The Resus Room

Welcome back to the podcast and to November's Papers of the Month!

We start off looking at the rate of pneumothoraces in patients following ROSC after a medical cardiac arrest. What is the incidence? Are there any risk factors? And how might this affect our index of suspicion and imaging practice?

We've spoken before about how difficult vertigo can be as a presentation to the Emergency Department; really common, often benign but with differentials that include posterior circulatory strokes, tumours and infections. Our second paper looks at a clinical risk score for patients presenting with vertigo to the ED and consider how this might affect practice.

And finally we take a look at a great paper focussing on pre-alerts to the ED; consider current barriers, understanding and ways that we could improve the process both for the patients and staff.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

In this episode we’re going to be running through adrenal presentations; both Adrenal insufficiency and Adrenal Crisis. There are some parts of these that aren’t completely understood and a lack of a universal definition of Adrenal Crisis, but both insufficiency and a crisis are similar problems at different points on a spectrum and solid understanding of the endocrinology and physiology can really help to improve care in this area. There is huge potential for improving current morbidity and mortality.

We’ll run through both primary and central adrenal insufficiency, describe how this leads to different effects on mineralocorticoids and glucocorticoids and the signs and symptoms that will occurs as a result. 

Many of the patients presenting to the department will be unknown to have adrenal insufficiency and we’ll run through those who are at higher risk, including a huge group due to ongoing medication, who may be those on steroid doses much lower than you would previously have considered as significant. 

NICE published their most recent guidance on Adrenal Insufficiency in August this year and we’ll be referring to a lot of this as we run through the episode. 

We’ll finish up looking at the critical presentation of Adrenal Crisis and the emergency and ongoing management, along with how we support patients with insufficiency to prevent a crisis occurring. 

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to October's Papers of the Month. We've been really spoilt with three fantastic papers to discuss this month!

First up we take a look at the accuracy of non-invasive blood pressure readings in critically unwell patients in the prehospital environment and see how they could falsely reassure in both hypotension and hypertension.

Next up we take a look at the superb SHED study, which looks to evaluate the accuracy of a plain CT head in identifying subarachnoid haemorrhage at different time frames. Currently NICE recommend an LP after a negative scan if the scan was performed more than 6 hours from onset. But what does this significant  dataset show and importantly how likely are you to 'miss' an aneurysmal subarachnoid haemorrhage if scanned within the first 24 hours and not following up with an LP?

Lastly we look at a paper that highlight the potential benefit of naloxone in out of hospital cardiac arrest in opioid overdose. This delves into priorities in resuscitation, the fundamentals and some possible unexpected physiological effects from naloxone.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

PE’s (or Pulmonary Emboli) are a key part of Emergency Care, something that many of us will consider as a differential diagnosis multiple times of a daily basis, in a similar way to acute coronary syndrome, so we need to be absolute experts on the topic!

A PE normally occurs when a Deep Vein Thrombosis shoots off to the pulmonary arterial tree, occurring in 60-120 per 100,000 of the population per year

The inhospital mortality is 14% and the 90 day mortality is around 20%. But this is proportional to its size, and risk stratifying PE’s once we’ve got the diagnosis is really important.

PE is a real diagnostic challenge and less than 1 in 10 who are investigated for a PE end up with the diagnosis, so knowing the risk factors, associated features and thresholds for work up are really important.

There are some key concepts in risk stratification and particularly in test thresholds that we’ll cover in this episode that are applicable to all of our practice…..we’re excited! Getting these right helps us to avoid missing the diagnosis and equally importantly ensure we aren’t ‘over testing’ & ‘over diagnosing’ because investigation and treatment for a PE isn’t without it’s own risks.

In the episode we’ll talk in depth about factors associated with presentation, risk factors, investigations and finally onto treatments, covering the whole spectrum from low risk PE’s up to those with massive PE’s and cardiac arrest. The evidence base behind the work up and treatments is truly fascinating and we hope you find this episode as eye-opening as we did to prepare for!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back after the summer break!

Three more papers for you to feast your ears on this month and as always make sure you go and check them out yourselves after you've had a listen!

First up, following on really nicely from the DOSE-VF paper on dual sequential defibrillation we take a look at the paper that looks at the association between shock interval and VF termination. We might be biased but this shines a light on an area that could make a huge difference to the outcomes for patients with refractory VF!

Next; when you're seeing a patient with an upper GI bleed, which scoring/prognostication tool do you use and is it the best? We cover a paper that looks at exactly this question.

Finally we look at whether TXA predisposes patients to a higher risk of venous thromboembolism and whether it might affect our practice patterns.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

The UK REBOA trial left many with doubts over its utility for trauma patients in ED. The time from injury to its use was around 90 minutes and the trial was stopped when it didn't reduce and maybe even increased mortality compared to standard care alone.

But what effect does REBOA have when used prehospitally and how feasible is it? Our first paper, from London HEMS, looks at this and gives a fascinating insight into it's use and the physiological response seen with it.

We've recently looked at dual sequential defibrillation for refractory VF with the DOSE-VF trial. Our second paper this month looks at how a double defibrillator strategy, in the context of cardioversion for AF, may affect restoration of sinus rhythm in obese patients.

Finally we take a look at the use of video livestreaming from scene to EMS, in a feasibility RCT. How can it affect accurate dispatch of the most appropriate resources and what impact does it have on those that use it?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Acute Kidney Injury is common, complicated and holds significant morbidity and mortality. But...if we recognise it, we can make a real difference to our patients' outcomes.

In this episode we run through the anatomy, physiology and aetiologies.

We have a think about the multitude of definitions of AKI and then take each of the pre renal, renal and post renal categories and think about the ways we can optimise our care in each.

We also have a think about who needs to be admitted and who can be safely managed in the community.

This was a hugely valuable episode for us all to research and bring clarity to a complicated topic, we hope it does the same for you too!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

There's a huge paper to talk about this month in the PREOXI trial, a multi centre RCT looking at the pre oxygenation strategy in critically unwell patients undergoing RSI, with patients either getting high flow oxygen through a facemask or NIV. The results are pretty remarkable and may well be practice changing as we'll discuss in the podcast!

Next up we take a look at a feasibility of lidocaine patches for older patients with rib fractures and the potential benefit in terms of pain and respiratory complications.

Lastly we take a look at the benefit of performing a CT head scan in the Emergency Department for patients with a first fit. At times this can feel like a significant utilisation of resources, but what is the yield of positive scans and impact on patient care?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

So this month we’re looking at major incidents and specifically the triage process that is now coming into play in the UK and further afield that you need to know about!

We normally stick pretty strongly to clinical topics; they’re pretty easy to focus on because you can imagine how extra knowledge in a certain clinical area could make a difference to presentations that we see pretty commonly. And being brutally honest, making the effort to prepare and rehearse what we might do, on the off chance that we ever come across a major incident, can be difficult to motivate yourself to do.

But this is probably an area that investing a bit of time in, really thinking about how you would act in a major incident, could make a phenomenal difference to what may be one of the most, if not the most challenging clinical days of your career.

In the episode we run through Ten Second Triage (TST) and the Major Incident Triage Tool (MITT). They replace the previous triage methodologies and are to be implemented by the end of this month. We also cover some other aspects of planning and approach for being the first responder at a major incident, and we were lucky enough to gain some insights to the new triage process from Phil Cowburn, an EM & PHEM consultant who was involved in their development.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to June's Papers of the month!

We kick off this month looking at the work up of patients with a first episode of psychosis. With these patients there is a chance of a psychosis secondary to an underlying structural cause. Getting neuro-imaging to look for this prior to psychiatric assessment is tricky though, often with a need for sedation and then the subsequent delay for psychiatric assessment. Our first paper looks at the yield of positive scans for these patients and helps us to understand a bit more about the need for this.

Secondly; sepsis screening tools are commonplace in most emergency services and departments, but how do they compare against senior clinician gestalt?

Finally we look at the association of gastric distension in cardiac arrest and the rates of ROSC, should we be concentrating more on decompression of gastric volume intra-arrest?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

We’ve covered Cardiac Arrest management (as in the medical delivery of it) in a previous Roadside to Resusepsiode. Since then we've had some updates with Paramedic-2, Refractory VF, Airways-2  and a whole host of other papers. But what we haven't talked much about is the art of creating the environment, space & workflow to deliver the best medical care possible. 

Whilst these might seem like less exciting and important parts of the package, they probably require a greater degree of skill and knowledge than running the medical aspects of the arrest. To do them with excellence you need to anticipate every single objective/obstacle that could stand in your way, including the medical interventions involved and the challenges of that unique case and environment. 

In this episode we run through the aspects of a cardiac arrest right from the initiation of the case to the clearing/transfer to onwards care. We talk about the use of immediate, urgent and definitive plans and then run through how these translate into both in-hospital and prehospital arrests.

We personally got a lot out of preparing and thinking about this episode, so we hope you find it useful too!

We’d love to hear any thoughts or feedback on this slightly different style of episode either on the website or via X @TheResusRoom!

Simon & James

Welcome back to the podcast and three great papers for May's episode!

First up we take a pretty deep look into refractory VF. This follows on from our our review of DOSE-VF in December '22's papers of the month and our recent Roadside to Resus on the topic. In that we discussed the possibility that many of the cases we see at pulse checks as being refractory VF may actually have had 5 seconds or more, post shock, where they jumped out of VF but then reverted back into it. This paper is a secondary analysis of DOSE-VF and reveals what really happen to these 'refractory VFs' by interrogating the defibrillators. What difference will it make to our strategy for recurrent and refractory VF?

Next up we take a look at elderly patients presenting to the Emergency Department with abdominal pain with an analysis of the features that predict a serious abdominal condition.

Lastly we look at the how different pressures exerted to the facemask when ventilating neonates can make in terms of bradycardia and apnoea.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Lower back pain is a really common cause for patients to present to primary care, urgent care and emergency care.

Thankfully many of these cases are self limiting, but somewhere in the region of 1:300 patients with back pain in the ED will have Cauda Equina Syndrome.

Cauda Equina Syndrome is something that is challenging for all clinicians because many patients with simple lower back pain may have many similar symptoms,  but if we miss it, or if there is a delay to surgery that can lead to potentially avoidable long-term disability for our patients and on top of that its a major cause of healthcare litigation.

And we’re not talking about a delay in weeks being a problem here, we’re talking about hours to days, with big  potential complications like impaired bowel/bladder/sexual dysfunction or lower limb paralysis - so you can see why litigation is a big part of some missed cases.

In this episode we run through the the signs, symptoms, investigations and treatment with a strong reference back to the underlying anatomy and disruption.

We also cover the recently published national Cauda Equina Pathway, which is a great resource but poses some real challenges in it’s implementation!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to the podcast! Three more papers covering topics that are relevant to all of our practice.

The importance of removing wet clothes from patients is often discussed, both to prevent hypothermia and increase patient comfort. But how important is it to get wet clothes off and is it something we can defer to a different point? We start off taking a look at an RCT on this very question.

Next up another RCT, this time looking at the efficacy of morphine, ibuprofen and paracetamol for patients with closed limb injuries. Which one, or combination, would you think would be most efficacious…

Lastly, following on from our most recent Roadside to Resus episode, we take a look at a paper on the association between end tidal CO2 levels and mortality in prehospital patients with suspected traumatic brain injury. This paper highlights really well the need understand the fundamentals that contribute to ETCO2 when applying to clinical practice. 

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

End Tidal CO2, or ETCO2 for short, is something that’s talked about pretty often in Emergency and Critical Care and that’s because it’s used a lot in the assessment and treatment of patients!

It’s got a big part to play in airway management, resuscitation, sedation and is also increasingly used in other situations. Some of these applications have some pretty strong evidence to back them up but others are definitely worth a deeper thought, because without a sound understanding of ETCO2 we can fall foul of some traps…

ETCO2 is a non-invasive measurement of the partial pressure of CO2 in expired gas at the end of exhalation. Ideally we’d like to know what’s really going on arterially with the partial pressure of arterial CO2 but we can use the end tidal because that’s an easy reading to get from exhaled breath, when it will most closely resemble the alveolar CO2 concentration.

Its value is reflective of ventilation but also really importantly is affected by the circulation, the circuit and how it’s applied. In the podcast we run through all of these aspects, its application to clinical care and also some of its pitfalls. 

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to the podcast, a new month, three more papers and discussion around the topics.

We kick off with a paper comparing mechanical ventilation in CPR compared to the more traditional hand ventilation; what difference does the machine make to ventilation in arrest and should we be changing to this strategy as a standard?

We've talked about aneurysmal subarachnoid haemorrhage a fair amount on the podcast and the second paper looks at the effectiveness of lumbar CSF drain compared to standard care with some pretty staggering results!

Lastly we take a look at a paper exploring decision making in prehospital trauma, specifically with regard to blood transfusion. This is a great paper to focus on the complexities of decision making, understand decision making strategies, recognise areas of weakness and consider how aspects of these can be used educationally and to improve emergency care for our patients.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

As we all know, rapid and effective resuscitation makes a huge difference to the chance of survival from a cardiac arrest.

If you’re going to pick a rhythm to have as the patient or as the Resuscitationist, then it’s going to be a shockable rhythm, so VF or pulseless VT as they hold the greatest chance of survival. You'll find an initial shockable rhythm in around 20% of cases & defibrillation alone may lead to a ROSC. So it’s absolutely imperative to get the immediate management spot on!

Whilst current practice is good, there are some aspects of care that we can improve on and make a real difference to outcomes in these patients, with those first on scene or at the bedside in a phenomenally important position to deliver life saving care.

In this episode we’ll be talking predominantly about refractory VF but the strategy will transfer to how we can also deal with refractory VT cardiac arrests. 

We'll be running through all of the following;

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to February's papers of the month.

Syncope is a really common presentation to the Emergency Department and it can be complicated to tease out those with a concerning precipitant from the others with a more benign cause. The first paper gives us some context to the management of these undifferentiated syncopes and provides a barometer for how stringently ESC guidance on the topic is followed.

Next up we take a look a huge RCT of transfusion thresholds in patients presenting with a myocardial infarction. Should we be restrictive in our approach, saving a valuable resource, or is it validated to transfuse more liberally in terms of the patients outcome?

Finally we take a look at a paper looking to tease out the predictors of post intubation hypotension in those getting a prehospital anaesthetic following trauma, with some interesting associations and factors to looks out for.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Fever is an incredibly effective mechanism to fight off pathogens.

Clearly, whilst many illnesses that cause a fever don’t require anything more than the body’s natural response, there are some patients in which a fever might represent a serious illness. Differentiating those serious illnesses from self-limiting presentations can be tricky at times, but can also be anxiety provoking for clinicians and parents, or carers of that child. 

In children the limited communication can make the diagnostic challenge of the origin of the fever a real challenge, along with the added difficult of gaining some tests. Differentiating those with a benign disease from those with a life threatening presentation can be a daunting challenge.

The numbers of presentations to healthcare providers are staggering. Paediatric fever has been reported to represent as high as 15-25% of all presentations in primary care and emergency departments, so massive numbers. Thankfully the prevalence of serious infections in children is low and is estimated at

Happy New Year!

We've got some great topic and in person events lined up for 2024 which we'll be able to share some more details about with you soon.

This month we look at an RCT of conservative airway management in patients with a low GCS following presentation with acute poisoning.

Next up we take a look at paper reviewing our diagnostic ability with dissociative seizures; this gives us some really valuable signs and symptoms to looks for and outlines how we can improve with these presentations.

Lastly we look at prognostic scores following out of hospital cardiac arrests with a study that compares four different scores. If reliable they have significant scope to help us to both prognosticate and give valuable information to family and loved ones on their presentation to ED.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

We know it's the festive season but we thought we’d try and cover an issue from which there appears to be no escape and is a particular problem at this time of year, queuing!

Whether we like it or not, this has become a factor for all of us working in emergency care, whether its delays getting your patient into the department, queueing down the corridor into ED, a prolonged stay in ED for an appropriate ward, or even in a physical queue to get out of the ED and onto an appropriate bed!

We are looking after our patients for significantly longer than we’re used to and this pushes the patient and the clinician into an area of care in which we have limited experience and comfort.

Rather than accepting delays and ignoring their inevitable impact on patient care, we need to move towards equipping ourselves with the skills and knowledge to fill that care vacuum and ensure that excellence in patient care continues throughout their time with the ambulance service.

So with that in mind, in this episode we’re going to think about some of the considerations and interventions that are required to ensure our patients remain safe and comfortable throughout their queueing experience. And to do that we’re going to draw on the concept of prolonged field care.

An article by Aehbric O’Kelley and Tom Mallinson recently authored a paper published in Journal of paramedic practice entitled “Prolonged field care principles in UK paramedic practice”. That article really provided the idea and stimulus for this episode, so thanks to them for all of the hard work and once you’ve listened to us waffle on you should head across to their paper for a far more eloquent explanation of it all!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

We've talked about Aortic Dissection before in our Roadside to Resus episode and the huge difficulties in picking out these rare but potentially devastating cases and this month we've got a fantastic paper on the topic! The DAShED study looks at patients presenting with symptoms that could be suggestive of aortic dissection and helps us understand the diagnostic challenge and approach to acute aortic syndrome, along with testing the characteristics of a number of decision tools.

Next up we look at a paper from Bendszus, an RCT of medical versus thrombectomy and medical treatment for acute ischaemic strokes with a large infarct, with some really powerful results.

Finally we look at a paper that shows some staggeringly different ROSC rates for patients in cardiac arrest depending on the size of the ventilation bag used!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Blood gases are really commonly used in ED, Critical Care, Respiratory Medicine and Prehospitally. In fact, you’d do well to walk 10 meters in an ED without being given one to sign off! But it’s for good reason, because they give you additional information about what’s going on from a respiratory and metabolic perspective in the patient.

And it’s probably worth mentioning at this point, this episode is going to be pretty ‘science-heavy’, there should be something in here for everyone; from the clinician that's been looking at these things for the last 30 years, to those that haven't started interpreting gases.

So arterial blood gases can tell you about the efficacy of the patients ventilation in terms of their partial pressures of oxygen and carbon dioxide levels and also from a metabolic perspective about other disorders of their acid-base balance. 

In the episode we'll be covering the following;

-Overview of blood gases

-Respiratory & metabolic sides of the gas

-Acidaemia

-Alkalaemia

-Bicarbonate or base excess?

-Compensation

-Oxygenation

-Anion gaps

-System of interpretation

-Venous gases

-Clinical application & examples of interpretation

We'll be referring to the equation listed on our webpage, so make sure you go and have a look at that and all the references listed.

Once you've listened to the podcast make sure you run through the quiz below to consolidate the concepts covered with some more gas examples and of course get you free CPD certificate for your TheResusRoom portfolio!

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Well this has been a huge month for Emergency Medicine and Critical Care in terms of papers!

We start off looking at REBOA; many resuscitationist's favourite concept or device with the much awaited UK-REBOA trial. What does the paper mean for practice in our Resus Rooms? Is this about to become a key part of trauma management? The paper is fascinating and one of the most though provoking we've discussed in a while.

Next up we look at CROYSTAT-2, another such anticipated trial looking at whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol.

Finally we look at a paper which describes a taxonomy of key performance errors in intubation and may inform our review and improvement of intubation in the ED.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

In this episode we’re going to cover the ‘atraumatic’ or ‘spontaneous’ pneumothoraces and focus on some new key guidelines from the British Thoracic Society which came out in July this year and also look at the relevant evidence on the topic.

There are pretty significant changes in the BTS guidance, it’s no longer about finding a pneumothorax, working out if it’s primary or secondary and then acting dependant on the size. It's now moved more towards looking at how the patient is clinically, taking into account the symptomatology, any big risk characteristics, whether it’s primary or secondary and then thinking about the patients wishes and priorities and nuancing the management plan towards those. 

This episode builds on some of the concepts we discussed in our Traumatic Pneumothorax podcast, so make sure you give that one a listen before clicking play on this one!

We'll be looking at the presentation, evidence, management and follow up, along with some trials that you can get involved in to help develop practice even further.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back!

This month we kick off looking at an RCT which looks at whether we should convey patients with a ROSC from a likely cardiac cause (without a STEMI in their ECG) to a cardiac arrest centre, or whether they would be as well served at their local Emergency Department. This paper has huge potential implications for service design for cardiac arrest patients.

Next up we look at another RCT evaluating if patients with a suspected uncomplicated appendicitis who have urgent surgical intervention benefit in terms of a reduced perforation rate, when compared with those who have surgery within 24 hours.

Lastly we take a look at the use of bicarbonate, calcium and magnesium in cardiac arrest and see if there use is supported in a huge cardiac arrest registry.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Delivering excellent End of Life Care in the Emergency Care is a real challenge but also a huge privilege and has formed some of the most rewarding parts of our careers to date.

We've been really keen to End of Life Care as a topic for a while now. Many, if not all of you, will have been out to these patients or received them in your ED. 

They aren’t simple cases to manage, with lots of issues around scope of practice, lack of alternative care pathways, confusion surrounding legal documentation and many studies have identified a lack of education around palliative care.

In this episode we’ll do our best to demystify those medico-legal terms, talk about care pathways and options that may be available to us, have a think about how we can talk with patients about death and then go on to discuss the clinical care we might need to deliver and the wider holistic nature of caring for these patients and their loved ones.

We're lucky enough to be joined by Ed Presswood, who's a palliative care consultant and clearly an expert on the topic. We gained a massive amount from this episode and we hope you find it really useful too.

You'll find the hyperlinks to some fantastic resources on the topic over on the webpage at TheResusRoom.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back to the podcast, coming to you all the way from Australia!

Rob and James were fortunate enough to be invited to deliver the keynote and an airway masterclass at this year's Australian College of Paramedicine International Conference.

At what was an amazing meeting, they were lucky enough to be able to catch up with some of the fantastic speakers to hear the key parts of their talks. In this episode you'll hear from;

Richard Armour, Mobile Intensive Care Ambulance Paramedic at Ambulance Victoria and PhD Candidate at Monash University; Identifying patients requiring chest compressions at overdose prevention sites

Nick Roder, MICA Flight Paramedic Educator, Ambulance Victoria and Teaching Associate, Monash University; Intubation in the setting of airways and inhalation burns

Dr Tegwyn McManamny, Intensive Care Paramedic and Lead Patient Review Specialist, Ambulance Victoria; Care of the Older Person - Delirium and Paramedic Detective

Olivia Hedges, Palliative Care Connect Lead, Ambulance Victoria; Palliative Care Connect Program

Chelsea Lanos, Advanced Care & Community Paramedic Researcher; Organ donation after out-of-hospital cardiac arrest in Canada - a potential role for paramedics

A huge thanks to ACP for the invite, Zoll for the support of the podcast and conference and to the fantastic speakers for giving ip their time to talk to us. We'll be back with another Roadside to Resus episode for you next week on End of Life Care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Rob & James

Welcome back to the podcast!

We're back with three really interesting papers after our summer break, with some great points to think about with regards to our practice and patient outcomes.

First up we take a look at the CT FIRST study which looks at the benefit of whole body CT in patients presenting with a ROSC after their out of hospital cardiac arrest with no obvious cause. Should we be more liberal in our imaging requests in this patient cohort?

Next up we have a think about thrombolysis for massive PEs. When it comes to these patients we have to consider the very real potential complications of thrombolysis and that can often dissuade us from treating them. This paper looks at an alternative dose in thrombolysis and describes some really interesting results.

Finally we take a look at a CT study which is scanning trauma patients after they have died. What injury patterns do they find, which injuries would have been amenable to treatment and are there any lessons on practice to be learnt?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Simon & Rob

Welcome back, this is our last podcast before our short summer break!

We start off having a look at the physiological effects of prolonged resuscitation with a supraglottic device compared with endotracheal intubation, which raises some really interesting questions about our ongoing ventilation strategy in resuscitations.

Next up we look at an RCT comparing RSI to DSI in critically injured patients and the effect on peri-intubation hypoxia.

Finally we take a look at the practice of lateral canthotomy for retrobulbar haemorrhage/orbital compartment syndrome. How effective is the procedure and how competent are EM clinicians compared to Opthalmogists?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Simon & Rob

So in this episode we’re going to run though the primary survey in trauma. This clinical assessment helps us identify and treat life threatening injuries and to rapidly intervene and correct them, so getting it right really matter1. 

How this is done is hugely dependant upon the setting (either pre or in-hospital) as it is affected by the access to the patient, the number of people there to contribute to care and the challenges that the scene or hospital environment might hold.

We run through a model of primary survey that looks to gain as much information as possible in a rapid and effective pattern and discuss the slightly different approaches we all take, along with  rationale behind them.

Finally we cover the communication of the primary survey to the team, strategies that we can undertake to achieve this and how this can affect the momentum and onwards care of the patient. 

We found this a really useful topic to consider in some depth and we hope it's of use to you too!

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

There have been some huge trials released over the last month and we've got three brilliant papers to discuss!

First up we take a look at an RCT on video versus direct laryngoscopy for patients requiring emergency intubation with the DEVICE trial. The VL versus DL debate has been ongoing for quite some time now, so is this a final nail in the coffin for DL?

Next up we take a look at an RCT of prehospital TXA use in patients at risk of bleeding from major trauma in the PATCH trial. The results seen in the trial look at a glance to oppose those seen in CRASH-2, so is this the end of TXA in this cohort of patients?

Finally we have a great paper giving us further information on whether we should we be initiating immediate antihypertensive treatment for patients admitted to hospital with asymptomatic hypertension.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

This is the first of two episodes looking at pneumothoraces. In this episode we're going to start out by taking a look at traumatic pneumothoraces.

Traumatic pneumothoraces are present in about a fifth of multiple trauma patients, so it's not infrequent to come across them and they can obviously occur in those with isolated chest injury too. Thoracic trauma occurs in around two thirds of multi-trauma cases and is classified as the primary cause of death in a quarter of trauma patients.

The clinical assessment carries with it a fair amount of dogma, including looking for tensions with tracheal deviation, so we'll be running through what the signs we should look for actually mean.

Then we'll move on to a detailed discussion about investigation strategies before finally looking at the guidelines and evidence on the topic, including which we have to intervene with, which we probably shouldn't and those in which there is much uncertainty...

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

ps; if you’re interested in getting your site involved with the CoMITED Trial then email comited-trial@bristol.ac.uk 

Welcome back to the podcast and to the first episode in collaboration with our new sponsors Zoll, a huge thanks to them in their support of free open access medical education!

First off this month we return to the topic of rib fractures; with an apparent shift in practice to the surgical fixation of multiple rib fractures, we take a look at an early vs late approach and consider the impact these results may have on trauma systems.

Next up it's a prehospital RCT assessing the use of a prehospital strategy including a single troponin to rule out acute coronary syndrome. Will this prove safe when compared to an in hospital strategy and what impact does it have on prehospital resources?

Finally we look at ventilation rates in cardiac arrest management. For as long as we can remember the guidance has been to ventilate at ten breaths per minute, but will a strategy involving a faster ventilatory rate yield better results?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

The last time we took a good look at head injuries was back in 2018 in our Roadside to Resus episodes and for all of the foundational stuff on incidence, assessment, management and loads more  make sure you go and check that episode out. 

But this episode is one of our new UPDATES episodes, because we’re pretty old now… and whilst we’ve been having a go at this for a while evidence and guidelines will have progressed, which clearly have implications on how we manage certain cases and that’s where these come in! So they’ll focus mainly on the last 5 years of practice.

The new NICE head injury guidance has just been released and it’s the first major overhaul since 2014.  Now we know it’s a UK guideline, but there’s some really key practice updates and evidence in there that’s relevant irrespective of where you find yourself listening this! 

So in this episode we're going to be having a look at the most recent TXA evidence, with in terms of indications, timing and dosing. We'll be having a look at the risk of intracerebral injury with regards to anticoagulants and antiplatelet agents and a few other bits and pieces that can help us inform and improve our care.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

This month we start off with a paper looking at the first pass success rate of intubation in cardiac arrest when performing continual CPR versus pausing.

We then come on to two really interesting diagnostic papers and our prehospital accuracy for identifying certain injuries; we take a look at the accuracy of HEMS clinicians in assessing the stability of a pelvic ring and subsequent application of a pelvic binder. And then we look at the accuracy of prehospital clincians in assessing for all life and limb threatening injuries.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Being in a situation of being unable to intubate and unable to oxygenate is an absolute time critical emergency. 

Focus needs to be paid to the techniques and strategy to deal with this situation. But we also need to consider steps to ensure it occurs at a low frequency and our decision making and recognition of the situation happens quickly and simply.

In the episode we’re going to be talking about a number of other aspects that are relevant for all emergency providers, irrespective of whether you intubate or not, along with how those aspects translate into everyday practice. 

We'll be covering bits around patient positioning, optimising simple ventilation via a BVM & supraglottics, all the way through to needle cricothyroidotomy and surgical airways.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back to the podcast!

This month we start off thinking about sepsis, specifically fluid management and whether a restrictive approach to fluid resuscitation in combination with earlier vasopressors is advantageous over a liberal approach.

Next we have a look at a study evaluating the diagnostic benefit of ultrasound in the prehospital setting.

Finally we have a think about the benefit that traumatic brain injury patients may benefit from with regards to beta blocker therapy.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So NOF's aren't the most glamorous of topics to cover on a podcast, but the difference we can make to patients but refining our care is huge. 

Neck of femur fractures have a high and increasing incidence. They occur predominantly in frail patients who have the greatest risk of complications, both from the injury and medical interventions. 

In this episode we'll be running through their presentation, discuss both the clinical and radiological diagnostics. We'll also be looking in depth about both pharmacological and non-pharmacological methods of pain relief and have a think about where fascia-iliaca compartment blocks sit with regards to pre and in- hospital practice. 

Finally we'll move on to the definitive surgical approach and in-hospital care.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back to the podcast!

ECMO-CPR is a growing conversation in the world of cardiac arrest management. This month we have a look at a paper which adds some great evidence to the overall picture; with an RCT on ECPR in refractory of out of hospital cardiac arrest. How will this compare to the amazing results from the ARREST trial?

Next up is a really informative paper looking at the utility of ultrasound in suspected testicular torsion in children, this may make a difference to your investigation strategy.

Lastly we look a a paper describing the journey of a quality improvement project on paramedic intubation and see the phenomenal results that the method led to.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So in this episode we’re going to be covering crush injury. 

When you think about it, visions of falling rocks, industrial accidents and high speed RTCs may come to mind, but actually a crush injury can be sustained in a huge variety of ways without such vivid circumstances.

Definitions according to the Faculty of Prehospital Care are that;

‘A crush injury is a direct injury resulting from crush. 

Crush syndrome is the systemic manifestation of muscle cell damage resulting from pressure or crushing’

So in the episode we’re going to run through all of the bits that we normally cover, from pathophysiology, to presentation and onto treatment. We'll also be looking at the controversy and evidence behind tourniquet use, fluid therapy, electrolyte management and much, much more!

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back!

Three more papers for you this month to inform and improve our care in acute and critical illness.

First up and following on from the recent DoseVF paper, we take a look at a study looking at the combined effect of vector change, esmolol and capping adrenaline administration in refractory VF with regards patient out ones. Could this be associated with even better patient outcomes?

Secondly we take a look at the utility of fentanyl lozenges in providing effective analgesia to patients in remote settings. Does this have potential for both prehospital and in-hospital patients prior to iv access.

Finally we cover a paper looking at prehospital management of acute behavioural disturbance; the need for restraint, the need for sedation and the subsequent effects on the patients.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Welcome back to our first Roadside to Resus episode for 2023!

We're back with the huge topic that is COPD. In this episode we're going to delve into the depths of the topic, helping us to deliver the best possible care for this frequently encountered presentation.

Along with the standard coverage from incidence, to pathophysiology, to presentation and treatment, we'll also be covering those topics that you've specifically asked for;

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome to 2023 and a very happy New Year!

We hope you managed to get some time with your loved ones over the festive period and we're back with the podcast again to kick off the new year.

First up, we take a look at a paper assessing whether there is benefit to treatment with thrombolytics or anticoagulants for patients in cardiac arrest due to a presumed MI.

Next up we look at the potential harm in administering steroids to patients with COVID-19 nor requiring supplemental oxygen.

Finally, we take a look at a paper assessing the potential use of point of care lactate in predicting the need for in-hospital blood product resuscitation.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So following on from our Bradycardia episode, we're going to look in detail at cardiac pacing.

Setting up emergency pacing in those compromised bradycardia patients can make a significant difference to patient outcomes, and doing so in a timely and slick fashion can be a real challenge.

In this episode we'll be discussing all forms of pacing, strategies for ensuring the greatest likelihood of success and the details of setup and analgesia/sedation strategies for external pacing.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Welcome back to 200th episode of the podcast! A huge thank to all of you for your support and engagement.

Three more papers for you this month to challenge thinking across a board range of Emergency Care. First up we take a look at DOSE VF, an RCT look at the best defibrillation strategy for refractory VF.

Next we take a look at another RCT looking at the potential benefit of dexamethasone, in order to reduce pain in patients suffering with renal colic.

Last up, we've talked a lot about the importance of first pass success in advanced airway management, but what (if any) is the association with mortality in prehospital RSI?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Acute Behavioural Disturbance (ABD), one of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients.

There is no widely accepted definition of ABD. Really it’s an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of;

In this episode we're going to run through ABD, it's causes, the approach and investigation. Excellent management of these cases relies upon high quality team working, planning, communications and strategies to keep all involved safe and we'll be discussing each of those in turn.

Enjoy!

Simon, Rob & James

Welcome back to the podcast and to November's Papers Of The Month.

First up we're taking a look at a paper that challenges the current American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines that recommend when right ventricular myocardial infarction, that patients are not administered nitrates due to the risks of compromise of cardiac output. 

Secondly we look at an RCT, with some really clever blinding, that looks at different BP targets for intubated and ventilated patients in ICU who have sustained a cardiac arrest.

Finally we take a look at a paper focussing on healthcare professionals’ perceptions  of interprofessional teamwork in the emergency critical incidents.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

We’ve covered tachycardias, both narrow and broad before, but we need to complete the set.  So this time we’ll be looking at the slower end of the spectrum, with bradycardias.

Bradycardias can be a physiological state in athletes, but they can also be of significant concern.

They occur due to a multitude of reasons, some cardiac and some not and they can require no treatment at all right up to those peri-arrest patients where you’ll be cracking open your critical care drugs and starting to pace them externally before getting them to definitive care.

In this episode we take an in-depth look at the cause, electrophysiological pathways, assessment and treatments for bradycardias.

Enjoy!

Simon, Rob & James

Welcome back to the podcast!

First up this month we're going have a think about fluid therapy, following an RCT focussing on those patients attending ED with moderate severity acute pancreatitis; are we flooding them with fluid & should we ease off?

Next we take a look at a paper evaluating the intubation performances between CCPs and physicians in prehospital anaesthesia of trauma patients.

Lastly we look at another RCT, this time comparing the benefit of surgical versus conservative management of significant chest wall trauma.

Enjoy!

Simon & Rob

Despite all the improvements that we have seen in trauma care over the past 20 or more years RTCs are still, sadly, a really common cause of both death and disability, with the number of deaths annually in the UK sitting somewhere between 1500-1900 per annum.

Survivors, who have serious injuries and are left with ongoing disabilities, total 22,000 people per year.

So anything we can do to improve care to these patients is definitely worth looking at and learning about!

Extrication is the process of injured (or potentially injured) patients being removed from vehicles involved in road traffic collisions. The fundamentals behind extrication have been based upon protecting the spine and not worsening an injury of it, but at the potential cost of other time critical injuries and with limited to no sound evidence base.

The EXIT project brings evidence to the practice of extrication and in this podcast we discuss the findings and implications for practice with the lead author Tim Nutbeam, Clare Bosanko (an EM & PHEM consultant) along with the three of us.

We also get the opportunity to hear from Freddie, a patient extricated from a high energy RTC and hear his perspective on Extrication.

Enjoy!

Simon, Rob & James

Welcome back to the podcast!

It's brilliant to be back after our summer break and we've got three great papers for you.

First up we take a look at a paper looking at the association the a geriatric assessment can make on the mortality of patients aged 65 years and older, admitted with significant injuries to our UK major trauma centres.

Next up we take a look at a newly proposed method to simple chest compressions in cardiac arrest, by comparing it to chest and abdominal compression and decompressions.

Finally we take a look at the diagnosis and management of TMJ dislocations and guarantee there will be a new technique in there for all of you!

Simon & Rob

Welcome back! This month we take a look at 3 papers covering the breadth of Emergency Care.

First up we look at a paper evaluating outcomes for patients discharged on scene by an EMS service; how many reattend ED, how many require ICU care and what is the associated mortality rate?

NEXUS and Canadian c-spine rules both incorporate the presence of c-spine tenderness when deciding whether to image the neck as a result of trauma. But what is the prevalence of c-spine tenderness without trauma and how might that affect our clinical assessment?

Finally we take a look at a paper focussing on the risk of laryngospasm in paediatric sedation; what is the risk, which factors make it more likely to occur, and what can we do to mitigate it's risk?

Enjoy!

Simon & Rob

So when people talk about patients having a high lactate we think about them being sick, it can at times be easy to slip into thinking that this equals sepsis or maybe ischaemia. And whilst the presence of a high lactate in the context of infection and ischaemia is important to note, there is a lot more to interpreting a raised lactate than may first be apparent...

So in this episode we’re going to delve down into lactate, have a think about what it is, what normal and raised levels are, consider the mechanisms behind it’s formation and breakdown and think about the causes of raised lactate. We'll then put this all together and have a think about how we can interpret and lactate levels ensuring we give the best treatment to our patients!

Enjoy!

Simon, Rob & James

So, as we all know, there are loads of presentations that we see in Emergency Medicine that require us to gain rapid access to the circulation. Either to administer medicines around the body or to get fluids into the circulation.

Now there’s a number of different ways we can get them into the circulatory system for them then to get to their sites of action, each of which comes with its pros and cons. There’s buccal, inhaled, intramuscular, sublingual, intranasal etc etc….

But, in the vast majority of cases we gain this access to the vasculature through intravenous access and a peripheral cannula. That means that iv access is a very common procedure in emergency care. The great news is that the equipment is cheap, there are multiple sites for insertion and it’s often feasible regardless of the patients age or presenting complaint. Compared to all the other options for drug administration, iv access and administration of drugs via the IV route, results in 100% bioavailability of all medicines because it avoids the first pass metabolism in the liver, and distribution around the body is rapid because it bypasses the need for absorption into the vasculature.

So that’s all good, so why are we doing an episode on intraosseous access then? Well, iv access and we as clinicians, are not infallible. And as we’re all too aware, gaining IV access can be challenging. There are other patient factors to like iv drug use, the morbidly obese and paediatric patients when everything is just smaller and more unfamiliar. So all of these factors increase the technical difficulty of iv cannulation. If we add to that some of the environmental issues we might find in the prehospital setting - so poor lighting or difficult patient access, it’s not a huge leap to realise that it would be great to have an alternative vascular access option available to a broad range of emergency care providers. And this is where IO access comes in.

So what will we be covering in this episode;

-A recap on the anatomy of bones

-Indications for IO access

-The evidence on IO access and administration

-Insertion site

-Needle selection

-Contraindications

-Case examples

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to June '22 papers podcast!

This month we start off with a look at rocuronium dosing in RSI; could a simple change of dosage lead to an increased first pass success for our intubations?

Next up we take a look at the use of TXA in trauma, with specific focus on gender based inequality in its use and a trial with shocking results.

Finally we take a look at a paper focussing on outcomes of cardiac arrest and cut-off points with regards to duration of resuscitation; could this help answer that ever-difficult question of when to stop?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

We talk a lot about the different skills involved in the management of the critically unwell patient; CPR, airway management, defibrillation, chest drains, RSI etc, etc…..but there is another aspect which is arguably as important and that is the non-technical skills involved in resuscitation.

In this podcast we discuss non-technical skills, followership, leadership and different models of working. What’s really important to remember in this episode is that at the centre of  leadership and follwership is a patient, or patients, that we’re trying to deliver the best care and outcomes for and that effective leadership and followership are key to achieving.

Now leadership and followership comes in a variety of places but for this episode we’re mainly going to look at the importance and way in which leadership and follower ship manifests itself in high acuity cases such as traumas and cardiac arrests but the concepts are translatable to all sorts of cases and parts of healthcare.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to May's papers of the month!

First up this month we'll be looking at an RCT focussed on prehospital intra-arrest management and comparing an early move in arrest towards ECMO-CPR and invasive treatment, versus remaining on scene continuing ALS until achieving a ROSC. Does E-CPR hold the promise we are hoping for?

Next up we take a look at another RCT on pad placement for electrical Cardioversion-BMI of AF, are antero-posterior pads superior to the standard antero-lateral position?

Finally we look at the potential for remote supervision of pre-hospital ultrasound, has technology moved the bar in what can be achieved?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

We have been wanting to do an episode on aortic dissections for quite a while now but you will see that what we’ve actually gone and done is created an episode on acute aortic syndromes…so we’ve done a great job of staying on point straight from the off!

In fairness, we’ve done this because it turns out that there are actually a few different potentially life threatening acute aortic conditions which we need to know about and getting them all into one episode seemed achievable, so let’s see how we get on with that!

Hopefully in this podcast we will try and improve your knowledge of these conditions and we’ll also discuss a couple of cases to bring out some key points.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to April ‘22 papers of the month podcast!

We start off this month with a paper looking at the effect of a structured airway course on first pass success in novice and HEMS clinicians.

Next up we take a look at the much discussed RePHILL trial; do packed red blood cells and lyoplas lead to better outcomes in patients with traumatic hypovolaemic shock?

Finally we take a look at the topic of over-diagnosis and a paper that has made us think and reflect really hard on our practice of Emergency Medicine!

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Debrief is an extremely important topic both in the prehospital and in-hospital environment. It offers the opportunity to clarify, reflect and improve on future practice. But partaking in and running a debrief can be challenging. So in this episode we'll be exploring debrief in a lot more detail.

We'll be covering both hot and cold debriefs, frameworks for debriefing and tips on what works well, as well as what sometimes doesn't.

To celebrate International Women's Day 2022 we have handed over the mics to three incredible colleague;

Gemma Richmond has worked for the Yorkshire Ambulance Service for 20 years. She joined as an Emergency medical technician and spent 10 years working on a DCA. She then took a full time position with the Yorkshire Hazardous Area Response Team and during that time qualified as a paramedic and remained there for 8 years. She is now currently seconded to work on the Yorkshire Air Ambulance as a HEMS paramedic

After leaving full time military service Clare Fitchett qualified as a Paramedic with South Central Ambulance Service in 2013. She joined Thames Valley Air Ambulance in 2018 and has been working as a trainee and then qualified Critical Care Paramedic since.

Finally Vicki Brown, who has been in the ambulance service for 20 years. She became a HEMS paramedic in 2006, joined Great Western Air Ambulance in 2012 and is currently working as an Advanced Practitioner Critical Care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to March '22 Papers Podcast!

This month we have a think about causes and coping strategies for Emergency Clinicians involved in stressful cases; what can trigger us and more importantly what can we do to mitigate these circumstances?

In our other two papers we have a think about ECMO-CPR and Resuscitative Thoracotomy, both relatively low frequency but high skill interventions. The papers look at outcomes and case selection and can give us more information about service setups and challenges, and also offer us an opportunity to mentally mode how we can best prepare and decision make in these cases.

Simon & Rob

So in our last Roadside to Resus episode we covered narrow complex tachycardias. In that we delved pretty deep into the normal cardiac conductance along with the clinical assessment and their management. This episode is going to build on some of that…so if you haven’t already given it a listen, we’d recommend you pause here, take a listen….and then come back on board!! 

But for those of you that have already listened, here we go with the bigger brother and even more exciting broad complex tachycardia episode!! Again we’ll be covering everything from the underlying electrophysiological abnormality, all the way through to the assessment and treatment of patients with these life threatening presentations.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

This month we’ve got three papers covering a wide variety of topics and practice in emergency care.

First up we’ll be looking at whether pre-charging the defibrillator prior to rhythm analysis in cardiac arrest can decrease our hands-off time.

Next we take a look at a paper that can help inform our assessment and investigation of trauma patients; looking at the risk of concomitant injuries with regards to specific levels of spinal trauma.

Finally have a think about how different methods of extrication affect spinal movements from road traffic collisions; will it make a difference to your extrication method and speed?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So in this episode we run through narrow complex tachycardias, not I hear you say a perfect visual topic for an audio platform like a podcast, but hold your horses…

No matter what your level, or your depth of understanding of narrow complex tachycardias, we really hope this will offer some extra knowledge and contemplation for both those of you, like us, that have been treating patient with NCT for decades, right through to those of you that are completely new to the topic.

We run through all the normal stuff like definitions, clinical context and electrical pathways. Then we have a think about those terms and concepts like node dependance, AVRT, AVNRT, WPW etc, and then we come back to the fundamentals of delivering excellent care and how we can use a structure of interpretation to decide how best to treat our patient both pre and in-hospital. 

We’ve tried to really nail down and describe some of the concepts in a way that should make this topic a lot easier to understand and most importantly help us all deliver excellent care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Happy New Year!

Well we’ve got three really excellent papers to start off your new year with!

First up we take a look at the complication rates seen when performing a prehospital thoracostomy; how frequent are complications and what could this information hold in improving our ongoing practice?

Next up we take a look at an RCT on the use of Calcium in the context of cardiac arrest. Can it’s inotropic and vasopressor effects translate into better outcomes for our patients?

Lastly we take a look at another excellent RCT comparing the use of a bougie to a stylet in adult emergency intubations; which will lead to a great first pass success and will the results lead to a change in or practice and teaching?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Critically unwell patients often present with inadequate oxygenation and ventilation, in this episode we’re going to explore some of the physiology of critical illness, look at how we can improve oxygenation and ventilation, take a look mechanical ventilation and have a think about how we can deliver this to a really high level.

We’ll be covering the following;

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to December’s paper of the month podcast!

In the first paper this month we take a look at a paper that assesses the utility of CT scans for patients presenting with fever of an unknown origin; could this help us identify the source more frequently and if so how often?

Next, we often focus on the specific of medical management in cardiac arrest, but what impact does witnessing a cardiac arrest have on bystanders and could this affect the way we interact and behave on scene?

Lastly we consider those patients that require a prehospital anaesthetic following return of spontaneous circulation from a medical cardiac arrest. Does the choice of induction agent between midazolam and ketamine affect the likelihood of hypotension and other complications?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Being involved in Emergency Care, by it’s very nature, sadly means that we will have to break bad news to patients and families both in the prehospital & in-hospital setting.

Breaking bad news well has benefits to both the recipient of that news and also to the provider delivering it. Teaching and education on the topic can be difficult to access and not always prioritised.

In this episode we run through some of the evidence around breaking bad news, techniques and structures to follow and talk about the practicalities of adopting these, along with our own varied personal thoughts and styles.

We hope listening to the podcast gives you an opportunity to reflect on how we could all work and improve on breaking bad news and also helps to make the process a little bit easier.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to the papers of the month podcast!

First up we take a look at a paper assessing the importance of symptoms and sings in suspected Cauda Equina cases and consider which factors we should be giving weight to, including whether a PR is appropriate.

Next up we take a look at a paper looking at electrical injuries presenting to the Emergency Department, the risk of significant injury and the appropriate investigations to perform on both high and low energy voltage injuries.

Lastly we take a look a paper looking at the use of vasopressin and steroids in in-hospital cardiac arrest and see what effect in has in the latest RCT.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon & Rob

So following on from the Roadside to Resus episode on intubation there were a lot of questions from listeners that we didn't have the opportunity to answer. These included some clinical aspects and also some really tricky issues around competency, governance and importantly who should and shouldn't be intubating.

We've separated this out from the main episode as a lot of the conversations are heavily opinion based and only our view on the topic. 

This is our first episode of this style and we'd love to hear any comments or feedback and also know if this is something you'd like to hear again for future topics.

Enjoy!

Simon, Rob & James

Intubation is a key part of advanced airway management.

Although some of you out there may not intubate, we’ll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes.

Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and learn the skill. This brings into question who should these limited opportunities to train go to, what defines competence, which patients now would benefit from intubation.

In this episode we’re going to cover these topics and more, including talking through how to fine your intubation technique as much as possible. We’re coming at this episode with our collective neonatal, ED and PHEM practice which all involve advanced airway management and it’s fair to say that we’re all passionate about delivering intubation and advanced airway management to the highest level possible. 

We hope this episode gives a further opportunity to consider the topic in great depth and reflect upon how we can all contribute to improving practice.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome to October’s papers of the month!

Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We’ve looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms.

Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests and think further about the decision making that goes into these complex decisions.

Finally we take a look at a huge trial assessing the use of balanced fluids versus Normal Saline in critically ill patients and gain more information about the strategy we should employ.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon & Rob

So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest!

There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!!

Some of the treatments we’ll discuss for patients with ACS can have a huge affect on morbidity and mortality and we can make a real difference to our patients. The ESC guidelines are a fantastic resource to take a look at and we've listen the papers that form the evidence we cover in the podcast.

We worry about missing ACS and conversely, with so many ‘suspected ACS patients’, we also worry about overly suspecting it and the subsequent burden of admissions and investigations that it may mean. We’re going to cover the approach to ACS in this episode in our standard format, all the way from definition, patho-physiology, assessment, investigations and management and cover aspects that are both new information and a sound revision of the topic.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back after our summer hiatus to September’s Papers Podcast!

Firstly we take a look at two different strategies for managing agitation in the Emergency Department, to achieve rapid control. Is haloperidol and midazolam, or ketamine alone, a better strategy?

Then we take a look at the results from RECOVERY-RS. We covered the design of the trial at it’s conception last year and this trial essentially looks to answer whether a strategy of high flow nasal oxygenation, CPAP or conventional oxygenation is best for our patients with suspected or confirmed COVID-19 when they present with hypoxia.

Lastly we turn to Rob and take a look at his recent publication on the use of cervical collars when dealing with a patient able to self extricate from a motor vehicle collision; how will the application of a collar or commands help with excessive movement?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon & Rob

Welcome to August 2021’s papers podcast!

Three more great papers for you this month which have challenged and informed our practice.

First up we look Impact of ambulance deceleration with patients lying flat vs 30 degrees head up on intracranial pressure in patients with a head injury.

Next, is a patient with a refractory VF arrest more likely to have a positive finding on coronary angiography than one with non-refractory VF?

And finally, in patients with blunt chest wall injury, does the presence of a flail chest indicate a worse morbidity and mortality compared to rib fractures alone? And what do the findings mean for our clinical examination focus?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

We're giving you all a summer break from us and we'll be back again with our Papers of the Month and Roadside to Resus episodes in September.

Enjoy!

Simon and Rob

So welcome back to another Roadside to Resus episode!

Pre alerts are a key part of the interface between pre hospital and in hospital care of the critically unwell patient, when made and received in an effective manner they can really benefit the patient and the system. But too often we hear of friction associated with pre alerts and recent discussions on social media has really highlighted this.

In this episode we explore the pre alert, the guidance that exists already on the topic, the challenges of both making and receiving those pre alerts and our four major questions; why we pre alert, what we should pre alert, how to pre alert and when to pre alert.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Another month and 3 more papers!

First up we have a look at a paper that has grabbed a lot of recent headlines in the form of TTM2. So we now seem to have the answer to whether comatose patients following out of hospital cardiac arrest benefit from therapeutic hypothermia over maintenance of normothermia.

Next up we take a look at a paper which adds some real value to our assessments of maxillofacial injuries and can help inform our assessment of the likelihood of fracture and need for imaging.

Lastly we take a look at the whether iv vs io access in cardiac arrest might make a difference to outcomes when it comes to the use of adrenaline.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon and Rob

So this time we're going to be talking about subarachnoid haemorrhage. So this is going to be a short and punchy look at a really important and interesting topic in subarachnoid haemorrhage.

We run through the approach to headache and then focus on the specific features and findings that we should be looking for with regards subarachnoid haemorrhage. We then consider who we should be investigating further, what value a CT head brings and the sticky subject of who should be going on to have a lumbar puncture.

Finally we consider the the management once the diagnosis of SAH is reached and how we can ensure the best outcomes for our patients.

At the time of recording NICE has published its draft version of Subarachnoid Haemorrhage Caused by a Ruptured Aneurysm; diagnosis and management, which will be a great resource once finalised.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

This month we've got three papers that have challenged our practice both from an in-hospital and pre-hospital perspective.

Firstly we consider a paper that looks at admission saturations for patients with exacerbations of COPD and compare this to the BTS guidance on oxygen therapy, regarding altering oxygen saturations for those proven not to be hypercapnoeic. Should we be aiming for 88-92% or 94-98%?

Next we look at a paper from the team at KSS looking at dispatch to older trauma victims and consider whether current triggers for HEMS dispatch are set at the appropriate level to catch those in this cohort that may benefit from critical care interventions.

Lastly we look at a paper evaluating the QRS width in PEA cardiac arrests and consider firstly whether a broad QRS complex is predictive of hyperkalaemia and secondly whether we would treat patients based off this finding?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon and Rob

So the Resuscitation Council UK have today published new guidelines on resuscitation based on the European Resuscitation Council 2021 Guidelines and recommendations from the International Liaison Committee on Resuscitation.

We were lucky enough to catch up with two key members of both ERC and RCUK, Gavin Perkins and Jasmeet Soar, gaining their valuable insights into the new guidelines.

As well as this Simon, Rob and James pick out some other key points from the guidelines and discuss how these may translate into systems and practice.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Welcome back to May's Papers of the Month Podcast!

Three more papers for you on three varied topics. We start off with the use of end tidal carbon dioxide in the content of prehospital head injuries.Taking a look at a paper delving a bit deeper into the utility of end tidal CO2 when compared with arterial CO2 measurements on arrival in ED, in patients having received a prehospital anaesthetic; how accurate is end tidal and what level should we be aiming for?

Next we consider the importance of frailty in the outcomes of our older trauma patients and the ability of three different screening tools in identification of this cohort of high risk patients presenting to our hospitals.

Finally we take a look at a treatment which some prehospital services have already employed and others are considering; the use of CPAP for patients presenting with acute respiratory distress. Does the evidence support its use?

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So last month we considered Maternal Emergencies and the approach and interventions we can make in order to minimise complications during pregnancy and during childbirth. As promised this month we're looking at the next step along the process and focussing on Newborn Life Support.

Dealing with newborns has the potential to be really stressful but hopefully by concentrating on the fundamentals and guidelines we'll all be able to approach the situation with greater confidence.

Let us know any thought and comments you have on the podcast.

Enjoy!

Simon, Rob & James

Well if last month was based on cardiac arrest, this month takes a deeper look at airways!

First up we take a look at a paper that benchmarks the use of video laryngoscopy, specifically with the C-MAC and gives some really useful information from a Swiss HEMS service on first-pass success, the relevance of operator experience on success and factors that alter intubation success.

Next up we're looking at blood in the airway with epistaxis...okay it's a tenuous link, but it pretty much works! The NOPAC study looks at the use of TXA in atraumatic epistaxis and compare it to placebo use, will TXA come up trumps in this setting?

Finally we take a look at the use of scalpel cricothyroidotomy within the London HEMS service over a 20 year period, with a number of things we can learn from this experience.

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So this is the first of a pregnancy related double-header, with the focus being firmly set on the mother this month and next month we’ll focus in on NLS.

This month though we’re going to be discussing maternal emergencies. Now many conditions that could fall into this category but, as much as we love a good yarn, we really can’t be here all day, so we’ve decided to focus on are the conditions that we are more likely to come across in either prehospital or EM practice. Those conditions in which we can make a really big difference to either the mum or the baby.

We’re talking antepartum haemorrhage, postpartum haemorrhage, cord prolapse, breech presentation and shoulder dystocia, all after we've set the scene on assisting with an uncomplicated delivery.

So what would be really good is if we could find someone to bring in some prehospital maternal experience too. Ideally, someone qualified as a midwidfe and paramedic…and we're incredibly lucky to have just that in Aimee Yarrington, who has joined us for the podcast!

As a background; PPH is the third leading cause of maternal death in the UK and the most common cause of obstetric-related intensive care admissions. APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Cord prolapse ranges from 0.1% to 0.6%. Breech presentation occurs in 3–4% of term deliveries. Shoulder dystocia has a reported incidence of around 0.70%. And the incidence of primary PPH continues to rise progressively in the UK, reaching as high as 13.8% in 2012–2013. So there's a good reason for us to be experts on these topics.

Let us know any thought and comments you have on the podcast.

Enjoy!

Simon, James & Aimee

So this month we've got a cardiac-arrest-fest for you! With 3 papers centered on the management of cardiac arrest, with some key points that will help inform and improve our practice.

First up we have a think about where patients with a presumed cardiac cause of their arrest should be transported to. Trauma networks in the UK have changed destinations for patients, but is there a patient benefit transporting this patients to a cardiac arrest centre and if so how much?

Next we look at the potential benefit to nurse-led cardiac arrests with a study that might change some thoughts on how we best run and collaborate our cardiac arrests.

Finally we take a look at an open access paper from SJTREM, looking at the use of serum markers to help us prognosticate in hypothermic cardiac arrest and in these really challenging cases there is some great stuff to take from the paper.

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Welcome back to the podcast and our next Roadside to Resus episode, this time we’re taking a look at Diabetic Ketoacidosis, DKA.

In this episode we’ll be getting our heads around the pathophysiology that underpins DKA, consider the clinical picture and severity of patients that present and look at both the in-hospital and pre-hospital management of these patients including topics such at fluid choice, insulin boluses and nasal ETCO2 for diagnosis of DKA.

Let us know any thought and comments you have.

Enjoy!

Simon, Rob & James

So three very different papers for you this month...

We start off having a look at a paper on the HINTS examination. This exam came to prominence a few years ago as a way to distinguish between central and peripheral causes of vertigo with a pretty amazing sensitivity and specificity. Since then many EM clinicians have brought it onto their practice and this paper seeks to assess how good the test is at the bedside in real life practice.

Next up we take a look at a paper assessing the injury patterns in trapped patients and consider the prevalence of injuries both with regard to spinal and other injury patterns and then consider the impact that this holds with respect to extrication.

Finally we have a look at a paper focussing on the inhospitable management of hypertension; the treatment strategies and the outcomes comparing those being treated during their inpatient stay versus this left untreated with some surprising outcomes...

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

So in this episode we’re going to have a deeper think about advanced airway management and specifically supraglottic use in the prehospital and ED environment. 

Many prehospital service have seen the removal of intubation from their scope of practice, and that’s understandably been received with mixed thoughts.

But this isn’t the end of ‘expert advanced airway care for all; in fact far, far from it… we’ve all heard people talking about ‘whacking in an i-gel’, but really utilising a supraglottic device to its maximal potential can make a huge difference to our critically unwell patients. 

We'll be running through an overview of supraglottic devices, the evidence surrounding their use, patient selection, patient positioning and size selection, placing a supraglottic device, troubleshooting and finally ongoing ventilation with a supraglottic device.

We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below.

Enjoy!

Simon, Rob & James

Happy New Year!

Well 2020 certainly wasn't what we were all expecting, so here's hoping for a phenomenally better 2021. We've got some really exciting episodes for you this year including Supraglottic Airways, Neonatal Resuscitation, Diabetic Emergencies, New Resuscitation guidelines and much much more!

We're kicking off the podcast year with three really interesting papers!

First up we consider the importance of first pass success of both supraglottic airways and endotracheal intubation in the context of cardiac arrest; a lot of attention has been shone recently on question of which approach we should consider after bag valve mask ventilation, but how important is the first pass of either of the approaches to the outcomes of our patients?

Next up we have a look at a paper that challenges the use of TXA in our patients with a severe traumatic brain injury after the publication of CRASH 3.

Finally we have another look at the mantra of 'GCS 8-intubate' with a systematic review which draws together all of the evidence across the age ranges and both traumatic and non-traumatic presentations.

Make sure you take a look at our new CPD apps on both Android and iOS to log your time listening to this episode.

Enjoy!

Simon & Rob

So for decades people have talked about Contrast Induced Nephropathy…or Contrast Induced Acute Kidney Injury, depending on the decade and location of discussion. The theory being that diuresis, increased urine viscosity and changes in vasoconstriction and vasodilation leads to a worsening of renal function following iv contrast administration.

It seems to come from the 1950’s where some patients were seen to develop acute kidney injuries following iv contrast. Now times have changed and treatments and contrasts evolved but the discussion around contrast induced nephropathy continues. At times these discussion can mean that some patients wait for scans in the Emergency Department whilst waiting for blood tests to come back first. But is this the right thing to do?

In this episode we take a look at the origins of contrast induced nephropathy, consider some recent publications on the topic and see how this translates to practice and applications of the most recent guidelines.

Reading around the topic has been hugely informative for us and we hope will be of benefit to you too!

Enjoy

Simon & Rob

Welcome back to December's Papers of The Month Podcast! Three more papers for you which will challenge and inform you practice.

First up we have a look at a systematic review and meta-analysis which considers the fluid choice in resuscitating those patients with suspected traumatic brain injury in the prehospital setting; should we be reaching for the hypertonic solutions, or is an isotonic fluid such as normal saline adequate?

Next we take a look at a paper that has received a lot of online discussion which looks at the two approaches of antibiotics or surgery for an appendicitis. This is a randomised control trial that looks to answer a question that the literature has dipped into over the last few years, but this RCT goes that bit further and will help give patients a good idea of the pro's and con's of each approach.

Finally we take a look at the UK national approach to oxygenation strategies in those patients receiving a prehospital emergency anaesthetic. How many clinicians provide PEEP, how commonly implemented is apnoeic oxygenation and do we all ventilate through apnoea? Gaining an understanding as to where our practice sits compared to others gives us the opportunity to consider the potential benefits and downsides of various strategies and may help unify practice to more streamlined working and better outcomes for our patients. We also get the opportunity to hear thoughts on the subject from one of the authors Dr. Amar Amshru, Emergency Medicine and and Pre Hospital Doctor in London and with Kent Surrey and Sussex Air Ambulance.

Enjoy!

Simon & Rob

Welcome back to the podcast!

In this episode of Roadside to Resus we're going to take a look Anaphylaxis, which has been highlighted on a national level of concern as NICE state ‘many people do not receive optimal management following their acute anaphylactic reaction’.

Much of the problem lies within a lack of understanding of what actually constitutes an anaphylactic reaction and the knock on effect this has to the treatment provided.

In this episode we'll explore the definition of anaphylaxis and the significant differences that can be seen in the presentation. We have a a think about the pathophysiology and reasons behind the variance in presentations and how this affects the importance of treatments available and their relative importance.

Anaphylaxis is known to have a a number of patients who have a biphasic reaction, it predicates the need to convey patients to hospital and a period of observation; however the frequency and severity of these biphasic reactions can help to inform this further and for that reason we take a look at the literature on it.

We've covered angioedema before in a separate episode, but we briefly cover the similarities and differences and how this affects management.

Lastly we cover the follow up and management that these patients require.

We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below.

Enjoy!

Simon, Rob & James

Welcome to November’s papers of the month podcast!

This month we kick things off looking at TXA in trauma and consider in complex scenes and resource limited environments if TXA could be administered effectively in an IM rather than IV route? We also get an authors inside view from Professor Ian Roberts.

Next up; does the anatomical location of a head injury affect the risk of an intracerebral bleed and could this affect those patients that can go without a scan?

And finally we have a look at the importance of a chest X-ray in COVID-19 and consider how accurate the X-ray is at both picking up and ruling out the infection.

Enjoy!

Simon & Rob 

So in our Toxidrome Roadside to Resus episode we covered the initial management of a poisoned patient, some of the constellation of features to look out for and the specific management. But what about specific agents and circumstances that require particular knowledge and management both in the prehospital environment and in ED?

Well in this episode we’ll cover these by running through;

We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below.

Enjoy!

Simon, Rob & James

Welcome back to the Papers of the Month podcast, once again we've got 3 more papers to inform, discuss and hopefully improve our practice.

First up we have a look at a paper which looks to quantify the prognostic utility of lactate in our sick Resus patients; we often look at the initial lactates and draw conclusions for what they mean, but this paper helps us understand the results a bit further.

For our patients that sustain a head injury, the NICE guidelines advocate that all patients on direct oral anticoagulants should have a CT head scan, irrespective of clinical findings or other high risk features of the patients history. Quantifying the risk that these patients have for an intracranial bleed is really important, as to date it isn't fully understood. Our second paper looks at this directly and can help inform practice, guidelines and discussions with patients.

Finally; we often think about how we can improve resuscitation of our patients in cardiac arrest, look for the latest treatment and evidence, but it can be easy to overlook how our actions can significantly affect their loved ones who may be present at this time. We take a look at a fascinating study looking at the impact of inviting patients in to witness the resuscitation in its entirety and the effect that this has in regards too PTSD. In our opinion this paper holds a huge amount to think about and is a game changer!

Finally keep an eye out for our CPD portal and app which is in the final stages of testing and will be out very shortly!! We'll be keeping you up to date on twitter @TheResusRoom with its launch Enjoy!

Simon & Rob

Drug ingestion both accidental and intentional accounts for a significant proportion of attendances at UK Emergency Departments and 999 calls.

In 2016 there were >2,500 registered deaths in England and Wales related to drug misuse, which had increased by nearly 60% in a decade.

So without a doubt we are all going to come across critically unwell patients with drug ingestions. But inappropriate drug use is not confined to illicit substances, with many prescription drugs being misused to ill effect and also overdosed in an attempt to end patients lives.

In this podcast we’re going to run through the assessment of patients presenting with a possible drug ingestion, cover the potential toxidromes you may encounter and talk about the management of these presentations. Specifically we take a look at serotonin syndrome, sedative toxidrome and both cholinergic and anti-cholinergic syndrome.

In next months Roadside to Resus we'll take a look at specific medications of overdose; paracetamol, beta blockers, calcium channel blockers and the intricacies of their management along with other key parts of critical care including the management of cardiac arrest due to toxicity.

Make sure to take a look at the references and resources below.

Enjoy!

Simon, Rob & James

Welcome back!!

So we've had a small summer hiatus and are now back with another Papers of The Month and a jam packed line up of episodes for the rest of the year!

We start off this month with a paper which looks to evaluate if there is any benefit on mortality with the use of checklists for endotracheal intubation.

Next up we take a look at the factors in cardiac arrest that are most important with regards to prognostication; what should your attention and handover be most focussed upon?

Finally we take a look at a paper suggesting that blood gases following ROSC can help us prognosticate for our patient and how this might this affect our practice.

Finally keep an eye out for our CPD portal and app which is in the final stages of testing and will be out very shortly!! We'll be keeping you up to date on twitter @TheResusRoom with its launch

All references can be found on our webpage at TheResusRoom.co.uk

Enjoy!

Simon & Rob