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Anaphylaxis is one of those conditions we think we have got pretty well sorted. Recognise it early, give adrenaline, support the airway and circulation, and crack on. And in fairness, for the vast majority of patients, that approach works really well. But in this Roadside to Resus episode we take a step back and ask a pretty uncomfortable question, have we actually been thinking about anaphylaxis in the wrong way? Using some fascinating new evidence from the UK National Child Mortality Database,...
This month's Papers of the Month is a real mix of papers that challenge some of the things we think we know, whilst also highlighting just how important systems and processes are in improving patient care. We start with intracerebral haemorrhage and the tricky issue of blood pressure management. We've all been taught that early, aggressive blood pressure reduction is key, but this paper raises some important questions about whether we may sometimes be overshooting. It looks at whether rapidly dr...
Timely and effective defibrillation is fundamental to excellent outcomes in cardiac arrest care. But there is a growing body of evidence suggesting that how we deliver those shocks may matter just as much as when we deliver them. Over the last few years we've seen increasing interest in alternative defibrillation strategies, particularly AP pad positioning and double sequential external defibrillation, and the potential impact they can have on outcomes in refractory VF. The DOSE-VF trial was a l...
This month we're heading firmly into the prehospital and community space, looking at how we make decisions when the diagnostics are limited and the system around us is evolving. We start with a really practical question around traumatic pneumothorax. How good are we, clinically, at spotting the patients who actually need urgent decompression? This paper takes a hard look at the performance of the classic signs we're all taught, and challenges just how much we can rely on them in isolation when i...
Decision making sounds like a slightly academic, niche topic… but in reality, it sits underneath every single thing we do in emergency and pre-hospital care. Every patient contact, every test we order, every treatment we start and every one we choose not to – is a decision made in an environment that is time critical, information-light and full of uncertainty. In this episode we take a step back and look at how we actually make decisions at the front door and on the roadside. We talk about why t...
March's Papers of the Month is here and we've got three absolute crackers to get stuck into. First up, we head prehospital to explore pseudo-pulseless electrical activity. This review challenges us to rethink how we approach organised electrical activity without a pulse. We discuss the role of POCUS, the concept of treating profound shock rather than "arrest," and what this means for decision-making and management. Next, we move to cardiac arrest physiology with a systematic review examining int...
This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial...
Welcome back to February's Papers of the Month! We start this month looking a the right place to perform a prehospital anaesthetic. Traditionally we've been taught it should be somewhere with 360-degree access to allow the greatest safety, which means intubating in an ambulance and other locations are a no-go. But does it actually reduce complications, and what about other locations and situations? This paper explores whether location is associated with outcomes, or whether it might actually be ...
Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm. In paediatric seizures, time really matters. In this episode we take a step-by-step look at how to a...
Welcome to January's Papers of the Month, which marks 10 years of the podcast! First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quantifies the impact of post-RSI hypotension in a dramatic way and the associated increase in 30-day mo...
Welcome to this special edition of Roadside to Resus where we're diving into some of the progressive and practice-defining developments in pre-hospital emergency care. This episode brings together a superb group of clinicians, educators and leaders who are shaping the future of PHEM across the UK, and we caught up with them at the recent Faculty of Pre-hospital Care Conference entitled 'The Wider World of Pre-hospital Care'! We start with Pam Hardy, the Chair of the FPHC, who offers an introduct...
December brings us to the final Papers of the Month for 2025 and we're finishing the year with three studies that challenge assumptions across critical care and resuscitation! This time questioning the role of arterial lines in shock, looking at the true prognostic value of end-tidal CO₂ in cardiac arrest and finally to airway management in neonates. We start in the ICU with the EVERDAC trial, a large multicentre RCT exploring whether early arterial catheterisation in shock truly changes outcome...
Whether you're just stepping into your first cardiac arrest or you've been running them since the days of paddles, this one's for you. The 2025 resuscitation guidelines have landed after further collaboration between ILCOR, the ERC and the Resuscitation Council UK and in this episode we break down exactly what's new, what's stayed the same, and how it all fits into day-to-day practice. Across the board the 2025 updates represent evolution, a steady refinement of evidence rather than wholesale ch...
This month we've got four cracking UK-led studies that really speak to how pre-hospital and emergency medicine continue to evolve, not just in the kit and skills we use, but in how we think about the whole patient journey. We'll start with a paper fromAnaesthesia with Pallavicini et al., exploring pre-hospital central venous access for patients in haemorrhagic shock. Drawing on London's Air Ambulance experience, it shows that large-bore central catheters can be placed safely and effectively, del...
How, when and why to make the call… The pre-alert is one of the most powerful and sometimes most painful parts of emergency care. It can feel like the Spanish Inquisition, trigger tension between pre-hospital and ED teams, or drop another challenge into an already overflowing department. But done well, a pre-alert isn't an irritation; it's an opportunity to line up critical care for the next patient and genuinely improve outcomes. In this episode, Simon, Rob and James break down The UK NHS Ambul...
This month we've got three really interesting papers that shine a light on aspects of cardiac arrest management that many of us will recognise from clinical practice. First up, we look at the feasibility of arterial line placement during ongoing cardiac arrest in the Emergency Department. In our SPEAR episode we talked about the balance between securing invasive monitoring versus the potential distraction from other essential parts of resuscitation. This paper takes a pragmatic look at whether a...
a focus on its acute presentations and the care we can deliver to improve outcomes for our patients. Sickle cell disease (SCD) is a lifelong inherited blood disorder that affects over 15,000 people in the UK, and millions worldwide. It's caused by the production of abnormal haemoglobin molecules, which distort red blood cells into a crescent, or "sickle," shape. These rigid cells can block small blood vessels, leading to painful vaso-occlusive crises and organ damage. While the condition has lon...
Welcome back to September's Papers of the Month. We've got three cracking studies for you this time, each tackling really core questions in pre-hospital and emergency care and each giving us plenty to chew over when it comes to the evidence base and what it means for our practice. First up, we're heading down under to Sydney with the PRECARE pilot feasibility study on pre-hospital extracorporeal CPR for refractory cardiac arrest. Now, we all know survival from refractory OHCA is pretty dismal wi...
Welcome back! First up a paper to challenge the way we think about rhythm recognition in cardiac arrest to start with, looking at the rate of VF identified on echo but not on the defibrillator. We have a huge amount of strategies to rule out acute coronary syndrome in the UK, our next paper looks at the clinical effectiveness of these, whilst also giving us some hugely important information about the incidence of ACS in those presenting to Eds. Finally we look at a paper quantifying the effect o...
This is a pretty special episode! If you're involved in cardiac arrest management or care of critically unwell patients then there's some ground breaking practice we'll be discussing with the two founders of the SPEAR course; Jon Barratt; Lt Col, British Army Emergency Medicine and PHEM Consultant, University Hospitals of the North Midlands Clinical Lead - Research and Clinical Innovation, Yorkshire Air Ambulance MERIT Consultant, West Midlands Ambulance Service Senior Lecturer, Academic Departm...
Welcome back to Papers of the Month! Three more papers to both inform and challenge our practice across the spectrum of emergency care. First up we look at a systematic review and meta-analysis on noradrenaline vs adrenaline for our medical post-ROSC patients; what evidence exists out there and should we all be delivering noradrenaline as our first line treatment for those with shock? Next up a paper to really challenge the treatment algorithm for status epilepticus in paediatrics, with an RCT o...
This episode delves into the complexities of acute pain management, revealing how current practices in emergency and prehospital care often fall short despite pain being a prevalent complaint. It covers the multidimensional definition of pain, practical assessment methods, and a range of pharmacological and non-pharmacological strategies. Discussions include overcoming clinician biases, addressing specific challenges like drug-seeking behavior and chronic pain, and ensuring effective discharge planning.
Welcome back to June 2025's papers podcast! Having been cynical about CPR feedback devices in the past we take a look at a recent paper on their use and their potential impact to both ROSC and survival for patients, when compared to standard practice; is it time to integrate them more definitively into our practice? Next up we take another look at the use of adrenaline in traumatic arrest. We've covered this before and there's some interesting data and discussion to be had around the topic and t...
Welcome back! In this episode, we're diving deep into something we all think we know, the Glasgow Coma Scale. The GCS has been a fundamental part of assessing patients with altered consciousness for over 50 years. You'll find it in trauma scores, neurology exams and practically every prehospital and ED handover. But here's the thing, is it as reliable and useful as we think? In this episode, we'll explore the origins of the scale, what it was designed for and how it's been used (and maybe misuse...
Welcome back to the podcast! We've got three papers this month covering the breadth of Emergency Care presentations and locations; from prehospital arrests, ketamine for analgesia in trauma and those complex elderly patients presenting with abdominal pain. First up we look at the use of prehospital thrombolysis for out of hospital cardiac arrest, something some critical care services are using for suspected PEs and MIs. But what are the outcomes for these patients and how accurate are the clinic...
Opioid toxicity is a major and growing challenge across the UK and beyond, with nearly 10 deaths every day from opioid overdose and over a million adults using Class A drugs annually, the impact on emergency services is enormous. In this episode, we're diving deep into the recognition and management of acute opioid toxicity in the emergency setting, including the reversal using naloxone. We'll run through; The scale of the problem, including the rise of novel synthetic opioids like fentanyl and ...
Welcome back to April's Papers of the Month! First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at ...
Welcome back to The Resus Room! This time, we're diving into the fascinating and often overlooked world of electrical injuries. From household mishaps and workplace accidents to tasers and even lightning strikes, electrical injuries can range from minor shocks to life-threatening cardiac arrests. As always, we'll be taking you through the full spectrum of care, from first contact at the roadside to critical management in resus. And let's be honest, there's a real lack of clear guidance out there...
Welcome back to March 2025's papers podcast! We start off this month with a fascinating paper looking at the experiences of relatives who were witness to unsuccessful resuscitation. We often talk on the podcast about the impact of medical or technical interventions, but this paper offer us an opportunity to consider the huge impact of our non-technical elements of practice and reflect on how we can best support relatives whilst still performing resuscitation to the best of our abilities. Next up...
Cardiac Arrest in pregnancy affects around 1: 12-30,000 women in the developed world. As you'd expect the risk of death for mother and child is extremely high, but some causes of arrest are reversible and we can make a real impact with our care and treatment of these cases Now it goes without saying that these are some of the most emotive, complex and technically challenging Resuscitations that you could think to be involved in; by definition young female arrest with unborn babies involved. Than...
