not otherwise been adequately explained. The numerical probabilities discussed come from populations already selected for investigation of suspected myocardial infarction, so they should not simply be transferred to every patient presenting with chest pain. About Rick Body Rick Body is Professor of Emergency Medicine at the University of Manchester and an Honorary Consultant in Emergency Medicine at Manchester University NHS Foundation Trust. His research has focused extensively on diagnostics in acute coronary syndromes, including cardiac troponin and strategies for the early rule-out of myocardial infarction. Timestamps 00:00 – Which patients with chest pain need a troponin?02:00 – What individual symptoms do to pre-test probability05:00 – Vomiting and observed sweating08:00 – The problem with “typical” and “atypical” symptoms10:00 – Do traditional cardiovascular risk factors help?13:00 – How reliable is clinical judgement or gestalt?16:00 – Avoiding both under-investigation and over-investigation17:00 – Rick’s practical approach to deciding when to test Links and resources The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes Examining the signs and symptoms experienced by individuals with suspected acute coronary syndrome in the Asia-Pacific region ‘Chest pain typicality’ in suspected acute coronary syndromes and the impact of clinical experience Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the Emergency Department? Can Emergency Physician Gestalt “Rule In” or “Rule Out” Acute Coronary Syndrome? Multicentre validation study More from St Emlyn’s St Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our blogs, podcasts and other resources. If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, we’d love to hear from you. Learning from podcasts? If podcasts form part of your CPD, MedPod Learn helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

2. 

   26 Sept 2026

   Ep 298 - Traumatic Cardiac Arrest: Rethinking Resuscitative Thoracotomy with Laura Kocierz at Trauma 2030

   Recorded at Trauma 2030 at the Royal College of Surgeons in London in December 2025, this short St Emlyn’s podcast looks at one of the most challenging situations in prehospital and emergency care: traumatic cardiac arrest. Iain is joined by Laura Kocierz, a Consultant with London’s Air Ambulance and a Consultant in Critical Care Medicine and Anaesthesia in the Midlands. In this conversation, Laura and Iain explore how data can help us make better decisions about resuscitative thoracotomy. Traumatic cardiac arrest is not always a simple binary event. Patients may deteriorate through a profound low-output state before complete circulatory arrest, and recognising the underlying cause quickly is critical. Laura discusses how the surface location of a penetrating injury can help distinguish cardiac tamponade from exsanguination. A wound within the cardiac box or epigastrium carries a substantially higher likelihood of tamponade, making immediate thoracotomy an important consideration when an organised cardiac rhythm remains. The conversation also explores the ECG as a potential surrogate for time since traumatic cardiac arrest. Sinus rhythm, bradycardia, agonal complexes and asystole may represent progressive physiological deterioration and can add useful information when the reported timing of arrest is uncertain. This leads to an important challenge to the traditional “15-minute rule”. If the history suggests a prolonged arrest but the patient has a penetrating injury consistent with tamponade and still has an organised rhythm, Laura explains why the physiological evidence may be more useful than an uncertain reported time. The other key message is equally important: resuscitative thoracotomy is not a treatment for exsanguination. When major blood loss is the likely cause, priorities remain haemorrhage control, blood transfusion and rapid access to definitive care, while continuing to look actively for co-existing tamponade. In this podcast: Defining traumatic cardiac arrest as a clinical and physiological state Using wound location to estimate the likelihood of cardiac tamponade The significance of penetrating injury within the cardiac box and epigastrium Using ECG rhythm as a clue to the duration of circulatory arrest Why reported arrest times may be unreliable Rethinking the traditional 15-minute threshold for resuscitative thoracotomy Distinguishing tamponade from exsanguination Why thoracotomy should not distract from haemorrhage control and blood transfusion How data from London’s Air Ambulance is helping make traumatic cardiac arrest care more targeted A short conversation with some important practical challenges to the way we think about traumatic cardiac arrest, particularly when deciding who may genuinely benefit from resuscitative thoracotomy. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. Trauma 2030 TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

3. 

   18 Sept 2026

   Ep 297 - The 5th Universal Definition of MI - what emergency clinicians need to know

   When does a raised troponin become a myocardial infarction? What has happened to “type 2 MI”? And how certain can we be about the diagnosis without imaging? Iain Beardsell introduces Professor Rick Body for a practical guide to the Fifth Universal Definition of Myocardial Infarction. Rick explains the changes in terminology, troponin interpretation and diagnostic criteria, focusing on what they mean for clinicians assessing patients in the emergency department. What Rick covers Primary, secondary and procedure-related MI. The new classification replaces the previous numbered types. Rick explains why primary MI now includes coronary dissection, vasospasm and embolism, alongside atherothrombosis. He also describes how the 30-day window after coronary intervention or bypass surgery defines procedure-related MI. Sex-specific troponin thresholds. The definition explicitly recommends sex-specific upper reference limits. Rick discusses why this matters and encourages clinicians to understand the thresholds used by their own laboratory, rather than assuming every troponin assay works in the same way. A likely diagnosis versus a confirmed diagnosis. Cardiac and coronary imaging take a more prominent role in confirming MI and identifying its cause. This is particularly relevant when considering secondary MI in patients with sepsis, tachyarrhythmia or gastrointestinal haemorrhage. A troponin rise alone does not establish myocardial infarction. Acute and chronic myocardial injury. Rick explores the causes of myocardial injury beyond infarction, including inflammation, haemodynamic stress, catecholamine effects, toxicity and trauma. He also challenges the habit of diagnosing chronic myocardial injury from two similar troponin results during an acute ED attendance, without establishing the patient’s stable baseline or investigating the underlying cause. Making sense of the troponin delta. Absolute changes, percentage changes, the starting concentration, time from symptom onset and the interval between samples all influence interpretation. Rick explains why there is no single delta that works for every patient, and why sampling intervals must match the evidence supporting the thresholds being used. STEMI, NSTEMI and occlusive MI. The traditional terminology remains, but the definition recognises important ECG patterns beyond conventional ST elevation. Rick discusses the place of posterior MI, de Winter T waves, Wellens syndrome, the Aslanger pattern and Sgarbossa criteria within this evolving approach. The episode also considers the practical consequences of these changes. More investigation brings additional resource demands, and Rick highlights the uncertainty about whether a more extensive assessment of chronic myocardial injury will improve patient outcomes. More from the accompanying blog Professor Nick Mills, first author of the new definition, adds an important clarification: a working clinical diagnosis can guide initial treatment. Imaging helps identify the cause and improve diagnostic certainty, but unavailable or inappropriate angiography does not prevent a clinical diagnosis. In secondary MI, managing the presenting illness remains the immediate priority. Rick also notes that HEART, T-MACS, EDACS and MI-3 are not addressed in the document. He interprets this as being outside its scope, rather than a change to their use. The post includes Rick’s video presentation and details of ADOPT-UDMI, an education, evaluation and research programme inviting clinicians from all specialties to help put the new classification into practice. Read the full post:The Fifth Universal Definition of Myocardial Infarction: What Emergency Clinicians Need to Know Learning from podcasts? If podcasts form part of your CPD, MedPod Learn brings together St Emlyn’s and other medical podcasts. Browsing and listening are free. Premium adds listening-time tracking, MCQs, structured reflection prompts and an exportable learning record for CPD and ap

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

Apple Podcasts (US)

4.7 / 5

11 ratings

Spotify

5.0 / 5

24 ratings

Podcast Authority Score: 58 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

78

Social presence

0

YouTube

0

Engagement

95

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Books guests

Based on episode analysis; this does not confirm that the show is currently accepting guests.

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