We were delighted to be invited to cover the joint Faculty of Prehospital Care and BASICS conference held at the Royal College of Surgeons of Edinburgh. This two-day prehospital extravaganza covered a broad range of topics and the content was delivered by some excellent speakers. As such, we were absolutely spoilt for choice when it came to content for the podcasts but we managed to catch up with: Dr Abi Hoyle – a paediatric emergency medicine consultant with a background in military and retriev...
Nov 20, 2018•33 min
We've heard a lot about advanced airway management recently, with some really significant publications over the last few months and in the last few weeks in JAMA we've had another! Cricoid pressure during emergency anaesthesia and for those at high risk of aspiration has been common place for more than half a century. But it's a topic that has caused quite some debate. On one hand it has the potential to reduce aspiration, a very real and potentially very serious complication of RSI. But on the ...
Nov 08, 2018•32 min
Welcome back to November's Papers Podcast! We've got 3 great papers for you again this month. First up we take a look at a paper that looks to quantify the amount of experience needed to be a proficient intubator, in this case in arrest. Next we have a look at a paper which shows a significant difference in mortality in cardiac arrest dependant on the intravascular access route used. Finally we have a look a really interesting paper in the dispatch method of a HEMS service which we be of real in...
Nov 01, 2018•34 min
With bonfire night approaching we thought it would be a good time to have a think about burns. However burns are a significant issue at all times of year with around 130,000 presentations to UK EDs annually, 10,000 cases are admitted to hospital, 500 of these have severe burns and 200 of these will die. But most importantly intervention that we make can make a big difference to both morbidity and mortality, really affecting outcomes. Throughout this episode we'll be covering the essential first ...
Oct 15, 2018•1 hr 5 min
Welcome back to October's Papers Podcast, this month we move airway from advanced airway management and bring you a broad array of papers. First up we have a look at the relative success of a variety of pharmacological strategies for managing the acutely agitated patient in ED. Next up we have look at the well know CURB-65 score and it's ability to predict the need for critical care interventions. Lastly, we may all feel at times that performing a CT head on those well patients solely because th...
Oct 01, 2018•24 min
So we're back with September's papers of the month a little later than usual but we wanted to give you a little time to digest AIRWAYS-2... before we give you some more prehospital research on advanced airway management in cardiac arrest! The American version of AIRWAYS-2, PART, has just been released in JAMA, looking at the laryngeal tube versus endotracheal intubation as a primary strategy for advanced airway management. The paper is fascinating accompaniment to AIRWAYS-2. Next we have a look ...
Sep 14, 2018•27 min
So we're back from our summer hiatus with a real treat. The long awaited AIRWAYS-2 paper has just been released and we've been lucky enough to speak with the lead author, Professor Jonathan Benger, about the paper and discuss what the findings mean for cardiac arrest management. AIRWAYS-2 looks at the initial advanced airway management strategy for paramedics attending out of hospital cardiac arrests, essentially whether or not the aim should be to place a supraglottic airway device or an endotr...
Aug 28, 2018•56 min
Welcome to August's papers of the month. So this is our last offering for the summer until whilst we take a short break until September, so we had to finish off we 3 great papers! First up we look at the drug of the moment (or decade...) in tranexamic acid and the effect that it has on outcomes in primary intracerebral haemorrhage. Next, what role does point of care ultrasound (POCUS) hold in the patient presenting with undifferentiated shock? We look at a randomised control trial of POCUS in th...
Aug 01, 2018•28 min
Drugs in cardiac arrest are controversial. Prehospital research is notoriously difficult to perform. PARAMEDIC2 has just published in the New England Journal of Medicine and is a multi centre randomised placebo controlled trial looking at adrenaline (or epinephrine depending on which side of the pond you reside) in out of hospital cardiac arrest, no mean undertaking and a landmark paper. The paper has gained a huge amount of traction online with multiple blogs discussing the primary outcome whic...
Jul 25, 2018•37 min
Head injury worldwide is a significant cause of morbidity and mortality. Besides prevention there isn't anything that can be done to improve the results from the primary brain injury, there is however a phenomenal amount that can be done to reduce the secondary brain injury that patients suffer, both from a prehospital and in hospital point of view. In the podcast we run through head injuries, all the way from initial classification and investigation, to specifics of treatment including neuro pr...
Jul 16, 2018•48 min
Welcome to July's papers podcast. There has been a plethora of superb and thought provoking papers published this month and we've got the best 3 that caught our eye for you. In this episode we look at the potential benefit of early vs late endoscopy in patients presenting with an acute upper GI bleed. Next we look at both intra and post ROSC hyperoxia and the associated outcomes. Finally we have a look at the utility of straight leg raise as a test to rule out potential pelvicfractures in out tr...
Jul 02, 2018•26 min
Managing external haemorrhage is easy right?! Then why does haemorrhage remain a major cause of death from trauma worldwide? Ok, some of that is from internal sources, but…. No one should die from compressible external haemorrhage With the right treatment applied in a timely fashion, the vast majority of these bleeds can be stopped. But with new advances like haemostatic agents, changing advice surrounding tourniquet use and practice changing evidence coming out of conflict zones can mean it's d...
Jun 20, 2018•42 min
Welcome back to our monthly round up of the best papers in the resuscitation world. Again we've got 3 great papers covering some really important points of practice. First up we have a look at one of the most talked about diagnostic tests in Emergency Medicine, Troponin. We're are always looking to increase the sensitivity of the assay and test in order to ensure the patient hasn't got Acute Coronary Syndrome, but what are the implications of implementing a high sensitivity test? In our first pa...
Jun 01, 2018•30 min
The management of a cardiac arrest can be stressful at the best of times, but add into that the patient being a child and you have the potential for an overwhelmingly stressful situation. Fortunately the major resuscitation bodies have some sound guidance on the management of paediatric arrests. In this episode we run through some of those guidelines and also the evidence base on the topic (scant at best!). We also touch on conveyance of the prehospital paediatric arrest, bringing familiy into t...
May 21, 2018•1 hr 14 min
Professor Simon Carley from St. Emlyns caught up with us at the superb Trauma Care Conference and talked through his top papers in trauma from the last 12 months. There's something for everyone from diagnosing arterial injuries, blood pressure targets in the head injury patient, to i.v. contrast all the way through to imaging in kids. If you haven't already, make sure you go and check out the St Emlyn's blog that underpins the talk that Simon gave. And if you're looking for a great value confere...
May 10, 2018•29 min
Dare we say it, we think this month's papers podcast is the best yet, we've got 3 superb papers and topics to consider! The literature has been pretty airway heavy this month so we've got 3 papers on and around the topic for you. First up we have a look at a really interesting paper from London HEMS looking at the risks v benefit of prehospital rapid sequence intubation in patients who are awake but hypotensive, is RSI a much needed move or something we should be looking to avoid prehospitally. ...
May 01, 2018•26 min
Evidence based medicine (EBM) allows us to deliver the best care to our patients and understanding the concepts involved is crucial. Over the last 18 month we've been building an online course to give people a sound understanding of EBM and we thought we'd give you a free taster of what it's all about. Have a listen to one of our episodes here on statistics and if you want to find out more have a read below about the full course at www.CriticalAppraisalLowdown.co.uk Enjoy! Simon , Rob & Jame...
Apr 23, 2018•22 min
For this episode we've been lucky enough to catch a number of the speakers from the traumacare conference. First up, conference organiser Caroline Leech (EM + PHEM consultant) gave us a few minutes of her time to talk about the latest major trauma key performance indicators from NICE. Nicola Curry (Consultant Haematologist) spoke about transfusion in trauma and the use of massive haemorrhage protocols. Importantly, she covers the evidence behind the current strategies and where future research o...
Apr 18, 2018•31 min
In this episode Rob takes us through a case he saw recently that brought about some invaluable learning. We're not going to give you anymore clues than that! Enjoy! Simon & Rob References & Further Reading (anonymised to keep the anticipation!) Article 1 Article 2 Article 3 Article 4...
Apr 08, 2018•24 min
Welcome back to April's papers of the month. We've got 3 papers this month that look to challenge our work up strategies for the critically unwell. First up we look at a paper on the Ottawa subarachnoid haemorrhage rule, specifically considering if we can decrease scanning in patients with a suspected SAH and what application of the rule might mean for our practice. Next up we look at a paper that might shine some real doubt on the use of IO access in our patients in cardiac arrest. Lastly we lo...
Apr 01, 2018•32 min
Gaining control of the airway in a critically unwell patient is a key skill of the critical care team and littered with potential for difficulty and complications. NAP4 highlighted the real dangers faced with their review of complications of airway management in the UK, lessons have been learnt and practice has progressed. As always there is room to improve on current practice and a recent paper published in Anaesthesia describes a comprehensive strategy to optimise oxygenation, airway managemen...
Mar 20, 2018•48 min
How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient? Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them. In the podcast we cover the following; Whats the big deal with crystalloids Previous trials on ...
Mar 12, 2018•22 min
Welcome to March's papers of the month. We know we're biased but we've got 3 more superb papers for you this month! First up we review a paper looking at oxygen levels in patient's with a return of spontaneous circulation following cardiac arrest, is hyperoxia bad news for this patient cohort as well as the other areas we've recently covered? Secondly we have a look at a paper reviewing the association between time to i.v. furosemide and outcomes in patients presenting with acute heart failure, ...
Mar 01, 2018•27 min
So the three of us are back together and going to take on Sepsis! It's vital to have a sound understanding of sepsis. It has a huge morbidity and mortality but importantly there is so much that we can do both prehospital and in hospital to improve patient outcomes. In the podcast we cover the following; Definitions Scale of problem Different bodies; NICE/Sepsis Trust/3rd international consensus definition including qSOFA Handover and pre alerts Treatment; Sepsis 6 The evidence base behind treatm...
Feb 22, 2018•1 hr 10 min
On a not infrequent basis we will come across patients in hospital who have a CT head scan that appears to show an unsurvivable event. Having sourced opinion from our neurosurgical and neurology colleagues we may well be given the advice to withdraw care for the patient. It has become increasingly recognised that prognosticating in such patients at an early stage is extremely difficult with numerous cases surviving what was initially thought to be an unsurvivable event, with a good neurological ...
Feb 12, 2018•14 min
Welcome back, we've got 3 absolute beauties of papers for you this month! You'll have struggled not to have heard about the ADRENAL trial, a trial of iv steroids in the sickest of patients with septic shock. We also have a look at a trial that many have been quoting as sound evidence for the utility of pH during the prognostication of patients in cardiac arrest. Finally we have a look at a paper that may shed some concern on the use of Double Sequential Defibrillation that we covered recently on...
Feb 01, 2018•27 min
In this episode we cover a paper that you have to know about! The use of tranexamic acid(or TXA) has become widespread in the case of major trauma and post partum haemorrhage. This time we discuss a recent paper that asks us if giving it within 3 hours is enough, or whether we need to be even more specific regarding its urgency of administration in order to save lives from bleeding. There is a superb podcast over at our buddies site PHEMCAST which covers an interview with one of the authors and ...
Jan 22, 2018•12 min
Prehospital Care is evolving rapidly and is one of the most exciting and dynamic specialties to be involved with at the moment. As a reflection of it's progress the Faculty of Pre Hospital Care held its first scientific conference this week. We were lucky enough to be invited by Caroline Leech , EM & PHEM Consultant and the person responsible for organising this superb event, to interview some of the superb speakers at the event . Here are the speakers we were lucky enough to catch up with a...
Jan 12, 2018•29 min
Happy New Year!! Welcome back to the podcast and what we hope will be a superb year. We've got three excellent papers that are extremely relevant to our practice and will have an impact on practice. First up it's a paper looking at the benefit of iv versus oral paracetamol in the Emergency Department, something we do really frequently but what does the evidence say? Next we have a look at the difference that topical TXA could make to epistaxis in terms of bleeding cessation. Lastly we look at a ...
Jan 01, 2018•26 min
Handover matters. Handover of patient care occurs at multiple points in the patient's journey and is a crucial point for transference of information and inter professional working. Whether it's the big trauma in Resus with the prehospital services presenting to the big crowd, right the way through to the patient coming to minors who looks like they will be going home shorty, each of these transactions of information needs to be done correctly. Handover can be stressful though and different parti...
Dec 11, 2017•40 min
