A UK Prehospital Emergency Medicine Podcast.
This podcast and associated website aims to:
- Share knowledge and expertise in the field of prehospital medicine with specific reference to the UK working environment
- Make this content relevant to all professional prehospital practitioners
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Further reading Matt has kindly provided a list of references from his Trauma Care talk which this podcast is based on: Peri-operative and critical care management of the brain – current evidence. Anaesthesia: Vol 77, No S1. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition Vasopressors in Trauma: A Never Event? : Anesthesia & Analgesia Blood pressure in trauma resuscitation: ‘pop the clot’ vs. ‘drain the brain’? – Wiles – 2017 – Anaesth...
Read more about the Cochrane injuries group: https://injuries.cochrane.org/about-us-0 Have a listen to the earlier TXA podcast here: https://phemcast.co.uk/2018/01/18/episode-26-tranexamic-acid/ Do you want to revise your clotting pathways and the mechanism of action of TXA?! Here are some links to the excellent Life in the Fast Lane: https://partone.litfl.com/clotting.html https://partone.litfl.com/unclotting.html Acute Coagulopathy of Trauma Tranexamic Acid The Resus Room podcast which discuss...
Road traffic collisions are a leading cause of death and injury. Following a road traffic collision many patients will remain trapped in their vehicle. Extrication is the process by which injured or potentially injured people are removed from their vehicle by the rescue services. Rescue service training focuses on the absolute movement minimisation of potentially injured patients’ spine and has developed extrication techniques with the focus of movement minimisation. Unfortunately these techniqu...
This is the book Jon quotes, “Pain is a symphony…” The International Association for the Study of Pain’s revised definition of pain is available here . If you’d like to read more about ‘nocebo’ i.e. the non-pharmacological adverse effects of an intervention, have a look at this article . Penthrox For more information on Penthrox, you can read about it in the BNF , The Emergency Medicines Compendium and on the manufacturers own website. Jon is the author of the Pain and analgesia chapter in the 2...
Before you listen to this new podcast, we encourage you to go back and have a listen to Episode 16: Blood which we released in 2017 outlining the available evidence about prehospital blood, and the background to the RePHILL trial. The RePHILL (Resuscitation with Pre-Hospital Blood Products) original paper is available here , and you can read more about the trial at the University Of Birmingham Clinical Trials site . On the day of publication, Critical Care Reviews hosted a Livestream which is av...
This podcast is dedicated to the memory of Emmanuel Cauchy. George’s adventures! Grading frostbite Stages of frostbite. From Cauchy et al, 2016. Grade 1 Grade 2 Grade 3 Grade 4 Stages of frostbite. From Cauchy et al. 2001 The GELOX study The Hyperbaric oxygen study described by Carron is now in print and available here . Guidelines The guidelines mentioned by Chris can be found on the Wilderness Medical Society website . References Cauchy et al. The value of technetium 99 scintigraphy in the pro...
Some useful videos: Hopefully you found the podcast interesting, but since this is quite a visual topic we have put together some videos to demonstrate some of the pathologies discussed and what they look like on ultrasound: How does ultrasound work? Want to know how to use ultrasound? This is a whole 45 minute introductory lecture. Although a face-to-face course is really required before you start on patients! The radiopaedia website is an amazing resource for all things imaging. Their section ...
Definitions UK definition (RCEM): It describes the sudden onset of aggressive and violent behaviour and autonomic dysfunction, typically in the setting of acute on chronic drug abuse or serious mental illness. Australian definition (NSW Health): Behaviour that puts the patient or others at immediate risk of serious harm and may include threatening or aggressive behaviour, extreme distress, and serious self-harm which could cause major injury or death. Toxidromes There are some superb resources o...
This was a joint podcast with our friends & colleagues at WEMCast – to hear more from them, have a look at their podcast back catalogue , and there’s more information on the World Extreme Medicine website . OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA Mosquito born disease Malaria risk areas. From: https://www.iamat.org/risks/malaria Malaria is transmitted through the bite of an infected female Anopheles mosquito. It is widely distributed throug...
Guidance documents College of Paramedics Statement on Intubation, available here . AAGBI Safer Prehospital Anaesthesia 2017, available here . Positioning From: http://anaesthesiatoday.blogspot.com/2013/03/10-common-procedural-basics_29.html Recommended Rich Levitan resources EMCrit 70 – Airway Management with Rich Levitan Airway axes From: McGuire B, Hodge K. Tracheal intubation. Anaesthesia & Intensive Care Medicine. 2019. 20(12);681-686. From: https://veteriankey.com/tracheal-intubation/ E...
From: https://www.bbc.co.uk/news/uk-wales-46441129 From: https://www.ultimatekilimanjaro.com/blog/should-i-use-supplemental-oxygen-on-kilimanjaro/ A portable hyperbaric chamber (Gamow bag) From: https://litfl.com/hypothermia/ Classic stretcher technique Improvised rucksack stretcher technique Want to know more? This is one of the organisations Lucy mentions: British Exploring And this is the Global Health MSc The Wilderness Society Guidelines are available here . This is the link to the Wilderne...
Some facts Drowning is important: 1,000 people drown every day, 2 every 3 minutes, 41 per hour. It is the world’s 3rd leading cause of accidental death: 3.6 million people over 10 years. Disease of youth 64% < 30 years old 43% < 15 years old 25% < 5 years old Male: female ratio 2:1 In 40%, alcohol is on board 4 stages of Immersion associated with particular risk in drowning Initial Responses/Sudden Death (first 3-5 min) Skin cooling Short-Term Responses (5-30 min) Superficial Nerve and ...
https://phemcast.co.uk/wp-content/uploads/2020/05/covid-02-05-2020-18.41.mp3 Case definition Current case definition for COVID-19 can be accessed here . Risk stratification This is the Emergency Medicine Specialty guide we discussed in the podcast, which includes use of the NEWS and 40 step test (edit: since recording the podcast yesterday (!) we’ve been made aware of the Sit to Stand test ). Here is a review of both if you’d like to read more. PPE As at May 1st, the advice from PHE is ‘ There i...
https://phemcast.co.uk/wp-content/uploads/2019/09/infant-with-fluid-clarification.mp3 A: Optimal airway position for infants Note how a rolled towel is placed under the baby’s shoulders to allow space for the occiput and avoid flexion of the neck and airway. From: https://www.jems.com/2017/02/28/an-overview-of-ems-pediatric-airway-management/ ‘B’ assessment Video links to examples of children with signs of respiratory distress: Stridor Grunting Increased work of breathing ‘D’ assessment Example ...
https://phemcast.co.uk/wp-content/uploads/2019/07/back-pain_final-12072019-17.13.mp3 So, where is the Cauda Equina? From Core EM How does a herniated disc cause CES? This fab infographic summarising the key points about the CES guidance was produced by @DrLindaDykes and @saspist. Here is the full guideline from The Society of British Neurological Surgeons and The British Association of Spinal Surgeons. NICE guidance on Low back pain and sciatica in over 16s: assessment and management NICE clinic...
https://phemcast.co.uk/wp-content/uploads/2019/03/f-psychosomatic-final-31032019-08.27.mp3 Many thanks to Suzanne O’Sullivan for her time in putting this podcast together. Her excellent books “It’s all in your head” and “Brainstorm” are well worth a read. It is certainly one of the PHEMcast recordings which is going to change my own practice the most. We can all find these patient’s challenging to look after – we often fail to communicate effectively and meaningfully. This is understandable as s...
https://phemcast.co.uk/wp-content/uploads/2019/03/ketfinal.mp3 Huge thanks to the team at World Extreme Medicine and WEM Cast for sharing the interview with Richard Harris. Dosing These are a guide only, each patient will need a bespoke approach depending on their pre-existing condition, degree of cardiovascular compromise, conscious level and drugs already administered. Clearly you also need to remain within your scope of practice and the guidelines for your organisation. For analgesia (IV/IO):...
https://phemcast.co.uk/wp-content/uploads/2019/01/stroke_final.mp3 The Danish mnemonic to help remember the elements of a cerebellar neurological examination: There are lots of Youtube videos to demonstrate these signs, here are a few which I thought were particularly helpful: Disdiadochokinesis Ataxia Nystagmus Intention tremor If you would like to read more, there is a blog post Martin and I wrote here on the subject of dizziness, including some videos demonstrating elements of the HINTS exam,...
https://phemcast.co.uk/wp-content/uploads/2018/10/head-injury_final.mp3 Quite a few of our previous podcasts include content which is relevant to this Head Injury one. Why not go back and have a listen to: Episode 3: Hyperoxia Episode 20: End Tidal Carbon Dioxide Episode 28: LOST (Low Output State in Trauma) Munroe-Kellie Doctrine The Munroe-Kellie Doctrine is illustrated by the following pictures: Or, alternatively, by Elfyn’s pint of Guinness analogy! Autoregulation Allows giraffes to drink fr...
https://phemcast.co.uk/wp-content/uploads/2018/07/mi.mp3 Another invitation to the Trauma Care Conference this year inspired us to combine two of the excellent speakers into this podcast considering major incidents. Thanks to both our speakers for sharing their talks from the conference. Trauma Care offer more than the annual conference; there are monthly webinars and regional meetings too, click here for more information. The Joint Emergency Services Interoperability Programme (JESIP) website a...
https://phemcast.co.uk/wp-content/uploads/2018/04/lost-final.mp3 Cardiac arrest is the end point, it is the symptom, not the diagnosis. The pathophysiological process varies, and this is particularly relevant in trauma vs medical. In medical cardiac arrest, the pathological processes tend to affect the heart’s ability to pump: eg primary cardiac event, chemical/electrolyte abnormality, but full circulation. In trauma the process is generally not primarily due to pump failure, but due to hypovola...
https://phemcast.co.uk/wp-content/uploads/2018/01/checklists_final.mp3 We recommend reading Atul Gawande’s book ‘The Checklist Manifesto’. It’s a well written, fascinating story about the introduction of the WHO Safer Surgery checklist and the impact it had. This link will take you straight to Amazon if you want to buy a copy (other internet retailers exist!!) To understand the how human factors failed in the death of Martin’s wife, Elaine, please watch this video: The fabulous Life in the Fast ...
https://phemcast.co.uk/wp-content/uploads/2018/01/txa-final.mp3 The paper which we discuss in the interview is available open access here How does tranexamic acid work? Taken from: https://pbrainmd.wordpress.com/2015/10/15/1335/ Critical appraisal aids To understand more about hierachy of evidence and how a systematic review fits into this please have a look at these resources available from the Cochrane group. http://consumers.cochrane.org/levels-evidence http://training.cochrane.org/path/grade...
https://phemcast.co.uk/wp-content/uploads/2017/12/tp2-final-11_11_2017-00-30.mp3 Where can you undertake decompression of a pneumothorax? Be particularly careful when using the 2nd intercostal space mid-clavicular line that you are sufficiently lateral. For example, here are the locations identified as ‘2nd ICS mid clavicular line’ amongst 25 EM physicians in a 2005 EMJ paper . From http://emj.bmj.com/content/22/11/788 The Three Kings: George Clooney’s recommended approach to decompression of a ...
https://phemcast.co.uk/wp-content/uploads/2017/12/tp-1-fin-11_11_2017-00-08.mp3 Firstly, go and read Simon and Tim Harris’ great 2005 paper on the subject which we reference repeatedly in the podcast. It is available free open access here . A pneumothorax exists when air accumulates in the potential space between the visceral and parietal pleura: From: www.wisdomjobs.com A tension pneumothorax exists when the air in the pleural cavity is under high pressure resulting in compression of the surrou...
This episode delves into the history, evolution, and practical application of intraosseous (IO) access, a crucial technique for rapid vascular access in critical care. It features discussions on the development of IO devices, their use in military trauma settings, and detailed anatomical guidance for proper insertion. Experts share insights into optimal sites, needle selection, and techniques to maximize success while minimizing complications.
Guest contributor: Lauren Weekes https://phemcast.co.uk/wp-content/uploads/2017/09/et-06092017-16-24.mp3 What is ETCO2? % or partial pressure of carbon dioxide measured somewhere near the mouth at the end of a normal exhalation (hence end tidal, end of tidal volume breath) To get a measurement the following systems need to be functioning: Metabolically active tissue to produce CO2 Circulation & cardiac output to carry that CO2 to the lungs in blood Transfer of CO2 between the blood and the a...
https://phemcast.co.uk/wp-content/uploads/2017/07/surg.mp3 The West Midlands surgical skills course offers cadaveric training for PHEM and EM practitioners on rare life saving procedures. Click here to go straight to their page. Anatomy The Guidelines Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk et al. Difficult Airway Society: Intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1...
