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This episode delves into the updated British Thoracic Society (BTS) guidelines for spontaneous pneumothorax, highlighting a crucial shift from size-based treatment to a patient-centered approach considering symptoms, risk, and preferences. It covers the pathophysiology, classification into primary and secondary types, and current evidence for conservative care, needle aspiration, and chest drains. The discussion extends to pre-hospital management, long-term follow-up, and ongoing trials aiming to further refine treatment strategies.
Welcome back! This month we kick off looking at an RCT which looks at whether we should convey patients with a ROSC from a likely cardiac cause (without a STEMI in their ECG) to a cardiac arrest centre, or whether they would be as well served at their local Emergency Department. This paper has huge potential implications for service design for cardiac arrest patients. Next up we look at another RCT evaluating if patients with a suspected uncomplicated appendicitis who have urgent surgical interv...
This episode from The Resus Room tackles the challenging yet rewarding topic of end-of-life care in emergency medicine, from roadside to resus. Featuring palliative care consultant Dr. Ed Presswood, the discussion demystifies medico-legal terms like DNACPR and advanced care plans, explores care pathways, and offers strategies for difficult conversations about death. It also delves into holistic patient care, symptom management, and navigating palliative emergencies, emphasizing the importance of confidence and compassion for clinicians.
Welcome back to the podcast, coming to you all the way from Australia! Rob and James were fortunate enough to be invited to deliver the keynote and an airway masterclass at this year's Australian College of Paramedicine International Conference. At what was an amazing meeting, they were lucky enough to be able to catch up with some of the fantastic speakers to hear the key parts of their talks. In this episode you'll hear from; Richard Armour, Mobile Intensive Care Ambulance Paramedic at Ambulan...
Welcome back to the podcast! We're back with three really interesting papers after our summer break, with some great points to think about with regards to our practice and patient outcomes. First up we take a look at the CT FIRST study which looks at the benefit of whole body CT in patients presenting with a ROSC after their out of hospital cardiac arrest with no obvious cause. Should we be more liberal in our imaging requests in this patient cohort? Next up we have a think about thrombolysis fo...
Welcome back, this is our last podcast before our short summer break! We start off having a look at the physiological effects of prolonged resuscitation with a supraglottic device compared with endotracheal intubation, which raises some really interesting questions about our ongoing ventilation strategy in resuscitations. Next up we look at an RCT comparing RSI to DSI in critically injured patients and the effect on peri-intubation hypoxia. Finally we take a look at the practice of lateral canth...
This episode focuses on the trauma primary survey, a vital clinical assessment for rapidly identifying and managing life-threatening injuries. It explores different approaches to the survey in pre-hospital and in-hospital settings, emphasizing effective team preparation, communication of findings, and a detailed walkthrough of the CABC method. The discussion also covers nuanced aspects like patient exposure and a debate on the appropriateness of secondary surveys in pre-hospital unstable trauma.
There have been some huge trials released over the last month and we've got three brilliant papers to discuss! First up we take a look at an RCT on video versus direct laryngoscopy for patients requiring emergency intubation with the DEVICE trial. The VL versus DL debate has been ongoing for quite some time now, so is this a final nail in the coffin for DL? Next up we take a look at an RCT of prehospital TXA use in patients at risk of bleeding from major trauma in the PATCH trial. The results se...
This podcast episode deeply explores traumatic pneumothoraces, detailing their causes, impact, and varied clinical presentations in both spontaneously breathing and ventilated patients. It covers key diagnostic tools like X-ray, CT, and ultrasound, discussing their advantages and limitations. The discussion also spans pre-hospital and in-hospital management strategies, including needle decompression, open thoracostomy, and chest drains, critically examining current guidelines and introducing the ongoing CoMITED trial to address existing ambiguities.
Welcome back to the podcast and to the first episode in collaboration with our new sponsors Zoll, a huge thanks to them in their support of free open access medical education! First off this month we return to the topic of rib fractures; with an apparent shift in practice to the surgical fixation of multiple rib fractures, we take a look at an early vs late approach and consider the impact these results may have on trauma systems. Next up it's a prehospital RCT assessing the use of a prehospital...
The last time we took a good look at head injuries was back in 2018 in our Roadside to Resus episodes and for all of the foundational stuff on incidence, assessment, management and loads more make sure you go and check that episode out. But this episode is one of our new UPDATES episodes, because we're pretty old now… and whilst we've been having a go at this for a while evidence and guidelines will have progressed, which clearly have implications on how we manage certain cases and that's where ...
This month we start off with a paper looking at the first pass success rate of intubation in cardiac arrest when performing continual CPR versus pausing. We then come on to two really interesting diagnostic papers and our prehospital accuracy for identifying certain injuries; we take a look at the accuracy of HEMS clinicians in assessing the stability of a pelvic ring and subsequent application of a pelvic binder. And then we look at the accuracy of prehospital clincians in assessing for all lif...
Being in a situation of being unable to intubate and unable to oxygenate is an absolute time critical emergency. Focus needs to be paid to the techniques and strategy to deal with this situation. But we also need to consider steps to ensure it occurs at a low frequency and our decision making and recognition of the situation happens quickly and simply. In the episode we're going to be talking about a number of other aspects that are relevant for all emergency providers, irrespective of whether y...
Welcome back to the podcast! This month we start off thinking about sepsis, specifically fluid management and whether a restrictive approach to fluid resuscitation in combination with earlier vasopressors is advantageous over a liberal approach. Next we have a look at a study evaluating the diagnostic benefit of ultrasound in the prehospital setting. Finally we have a think about the benefit that traumatic brain injury patients may benefit from with regards to beta blocker therapy. Once again we...
Neck of femur fractures, a common yet serious injury, are discussed from roadside to resus. The hosts explore their increasing incidence, high mortality, and detailed assessment, including differentiating from dislocations. Key focus areas include optimizing multimodal pain relief, the utility and technique of fascia iliaca blocks, current research, and crucial aspects of in-hospital imaging and ongoing patient care. The episode emphasizes refining care to significantly improve patient outcomes.
Welcome back to the podcast! ECMO-CPR is a growing conversation in the world of cardiac arrest management. This month we have a look at a paper which adds some great evidence to the overall picture; with an RCT on ECPR in refractory of out of hospital cardiac arrest. How will this compare to the amazing results from the ARREST trial? Next up is a really informative paper looking at the utility of ultrasound in suspected testicular torsion in children, this may make a difference to your investiga...
So in this episode we're going to be covering crush injury. When you think about it, visions of falling rocks, industrial accidents and high speed RTCs may come to mind, but actually a crush injury can be sustained in a huge variety of ways without such vivid circumstances. Definitions according to the Faculty of Prehospital Care are that; 'A crush injury is a direct injury resulting from crush. Crush syndrome is the systemic manifestation of muscle cell damage resulting from pressure or crushin...
Welcome back! Three more papers for you this month to inform and improve our care in acute and critical illness. First up and following on from the recent DoseVF paper, we take a look at a study looking at the combined effect of vector change, esmolol and capping adrenaline administration in refractory VF with regards patient out ones. Could this be associated with even better patient outcomes? Secondly we take a look at the utility of fentanyl lozenges in providing effective analgesia to patien...
Welcome back to our first Roadside to Resus episode for 2023! We're back with the huge topic that is COPD. In this episode we're going to delve into the depths of the topic, helping us to deliver the best possible care for this frequently encountered presentation. Along with the standard coverage from incidence, to pathophysiology, to presentation and treatment, we'll also be covering those topics that you've specifically asked for; The mechanism behind hypercapnoeic respiratory failure, in thos...
Welcome to 2023 and a very happy New Year! We hope you managed to get some time with your loved ones over the festive period and we're back with the podcast again to kick off the new year. First up, we take a look at a paper assessing whether there is benefit to treatment with thrombolytics or anticoagulants for patients in cardiac arrest due to a presumed MI. Next up we look at the potential harm in administering steroids to patients with COVID-19 nor requiring supplemental oxygen. Finally, we ...
So following on from our Bradycardia episode, we're going to look in detail at cardiac pacing. Setting up emergency pacing in those compromised bradycardia patients can make a significant difference to patient outcomes, and doing so in a timely and slick fashion can be a real challenge. In this episode we'll be discussing all forms of pacing, strategies for ensuring the greatest likelihood of success and the details of setup and analgesia/sedation strategies for external pacing. Once again we'd ...
Welcome back to 200th episode of the podcast! A huge thank to all of you for your support and engagement. Three more papers for you this month to challenge thinking across a board range of Emergency Care. First up we take a look at DOSE VF, an RCT look at the best defibrillation strategy for refractory VF. Next we take a look at another RCT looking at the potential benefit of dexamethasone, in order to reduce pain in patients suffering with renal colic. Last up, we've talked a lot about the impo...
This episode provides a comprehensive guide to Acute Behavioural Disturbance (ABD), a challenging presentation often lacking a clear definition, emphasizing its triad of features and significant mortality risk. It details critical assessment clues, effective de-escalation techniques, and the judicious use of restraint. The discussion further explores rapid tranquilization, comparing agents like ketamine and droperidol, and outlines crucial post-sedation management and documentation, highlighting the importance of a team approach and patient advocacy.
Welcome back to the podcast and to November's Papers Of The Month. First up we're taking a look at a paper that challenges the current American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines that recommend when right ventricular myocardial infarction, that patients are not administered nitrates due to the risks of compromise of cardiac output. Secondly we look at an RCT, with some really clever blinding, that looks at different BP targets for intubated and ventilated...
We've covered tachycardias, both narrow and broad before, but we need to complete the set. So this time we'll be looking at the slower end of the spectrum, with bradycardias. Bradycardias can be a physiological state in athletes, but they can also be of significant concern. They occur due to a multitude of reasons, some cardiac and some not and they can require no treatment at all right up to those peri-arrest patients where you'll be cracking open your critical care drugs and starting to pace t...
Welcome back to the podcast! First up this month we're going have a think about fluid therapy, following an RCT focussing on those patients attending ED with moderate severity acute pancreatitis; are we flooding them with fluid & should we ease off? Next we take a look at a paper evaluating the intubation performances between CCPs and physicians in prehospital anaesthesia of trauma patients. Lastly we look at another RCT, this time comparing the benefit of surgical versus conservative manage...
This episode delves into the critical field of extrication for road traffic collision patients, introducing the groundbreaking EXIT project's findings. It discusses how traditional spinal immobilization techniques often delay critical care without significant evidence, highlighting the project's data on patient demographics, injury patterns, and biomechanical analysis of extrication methods. The discussion emphasizes prioritizing rapid extrication and even self-extrication, backed by patient experience and expert consensus, to improve patient outcomes by minimizing entrapment time.
Welcome back to the podcast! It's brilliant to be back after our summer break and we've got three great papers for you. First up we take a look at a paper looking at the association the a geriatric assessment can make on the mortality of patients aged 65 years and older, admitted with significant injuries to our UK major trauma centres. Next up we take a look at a newly proposed method to simple chest compressions in cardiac arrest, by comparing it to chest and abdominal compression and decompre...
Welcome back! This month we take a look at 3 papers covering the breadth of Emergency Care. First up we look at a paper evaluating outcomes for patients discharged on scene by an EMS service; how many reattend ED, how many require ICU care and what is the associated mortality rate? NEXUS and Canadian c-spine rules both incorporate the presence of c-spine tenderness when deciding whether to image the neck as a result of trauma. But what is the prevalence of c-spine tenderness without trauma and h...
So when people talk about patients having a high lactate we think about them being sick, it can at times be easy to slip into thinking that this equals sepsis or maybe ischaemia. And whilst the presence of a high lactate in the context of infection and ischaemia is important to note, there is a lot more to interpreting a raised lactate than may first be apparent... So in this episode we're going to delve down into lactate, have a think about what it is, what normal and raised levels are, conside...
