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 ...
Apr 01, 2021•29 min
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 w...
Mar 15, 2021•1 hr 43 min
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 potenti...
Mar 01, 2021•37 min
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 ...
Feb 15, 2021•59 min
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 pat...
Feb 01, 2021•36 min
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 d...
Jan 18, 2021•1 hr 8 min
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 ...
Jan 01, 2021•32 min
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 treatmen...
Dec 14, 2020•25 min
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 dis...
Dec 01, 2020•37 min
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...
Nov 16, 2020•1 hr
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 th...
Nov 01, 2020•32 min
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; Paracetamol poisoning and treatment Calcium channel blocker overdose Beta blocker overdose High dose insulin e...
Oct 15, 2020•1 hr 1 min
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 dire...
Oct 01, 2020•33 min
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 ef...
Sep 15, 2020•59 min
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...
Sep 01, 2020•31 min
So this is our last episode before a small summer hiatus, so it better be a good one! Journals are littered with some great articles at the moment, so we've chosen 3 great papers that cover a number of really important EM topics. Over the last few years more emphasis has been put on a more conservative management on pneumothoraces and following that trend we take a look at a paper evaluating the safety of using a small bore chest drain for the delayed management of haemothoraces, compared with l...
Aug 01, 2020•33 min
The more you delve into cardiac arrest, the more it seems that delivering the essentials well is the key to great outcomes; timely recognition, high quality chest compressions, with early and appropriate defibrillation. But is ultrasound in cardiac arrest a layer that we should all be adding in as a standard. It holds the potential to not only prognose outcomes from cardiac arrest, both medical and traumatic, but also to add a level of diagnosis of potentially reversible causes. In this podcast ...
Jul 20, 2020•53 min
There are more great pieces of research to enjoy this month! We start off with a paper following on nicely from our Roadside to Resus episode on Stabbing, which looks at the ability of prehospital providers to predict whether stab injuries penetrate to deep structures, or are purely superficial from clinical assessment. Next up we take a look at a paper using high sensitivity troponin and their limit of detection, to assess whether we could be safely discharging patients earlier from the emergen...
Jul 01, 2020•30 min
Tranexamic Acid (TXA) has gained a significant amount of attention over the last few years as multiple studies have shown it's utility in decreasing haemorrhage and associated mortality. It has become part of major trauma guidelines, post part haemorrhage protocols and many have adopted it to the management of traumatic brain injury. The findings have been very similar across a spectrum of haemorrhage disease processes and from this further interest in expanding TXA's application to pretty much ...
Jun 18, 2020•44 min
Welcome back to June's Papers Podcast! Traditionally when you're taught about working a patient up for a potential diagnosis you'll find a list of signs, symptoms and tests that you need to perform in order to obtain your diagnosis. What that teaching doesn't tell you is how important each of those aspects is and this month we take a deeper look at this for pneumonia. We look two papers, one focussing on the clinical findings both in signs and symptoms and then a further paper on the importance ...
Jun 01, 2020•26 min
Transfers of patients happen all the time. It's easy to think about transfers as only those that involve an ambulance and moving patients from one hospital to the next, but in reality it's far more extensive than that. We all move patients all the time, whether that be the unwell patient in the upstairs of their house to the ambulance, the patient in the Emergency Department to the CT scanner or another ward, or the more traditional interhosptal transfer. Transfers of patients are inherently hig...
May 25, 2020•1 hr 6 min
Welcome to May's papers of the month podcast. Hope you are all well and keeping safe. This month James joins Simon to discuss some of the great work published following the London Trauma Conference, all available in the hyperlinks on the website. First up we have a look at the incidence of prehospital hypotension and hypoxia in patients with suspected traumatic brain injury and the ways in which we might look to mitigate against these complications. Next we have a think about end-tidal CO2 level...
May 01, 2020•23 min
Fractures of the pelvis are found reasonably often in major trauma, but they're a really challenging presentation. They are difficult to assess and accurately diagnose in the prehospital setting, mortality rates are high, particularly in patients with haemodynamic instability and there are often associated injuries. Associated mortality from patients with pelvic fractures who reach hospital is reported to be up to 19%, with mortality rates as high as 37% reported in the presence of haemodynamic ...
Apr 20, 2020•58 min
So COVID-19 has produced a multitude of challenges to healthcare providers, the response to these challenges has been phenomenal. One uncertainty is the strategy we should employ for hypoxic respiratory failure and several high quality guidelines have presented conflicting advice for the severely hypoxic patient. The Warwick Clinical Trials Unit has already begun recruiting patients to their RECOVERY-RS trial, which is open for hospitals in the UK to sign up for. This looks at 3 different strate...
Apr 10, 2020•18 min
First we hope you're all well. The world has changed dramatically over the the last few weeks and you are all doing a phenomenal job of providing healthcare under extremely challenging circumstances. We are determined to add a bit of normality to life with a non-COVID-19 papers of the month, full of bad jokes and some EBM. This month we're looking at intubation of acute alcohol intoxication in ED. We take a look at a paper that tries to quantify the risk of patients developing an intracerebral i...
Apr 01, 2020•33 min
Excellent practice is led by following the high quality evidence based medicine, and there have been a lot of great papers published in the last 12 months! We were kindly invited to the Faculty of Pre Hospital Care Annual Scientific Conference to give a talk on the top 10 papers over the last year. Sadly, but completely understandably, the conference had to be cancelled due to COVID-19. In this podcast we cover the talk which is based on 2 cases that are common to PHEM;a major trauma and a cardi...
Mar 17, 2020•51 min
We've got a great spread of topics for you this month, stretching all the way from Prehospital Critical Care, to core Emergency Medicine topics. Those of us seeing 'non-specific' complaints will appreciate how difficult they can be to diagnose and manage effectively. We have a look at a paper that helps characterise this group and give some context to their mortality risk. This may well help inform conversations and decision making with this patient group. Recent literature has looked at a more ...
Mar 01, 2020•32 min
Figures for the year ending September 2019 showed a 7% rise in offences involving knives or sharp instruments recorded by the police (to 44,771 offences). This is 46% higher than when comparable recording began (year ending March 2011) and the highest on record. The news is sadly littered with cases of knife crime and terror and whilst we may have thought of stabbings as confined to small pockets of the country, sadly it now seems that we all have or all will be dealing with such cases. The vari...
Feb 14, 2020•59 min
Welcome back! Three very different topics and papers for you this month. First up we have a look at the risk/benefit of sending troponins on patients aged 65 years an older when presenting with non-specific complaints; does this help their work up, or is this a classic case of over-testing? Next up we take a look at the causes of our patients presenting to the ED with a reduced level of consciousness, this paper may help inform your differentials and knowledge on the likelihood of different path...
Feb 01, 2020•36 min
Seizures are defined as a "paroxysmal electrical discharge of the neurones in the brain resulting in a change of function or behaviour". All of us involved in Emergency Care will encounter patients with seizures which can occur for a number of reasons, with Epilepsy affecting 1 in 100 people in the UK. Being able to identify the cause, terminate ongoing seizures and provide ongoing investigation and care is complicated and of paramount importance, as some of these episodes carry with them a high...
Jan 15, 2020•1 hr 4 min
