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Happy New Year!! We hope you've all had a great Christmas and New Year and that you managed to get some well earned time off over the festive period. 2019 saw us publish more insights from lead authors of the latest and most influential studies in Emergency Medicine and Critical Care, and we're really excited to say that we'll be delivering you even more in 2020 with some excellent RCTs, international guidelines and much, much more! This month we've got 3 papers to challenge practice across a wi...
REBOA, ECMO, Thoracotomy? Where should we be focussing our attention in the world of Pre-hospital care? We were lucky enough to be invited to the London Trauma Conference on the Prehospital Day supported by the Norwegian Air Ambulance Foundation. The day focussed on the areas we can make a real impact to the outcomes of our pre-hospital critical care patients. We grabbed a few minutes time of the following speakers to hear their thoughts; Introosseous Access; Jerry Nolan Pre-hospital Blood produ...
Well the year has flown by and it's already time for December's Papers of the Month Podcast! Head injuries are a huge work load for those of us involved in Emergency Care. Identifying those at risk of deterioration from a traumatic brain injury is a priority, as early intervention and prognostication can make a huge difference to patient outcomes. CT scanning is relatively easy to access and with it investigation creep has lowered our threshold of investigation and use of radiology resources; fi...
Angioedema is something we'll all encounter in the acute setting, whether we recognise it or not... Understanding the different causes and mechanisms is imperative to ensuring the patients get treatment that is not only effective, but in extremis potentially lifesaving. In this episode we talk through the condition; from clinical presentation, causative agents, mechanisms of action, differentials and the evidence base of treatment. Get in touch with any comments on the podcast, ensure to read th...
As care on our emergency and urgent care demand is on an ever upwards course, whilst alongside this the scope of what we can potentially deliver to patients is also increasing. In order to meet this demand and to deliver the best care possible to our patients we will need to look for other solutions. We were lucky enough to be invited to the First Community Emergency at the Royal Society of Medicine in London, hosted by the Physician's Response Unit. This event looked at the current challenges a...
We've got some papers this month that focus on our sickest patients! If you had a patient that you found in cardiac arrest and you believed they had a PE, would you thrombolyse them during the arrest, and how much more likely do you think they would be to survive? Our first paper looks at exactly this question. Second up we consider the potential harms associated with adrenaline administration to those in traumatic arrest. Finally, when RSI'ing a patient and considering your pharmacological cock...
So an incredibly important paper, CRASH-3 has just been published in the Lancet, which looks at the treatment of head injuries with Tranexamic Acid (TXA). TXA has been shown to save lives in trauma patients at the risk of major haemorrhage, with the notable exclusion of those with head injuries, CRASH-2. TXA has been shown to save lives in those with post parts haemorrhage, WOMAN trial. Time to treatment with TXA has been shown to be hugely influential in it's ability to decrease blood loss and ...
Welcome to October '19 papers podcast. You can't go far without the topic of TXA as a treatment for anything that bleeds being mentioned! With the publication of CRASH-2 and the WOMAN trial practice has crept such that administration in gastro-intestinal bleeding is seen fairly frequently. However, current guidelines don't recommend the use of TXA in GI bleeding, so this month we have a look at a systematic review which looks to answer whether it's administration is supported by the evidence, be...
So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes. There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the fo...
We start off this month with a much talked about paper in the pre-hospital services, what benefit does Pre Hospital Critical Care bring to cardiac arrest victims? We are lucky enough to have the inside thoughts of the lead author, this a really interesting piece of work and will no doubt lead to further discussions, for more information from the author take a look at his thesis here . Next up we take a look at the utility of troponins in patients that have suffered cardiac arrest, can we use the...
This podcast offers a comprehensive overview of modern stroke management, bridging pre-hospital assessment and in-hospital interventions. It examines the evidence and practical considerations behind treatments like aspirin, thrombolysis (including the controversial mobile stroke units), and the rapidly evolving field of thrombectomy for acute ischemic stroke. The discussion also covers decompressive hemicraniectomy, supportive care, and long-term management strategies, highlighting the importance of timely, evidence-based care for improving patient outcomes.
Well the summer has definitely hit and we hope you get a chance for a break... making sure you spend spend some time listening to our Heat Illness episode on a beach somewhere! It's a wide variety of papers for you this month; Should we be looking to immediately cardiovert acute onset AF in the ED? What difference does glucagon make to clearing oesophageal foreign bodies? How important is our diagnostic accuracy in ED to the patients morbidity and mortality? And finally we cover a paper looking ...
This podcast episode provides an in-depth look at stroke recognition, starting with definitions of stroke and TIA, and exploring the pathophysiology of ischemic versus hemorrhagic strokes. It details the symptoms associated with anterior and posterior circulation strokes, emphasizing the difficulty in diagnosing the latter. The discussion covers key risk factors, common stroke mimics, comprehensive assessment techniques (history, neurological exam), and the effectiveness of pre-hospital and in-hospital screening tools like FAST and ROSIER. Finally, the hosts examine the role and limitations of CT and MRI imaging, alongside NICE guidelines, in the acute stroke pathway.
Welcome back! This month we're finishing off our theme of syncope with a paper that looks to answer the big question; in those with undifferentiated syncope, does hospitalisation result in better outcomes when compared to discharge? We have a look at a paper reviewing the feasibility of live streaming video from scene using the 999 caller's mobile phone, a fantastic utilisation of technology and a really exciting area; we also get the thoughts of one of the co-authors, Richard Lyon, Associate Me...
If you live in the UK you may be fooled in to thinking that Heat Illness isn't really something we need to worry about...but you'd be wrong! Each year there are 800 deaths due to Heat Illness and figures in more temperate climates are significantly more. In this podcast we tackle the topic of Heat Illness, all the way through Heat Cramps, Heat Syncope, Heat Exhaustion and to Heat Stroke. We'll cover the following; Definition, clinical spectrum and categories Scale of the problem Thermoregulatory...
Status Epilepticus in children, lying and standing blood pressures in syncope or presyncope and decompressing paediatric tension pneumothoraces. You'll no doubt have seen and heard about the two papers published this month in the Lancet, both Consept and Eclipse look at the use of keppra vs phenytoin as a second line anti convulsant therapy for children in status epilepticus. We take a look at both papers, and have a think about what this means for practice. There has been a large amount of focu...
Drowning is a huge worldwide problem, and here in the UK there are around 350 accidental deaths from drowning each year. From the patient who is potentially well enough for discharge on scene, all the way through to the resuscitation and prognostication of a cardiac arrest due to drowning, the topic carries a number of unique questions and challenges. In this podcast we run through; The scale of the problem Modes of drowning Prognostic factors Extrication Advanced Life Support in Drowning Termin...
So first up a huge welcome to SJTREM, the free open access journal who we've teamed up with in the delivery of the podcast, every paper they publish is available online to read for free. Each month we'll be covering one of their papers in our Papers of the Month episodes, giving you the opportunity to review the literature yourself, come to your own conclusions and join the conversation. SJTREM have made our podcast a sustainable venture and together we look forward to promoting review and discu...
'Patients with GCS scores of 8 or less require prompt intubation', that's what ATLS tells us. The mantra of GCS 8, intubate has pervaded teaching for those involved in the management of patients with a reduced GCS (Glasgow Coma Scale). But on reflection it would seem slightly odd that the gain or loss of a single point on the Glasgow Coma Scale could simply account for a change in the decision as to whether a patient would benefit from intubation and ventilation. So should the patient with a GCS...
So we've got a massively important paper that we're going to kick off April's Papers of the Month podcast with, which is the RCT we've been waiting for; whether patients who have a ROSC should go to the cath lab, without a stemi, if the presumed cause is a coronary event? We've covered this topic in the past, for a background take a listen to PCI following ROSC and our December '17 papers of the month podcast. Next up, on the topic of over-testing, we have a look if we should be sending troponin...
We were lucky enough to be back at the fantastic TraumaCare Conference last week. There were a whole host of fantastic talks on offer and the Emergency Medicine stream, arranged by our very own Rob Fenwick, included a pro/con debate on whether Emergency Medicine should be managing the trauma airway. During that debate a number of important papers were raised on the evolution and improvement in advanced airway management. In this podcast we'll run through some of the most important points from th...
We've got a broad array of topics and papers for you this month! First up we look at a paper from the NEJM assessing the potential benefits in providing ventilations to patients undergoing an RSI. Next we look at patients presenting with both syncope and pre-syncope to the emergency department, this paper quantifies the risk that we should be apportioning to these two different presentations. Finally, we look at a paper that suggests the manual pulse check in CPR is dead, and that the time has c...
Hypothermia is a common problem for both pre and in-hospital clinicians. Understanding the underpinning physiology helps us deliver first class care to our patients, decreasing associated morbidity and mortality. There is some extremely difficult decision making to be done in severe cases of hypothermia and the podcast gives us an opportunity to explore them further. We'll cover the subject in depth with particular reference to the following categories of hypothermia; treatment, modifications in...
Ketamine and trauma are the topics for this months papers. The three papers we cover are really important for all of us involved in the care of critically unwell patients. Hypotensive resuscitation in the context of trauma has been an evolving area of practice in the treatment of our acute trauma victims. A paper published in SJTREM this month meta-analyses the data that exists out there on the topic and looks to give us an idea of the benefits and potential risks associated with such an approac...
If you're involved in the care of critically unwell patients then you will frequently encounter patients who are shocked. The European Society of Intensive Care Medicine defines shock as; 'Life-threatening, generalized form of acute circulatory failure associated with inadequate oxygen utilization by the cells. It is a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysfunction.' The assessment for shock needs to be ...
Happy New Year!! Hopefully you got a bit of downtime over the festive period and are feeling suitably refreshed and ready to attack 2019! We've got 3 great papers to kick off the year. First up we look at the recent PReVENT trial which looks at ventilator strategies in patients without ARDS with respect to tidal volumes. This paper continues the work from the much cited ARDSNet paper from 2000, and we'd highly recommend you go and have a look at that paper first. Next we look at another paper fr...
Festive greetings to all! We hope you've had a fantastic 2018 and have some time off over Xmas and New Year to celebrate with friends and family. We thought we'd bring you some of the most influential papers that we've read over the last 12 months, that haven't necessarily fitted in that closely with some of the topics we've covered...we hope you enjoy! Thanks for all of your support with the podcast throughout 2018 and we wish you a very happy 2019. Simon , Rob & James References Pediatric ...
Cardiac arrest management is core business of a resuscitationist and practice is constantly evolving in the pursuit of improving patient outcomes. We were lucky enough to be invited to the London Trauma Conference's Cardiac Arrest Masterclass stream, where Matt Thomas put on a superb array of talks around all things cardiac arrest. We managed to borrow a bit of time from some of the speakers and caught up with some of the topics covered including; airway management, ECGs pre/post arrest, POCUS, ...
Well the year maybe coming to a close but the high quality papers keep on coming out! We've got 3 great articles to cover in this episode which have some key points to reflect on in our practice. First up we take a look at the application of Canadian c-spine rules by ED triage nurses and the potential impact this approach could hold. Next up we have a look at the addition of magnesium to current ED rate control of uncompromised patients presenting with rapid AF. Lastly we look at a paper on the ...
We were delighted to be back to cover the joint Faculty of Prehospital Care and BASICS conference, day 2, held at the Royal College of Surgeons of Edinburgh. Again we were absolutely spoilt for choice when it came to content for the podcasts but we managed to catch up with: • Dr Anne Weaver – a consultant in Emergency Medicine and Prehospital Care working for the Royal London Hospital and London HEMS. She talked to us about chemical burns and a novel treatment for managing these injuries. • Dr V...
