The Resus Room

July 2022; papers of the month

Intraosseous Access; Roadside to Resus

So, as we all know, there are loads of presentations that we see in Emergency Medicine that require us to gain rapid access to the circulation. Either to administer medicines around the body or to get fluids into the circulation. Now there's a number of different ways we can get them into the circulatory system for them then to get to their sites of action, each of which comes with its pros and cons. There's buccal, inhaled, intramuscular, sublingual, intranasal etc etc…. But, in the vast majori...

June 2022; papers of the month

Welcome back to June '22 papers podcast! This month we start off with a look at rocuronium dosing in RSI; could a simple change of dosage lead to an increased first pass success for our intubations? Next up we take a look at the use of TXA in trauma, with specific focus on gender based inequality in its use and a trial with shocking results. Finally we take a look at a paper focussing on outcomes of cardiac arrest and cut-off points with regards to duration of resuscitation; could this help answ...

Leadership and Followership; Roadside to Resus

We talk a lot about the different skills involved in the management of the critically unwell patient; CPR, airway management, defibrillation, chest drains, RSI etc, etc…..but there is another aspect which is arguably as important and that is the non-technical skills involved in resuscitation. In this podcast we discuss non-technical skills, followership, leadership and different models of working. What's really important to remember in this episode is that at the centre of leadership and follwer...

May 2022; papers of the month

Welcome back to May's papers of the month! First up this month we'll be looking at an RCT focussed on prehospital intra-arrest management and comparing an early move in arrest towards ECMO-CPR and invasive treatment, versus remaining on scene continuing ALS until achieving a ROSC. Does E-CPR hold the promise we are hoping for? Next up we take a look at another RCT on pad placement for electrical Cardioversion-BMI of AF, are antero-posterior pads superior to the standard antero-lateral position? ...

Acute Aortic Syndromes; Roadside to Resus

We have been wanting to do an episode on aortic dissections for quite a while now but you will see that what we've actually gone and done is created an episode on acute aortic syndromes…so we've done a great job of staying on point straight from the off! In fairness, we've done this because it turns out that there are actually a few different potentially life threatening acute aortic conditions which we need to know about and getting them all into one episode seemed achievable, so let's see how ...

April 2022; papers of the month

Welcome back to April '22 papers of the month podcast! We start off this month with a paper looking at the effect of a structured airway course on first pass success in novice and HEMS clinicians. Next up we take a look at the much discussed RePHILL trial; do packed red blood cells and lyoplas lead to better outcomes in patients with traumatic hypovolaemic shock? Finally we take a look at the topic of over-diagnosis and a paper that has made us think and reflect really hard on our practice of Em...

Debrief - Roadside to Resus

Debrief is an extremely important topic both in the prehospital and in-hospital environment. It offers the opportunity to clarify, reflect and improve on future practice. But partaking in and running a debrief can be challenging. So in this episode we'll be exploring debrief in a lot more detail. We'll be covering both hot and cold debriefs, frameworks for debriefing and tips on what works well, as well as what sometimes doesn't. To celebrate International Women's Day 2022 we have handed over th...

March 2022; papers of the month

Welcome back to March '22 Papers Podcast! This month we have a think about causes and coping strategies for Emergency Clinicians involved in stressful cases; what can trigger us and more importantly what can we do to mitigate these circumstances? In our other two papers we have a think about ECMO-CPR and Resuscitative Thoracotomy, both relatively low frequency but high skill interventions. The papers look at outcomes and case selection and can give us more information about service setups and ch...

Broad Complex Tachycardia; Roadside to Resus

So in our last Roadside to Resus episode we covered narrow complex tachycardias. In that we delved pretty deep into the normal cardiac conductance along with the clinical assessment and their management. This episode is going to build on some of that…so if you haven't already given it a listen, we'd recommend you pause here, take a listen….and then come back on board!! But for those of you that have already listened, here we go with the bigger brother and even more exciting broad complex tachyca...

February 2022; papers of the month

This month we've got three papers covering a wide variety of topics and practice in emergency care. First up we'll be looking at whether pre-charging the defibrillator prior to rhythm analysis in cardiac arrest can decrease our hands-off time. Next we take a look at a paper that can help inform our assessment and investigation of trauma patients; looking at the risk of concomitant injuries with regards to specific levels of spinal trauma. Finally have a think about how different methods of extri...

Narrow Complex Tachycardia; Roadside to Resus

So in this episode we run through narrow complex tachycardias, not I hear you say a perfect visual topic for an audio platform like a podcast, but hold your horses… No matter what your level, or your depth of understanding of narrow complex tachycardias, we really hope this will offer some extra knowledge and contemplation for both those of you, like us, that have been treating patient with NCT for decades, right through to those of you that are completely new to the topic. We run through all th...

January 2022; papers of the month

Happy New Year! Well we've got three really excellent papers to start off your new year with! First up we take a look at the complication rates seen when performing a prehospital thoracostomy; how frequent are complications and what could this information hold in improving our ongoing practice? Next up we take a look at an RCT on the use of Calcium in the context of cardiac arrest. Can it's inotropic and vasopressor effects translate into better outcomes for our patients? Lastly we take a look a...

Ventilation; Roadside to Resus

Critically unwell patients often present with inadequate oxygenation and ventilation, in this episode we're going to explore some of the physiology of critical illness, look at how we can improve oxygenation and ventilation, take a look mechanical ventilation and have a think about how we can deliver this to a really high level. We'll be covering the following; Type 1 & 2 respiratory failure Breathing assessment Optimising patients own ventilation Mechanical ventilation Modes of ventilation ...

December 2021; papers of the month

Welcome back to December's paper of the month podcast! In the first paper this month we take a look at a paper that assesses the utility of CT scans for patients presenting with fever of an unknown origin; could this help us identify the source more frequently and if so how often? Next, we often focus on the specific of medical management in cardiac arrest, but what impact does witnessing a cardiac arrest have on bystanders and could this affect the way we interact and behave on scene? Lastly we...

Breaking Bad News; Roadside to Resus

Being involved in Emergency Care, by it's very nature, sadly means that we will have to break bad news to patients and families both in the prehospital & in-hospital setting. Breaking bad news well has benefits to both the recipient of that news and also to the provider delivering it. Teaching and education on the topic can be difficult to access and not always prioritised. In this episode we run through some of the evidence around breaking bad news, techniques and structures to follow and t...

November 2021; papers of the month

Welcome back to the papers of the month podcast! First up we take a look at a paper assessing the importance of symptoms and sings in suspected Cauda Equina cases and consider which factors we should be giving weight to, including whether a PR is appropriate. Next up we take a look at a paper looking at electrical injuries presenting to the Emergency Department, the risk of significant injury and the appropriate investigations to perform on both high and low energy voltage injuries. Lastly we ta...

Intubation; The Discussion

So following on from the Roadside to Resus episode on intubation there were a lot of questions from listeners that we didn't have the opportunity to answer. These included some clinical aspects and also some really tricky issues around competency, governance and importantly who should and shouldn't be intubating. We've separated this out from the main episode as a lot of the conversations are heavily opinion based and only our view on the topic. This is our first episode of this style and we'd l...

Intubation; Roadside to Resus

Intubation is a key part of advanced airway management. Although some of you out there may not intubate, we'll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes. Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and l...

October 2021; papers of the month

Welcome to October's papers of the month! Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We've looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms. Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests a...

Acute Coronary Syndrome; Roadside to Resus

So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest! There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!! Some of the treatments we'll discuss for patients with ACS can have a huge affe...

September 2021; papers of the month

Welcome back after our summer hiatus to September's Papers Podcast! Firstly we take a look at two different strategies for managing agitation in the Emergency Department, to achieve rapid control. Is haloperidol and midazolam, or ketamine alone, a better strategy? Then we take a look at the results from RECOVERY-RS. We covered the design of the trial at it's conception last year and this trial essentially looks to answer whether a strategy of high flow nasal oxygenation, CPAP or conventional oxy...

August 2021; papers of the month

Welcome to August 2021's papers podcast! Three more great papers for you this month which have challenged and informed our practice. First up we look Impact of ambulance deceleration with patients lying flat vs 30 degrees head up on intracranial pressure in patients with a head injury. Next, is a patient with a refractory VF arrest more likely to have a positive finding on coronary angiography than one with non-refractory VF? And finally, in patients with blunt chest wall injury, does the presen...

Pre Alert; Roadside to Resus

So welcome back to another Roadside to Resus episode! Pre alerts are a key part of the interface between pre hospital and in hospital care of the critically unwell patient, when made and received in an effective manner they can really benefit the patient and the system. But too often we hear of friction associated with pre alerts and recent discussions on social media has really highlighted this. In this episode we explore the pre alert, the guidance that exists already on the topic, the challen...

July 2021; papers of the month

Another month and 3 more papers! First up we have a look at a paper that has grabbed a lot of recent headlines in the form of TTM2. So we now seem to have the answer to whether comatose patients following out of hospital cardiac arrest benefit from therapeutic hypothermia over maintenance of normothermia. Next up we take a look at a paper which adds some real value to our assessments of maxillofacial injuries and can help inform our assessment of the likelihood of fracture and need for imaging. ...

Subarachnoid Haemorrhage; Roadside to Resus

So this time we're going to be talking about subarachnoid haemorrhage. So this is going to be a short and punchy look at a really important and interesting topic in subarachnoid haemorrhage. We run through the approach to headache and then focus on the specific features and findings that we should be looking for with regards subarachnoid haemorrhage. We then consider who we should be investigating further, what value a CT head brings and the sticky subject of who should be going on to have a lum...

June 2021; papers of the month

This month we've got three papers that have challenged our practice both from an in-hospital and pre-hospital perspective. Firstly we consider a paper that looks at admission saturations for patients with exacerbations of COPD and compare this to the BTS guidance on oxygen therapy, regarding altering oxygen saturations for those proven not to be hypercapnoeic. Should we be aiming for 88-92% or 94-98%? Next we look at a paper from the team at KSS looking at dispatch to older trauma victims and co...

Resuscitation Guidelines 2021; Roadside to Resus

So the Resuscitation Council UK have today published new guidelines on resuscitation based on the European Resuscitation Council 2021 Guidelines and recommendations from the International Liaison Committee on Resuscitation. We were lucky enough to catch up with two key members of both ERC and RCUK, Gavin Perkins and Jasmeet Soar, gaining their valuable insights into the new guidelines. As well as this Simon, Rob and James pick out some other key points from the guidelines and discuss how these m...

May 2021; papers of the month

Welcome back to May's Papers of the Month Podcast! Three more papers for you on three varied topics. We start off with the use of end tidal carbon dioxide in the content of prehospital head injuries.Taking a look at a paper delving a bit deeper into the utility of end tidal CO2 when compared with arterial CO2 measurements on arrival in ED, in patients having received a prehospital anaesthetic; how accurate is end tidal and what level should we be aiming for? Next we consider the importance of fr...

Newborn Life Support; Roadside to Resus

So last month we considered Maternal Emergencies and the approach and interventions we can make in order to minimise complications during pregnancy and during childbirth. As promised this month we're looking at the next step along the process and focussing on Newborn Life Support. Dealing with newborns has the potential to be really stressful but hopefully by concentrating on the fundamentals and guidelines we'll all be able to approach the situation with greater confidence. Let us know any thou...