Welcome back to February 2025's papers podcast! This month we're exploring papers on seizure management, oxygen strategies in trauma, along with transfusion strategies in patients with traumatic brain injuries. First up we look at at a paper exploring the potential benefit of adding ketamine into the strategy for treating patients with status epilepticus. Does it help to more reliably terminate seizures and what can we take from the paper? Trauma courses frequently mention the use of high flow o...
Feb 01, 2025•29 min
Welcome back to the first Roadside to Resus episode for 2025!! In this episode, we're diving into a seasonally appropriate, and really paediatric common presentation for anyone involved in emergency care….Bronchiolitis. Now although it's one of the most common respiratory illnesses affecting kids, bronchiolitis can easily cause confusion and concern around the severity of illness, whether to convey/admit/discharge, and also which treatments are indicated and which aren't, including the perennial...
Jan 15, 2025•53 min
Happy New Year!!! We hope you've had some time off over the festive period and now we're back to kick start the new year with three more great papers. Syncope is common presentation to the Emergency Department, accounting for 1% of presentations. Without a clear precipitant of the event it can be challenging to identify those patients who have a higher risk of associated morbidity and mortality, and furthermore those who would benefit from further investigation and observations. Our first paper ...
Jan 01, 2025•34 min
This is an episode we've been wanting to cover for a long time now! In it we explore the challenges in entering and developing in prehospital critical care, which translate into pretty much developing in any new role both in and out of health care. We cover some pretty personally challenging experiences and the strategies that both clinicians new to prehospital critical care may find useful to employ. We also discuss how supervisors can use these techniques to both guide and support new clinicia...
Dec 11, 2024•59 min
A really strong line up of papers to bring this year's evidence round up to a close! First up we take a look at a paper evaluating the utility of pulse oximetry (along with several other diagnostic tests) in identifying vascular injury following trauma, a really interesting look at an approach we didn't know much about. Next up we run through PARAMEDIC-3, a huge RCT looking at the best vascular access strategy for patients in cardiac arrest, will the result of this paper change our approach? And...
Dec 01, 2024•32 min
Motor vehicle collisions or road traffic collisions are a massive problem worldwide. Data from the World Health Organisation reports that there are around 1.2 million deaths every year and this is the leading cause of death internationally for children and young adults aged 5-29 years. In the UK there are around 1,500 deaths annually and also around 60,000 patients with significant and life changing injuries, which is 7 patients every hour!! So anything we can do to improve patient care followin...
Nov 14, 2024•43 min
Welcome back to the podcast and to November's Papers of the Month! We start off looking at the rate of pneumothoraces in patients following ROSC after a medical cardiac arrest. What is the incidence? Are there any risk factors? And how might this affect our index of suspicion and imaging practice? We've spoken before about how difficult vertigo can be as a presentation to the Emergency Department; really common, often benign but with differentials that include posterior circulatory strokes, tumo...
Nov 01, 2024•34 min
In this episode we're going to be running through adrenal presentations; both Adrenal insufficiency and Adrenal Crisis. There are some parts of these that aren't completely understood and a lack of a universal definition of Adrenal Crisis, but both insufficiency and a crisis are similar problems at different points on a spectrum and solid understanding of the endocrinology and physiology can really help to improve care in this area. There is huge potential for improving current morbidity and mor...
Oct 15, 2024•54 min
Welcome back to October's Papers of the Month. We've been really spoilt with three fantastic papers to discuss this month! First up we take a look at the accuracy of non-invasive blood pressure readings in critically unwell patients in the prehospital environment and see how they could falsely reassure in both hypotension and hypertension. Next up we take a look at the superb SHED study, which looks to evaluate the accuracy of a plain CT head in identifying subarachnoid haemorrhage at different ...
Oct 01, 2024•38 min
PE's (or Pulmonary Emboli) are a key part of Emergency Care, something that many of us will consider as a differential diagnosis multiple times of a daily basis, in a similar way to acute coronary syndrome, so we need to be absolute experts on the topic! A PE normally occurs when a Deep Vein Thrombosis shoots off to the pulmonary arterial tree, occurring in 60-120 per 100,000 of the population per year The inhospital mortality is 14% and the 90 day mortality is around 20%. But this is proportion...
Sep 16, 2024•1 hr 4 min
Welcome back after the summer break! Three more papers for you to feast your ears on this month and as always make sure you go and check them out yourselves after you've had a listen! First up, following on really nicely from the DOSE-VF paper on dual sequential defibrillation we take a look at the paper that looks at the association between shock interval and VF termination. We might be biased but this shines a light on an area that could make a huge difference to the outcomes for patients with...
Sep 01, 2024•36 min
The UK REBOA trial left many with doubts over its utility for trauma patients in ED. The time from injury to its use was around 90 minutes and the trial was stopped when it didn't reduce and maybe even increased mortality compared to standard care alone. But what effect does REBOA have when used prehospitally and how feasible is it? Our first paper, from London HEMS, looks at this and gives a fascinating insight into it's use and the physiological response seen with it. We've recently looked at ...
Aug 01, 2024•32 min
Acute Kidney Injury is common, complicated and holds significant morbidity and mortality. But...if we recognise it, we can make a real difference to our patients' outcomes. In this episode we run through the anatomy, physiology and aetiologies. We have a think about the multitude of definitions of AKI and then take each of the pre renal, renal and post renal categories and think about the ways we can optimise our care in each. We also have a think about who needs to be admitted and who can be sa...
Jul 16, 2024•1 hr
There's a huge paper to talk about this month in the PREOXI trial, a multi centre RCT looking at the pre oxygenation strategy in critically unwell patients undergoing RSI, with patients either getting high flow oxygen through a facemask or NIV. The results are pretty remarkable and may well be practice changing as we'll discuss in the podcast! Next up we take a look at a feasibility of lidocaine patches for older patients with rib fractures and the potential benefit in terms of pain and respirat...
Jul 01, 2024•30 min
So this month we're looking at major incidents and specifically the triage process that is now coming into play in the UK and further afield that you need to know about! We normally stick pretty strongly to clinical topics; they're pretty easy to focus on because you can imagine how extra knowledge in a certain clinical area could make a difference to presentations that we see pretty commonly. And being brutally honest, making the effort to prepare and rehearse what we might do, on the off chanc...
Jun 18, 2024•58 min
Welcome back to June's Papers of the month! We kick off this month looking at the work up of patients with a first episode of psychosis. With these patients there is a chance of a psychosis secondary to an underlying structural cause. Getting neuro-imaging to look for this prior to psychiatric assessment is tricky though, often with a need for sedation and then the subsequent delay for psychiatric assessment. Our first paper looks at the yield of positive scans for these patients and helps us to...
Jun 01, 2024•31 min
We've covered Cardiac Arrest management (as in the medical delivery of it) in a previous Roadside to Resusepsiode. Since then we've had some updates with Paramedic-2, Refractory VF, Airways-2 and a whole host of other papers. But what we haven't talked much about is the art of creating the environment, space & workflow to deliver the best medical care possible. Whilst these might seem like less exciting and important parts of the package, they probably require a greater degree of skill and k...
May 15, 2024•57 min
Welcome back to the podcast and three great papers for May's episode! First up we take a pretty deep look into refractory VF. This follows on from our our review of DOSE-VF in December '22's papers of the month and our recent Roadside to Resus on the topic. In that we discussed the possibility that many of the cases we see at pulse checks as being refractory VF may actually have had 5 seconds or more, post shock, where they jumped out of VF but then reverted back into it. This paper is a seconda...
May 01, 2024•28 min
Lower back pain is a really common cause for patients to present to primary care, urgent care and emergency care. Thankfully many of these cases are self limiting, but somewhere in the region of 1:300 patients with back pain in the ED will have Cauda Equina Syndrome. Cauda Equina Syndrome is something that is challenging for all clinicians because many patients with simple lower back pain may have many similar symptoms, but if we miss it, or if there is a delay to surgery that can lead to potent...
Apr 15, 2024•40 min
Welcome back to the podcast! Three more papers covering topics that are relevant to all of our practice. The importance of removing wet clothes from patients is often discussed, both to prevent hypothermia and increase patient comfort. But how important is it to get wet clothes off and is it something we can defer to a different point? We start off taking a look at an RCT on this very question. Next up another RCT, this time looking at the efficacy of morphine, ibuprofen and paracetamol for pati...
Apr 01, 2024•27 min
End Tidal CO2, or ETCO2 for short, is something that's talked about pretty often in Emergency and Critical Care and that's because it's used a lot in the assessment and treatment of patients! It's got a big part to play in airway management, resuscitation, sedation and is also increasingly used in other situations. Some of these applications have some pretty strong evidence to back them up but others are definitely worth a deeper thought, because without a sound understanding of ETCO2 we can fal...
Mar 14, 2024•53 min
Welcome back to the podcast, a new month, three more papers and discussion around the topics. We kick off with a paper comparing mechanical ventilation in CPR compared to the more traditional hand ventilation; what difference does the machine make to ventilation in arrest and should we be changing to this strategy as a standard? We've talked about aneurysmal subarachnoid haemorrhage a fair amount on the podcast and the second paper looks at the effectiveness of lumbar CSF drain compared to stand...
Mar 01, 2024•37 min
As we all know, rapid and effective resuscitation makes a huge difference to the chance of survival from a cardiac arrest. If you're going to pick a rhythm to have as the patient or as the Resuscitationist, then it's going to be a shockable rhythm, so VF or pulseless VT as they hold the greatest chance of survival. You'll find an initial shockable rhythm in around 20% of cases & defibrillation alone may lead to a ROSC. So it's absolutely imperative to get the immediate management spot on! Wh...
Feb 14, 2024•1 hr
Welcome back to February's papers of the month. Syncope is a really common presentation to the Emergency Department and it can be complicated to tease out those with a concerning precipitant from the others with a more benign cause. The first paper gives us some context to the management of these undifferentiated syncopes and provides a barometer for how stringently ESC guidance on the topic is followed. Next up we take a look a huge RCT of transfusion thresholds in patients presenting with a my...
Feb 01, 2024•31 min
Fever is an incredibly effective mechanism to fight off pathogens. Clearly, whilst many illnesses that cause a fever don't require anything more than the body's natural response, there are some patients in which a fever might represent a serious illness. Differentiating those serious illnesses from self-limiting presentations can be tricky at times, but can also be anxiety provoking for clinicians and parents, or carers of that child. In children the limited communication can make the diagnostic...
Jan 15, 2024•58 min
Happy New Year! We've got some great topic and in person events lined up for 2024 which we'll be able to share some more details about with you soon. This month we look at an RCT of conservative airway management in patients with a low GCS following presentation with acute poisoning. Next up we take a look at paper reviewing our diagnostic ability with dissociative seizures; this gives us some really valuable signs and symptoms to looks for and outlines how we can improve with these presentation...
Jan 01, 2024•28 min
We know it's the festive season but we thought we'd try and cover an issue from which there appears to be no escape and is a particular problem at this time of year, queuing! Whether we like it or not, this has become a factor for all of us working in emergency care, whether its delays getting your patient into the department, queueing down the corridor into ED, a prolonged stay in ED for an appropriate ward, or even in a physical queue to get out of the ED and onto an appropriate bed! We are lo...
Dec 14, 2023•56 min
We've talked about Aortic Dissection before in our Roadside to Resus episode and the huge difficulties in picking out these rare but potentially devastating cases and this month we've got a fantastic paper on the topic! The DAShED study looks at patients presenting with symptoms that could be suggestive of aortic dissection and helps us understand the diagnostic challenge and approach to acute aortic syndrome, along with testing the characteristics of a number of decision tools. Next up we look ...
Dec 01, 2023•33 min
Blood gases are really commonly used in ED, Critical Care, Respiratory Medicine and Prehospitally. In fact, you'd do well to walk 10 meters in an ED without being given one to sign off! But it's for good reason, because they give you additional information about what's going on from a respiratory and metabolic perspective in the patient. And it's probably worth mentioning at this point, this episode is going to be pretty 'science-heavy', there should be something in here for everyone; from the c...
Nov 15, 2023•56 min
Well this has been a huge month for Emergency Medicine and Critical Care in terms of papers! We start off looking at REBOA; many resuscitationist's favourite concept or device with the much awaited UK-REBOA trial. What does the paper mean for practice in our Resus Rooms? Is this about to become a key part of trauma management? The paper is fascinating and one of the most though provoking we've discussed in a while. Next up we look at CROYSTAT-2, another such anticipated trial looking at whether ...
Nov 01, 2023•32 min
