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The Resus Room

Podcasts from the website TheResusRoom.co.uk Promoting excellent care in and around the resus room, concentrating on critical appraisal, evidenced based medicine and international guidelines.
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Now displaying: 2018
Dec 20, 2018

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.

SimonRob & James

References

Pediatric golf cart trauma: Not par for the course. Tracy BM. J Pediatr Surg. 2018

What to eat and drink in the festive season: a pan-European, observational, cross-sectional study. Parker HL, et al. Eur J Gastroenterol Hepatol. 2017.

Work of Breathing into Snow in the Presence versus Absence of an Artificial Air Pocket Affects Hypoxia and Hypercapnia of a Victim Covered with Avalanche Snow: A Randomized Double Blind Crossover Study. Karel Roubík. PLoS One. 2015.

Dec 17, 2018

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, CRM and breaking bad news. We found the day hugely useful and we hope the podcast sums up some of the great points from the day.

Enjoy!

SimonRob & James

References

London Trauma Conference

AIRWAYS-2; podcast

SPIKES Protocol

LITFL; Killer ECG Patterns

Beyondprognostication: ambulancepersonnel's livedexperiencesof cardiacarrestdecision-makingAnderson NE. Emerg Med J.2018

Zero Talent Battle

Dec 1, 2018

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 conservative management of traumatic pneumothoraces, including those undergoing positive pressure ventilation, which reviews the complication rate of this approach.

As always make sure you take a look at the papers yourselves and form your own opinions, we would love to hear you comments and feedback.

Enjoy!

Simon & Rob

References & Further Reading

Ian G. Stiell, Catherine M. Clement, Maureen Lowe, Connor Sheehan, Jacqueline Miller, Sherry Armstrong, Brenda Bailey, Kerry Posselwhite, Jannick Langlais, Karin Ruddy, Susan Thorne, Alison Armstrong, Catherine Dain, Jeffrey J. Perry, Christian Vaillancourt, 2018, 'A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses', Annals of Emergency Medicine, vol. 72, no. 4, pp. 333-341

Wahid Bouida, Kaouthar Beltaief, Mohamed Amine Msolli, Noussaiba Azaiez, Houda Ben Soltane, Adel Sekma, Imen Trabelsi, Hamdi Boubaker, Mohamed Habib Grissa, Mehdi Methemem, Riadh Boukef, Zohra Dridi, Asma Belguith, Semir Nouira, 2018, 'Low‐dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double‐blind Study (LOMAGHI Study)', Academic Emergency Medicine

Steven P. Walker, Shaney L. Barratt, Julian Thompson, Nick A. Maskell, 2018, 'Conservative Management in Traumatic Pneumothoraces', Chest, vol. 153, no. 4, pp. 946-953

SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse

London Trauma Conference; Cardiac Arrest Masterclass

Nov 23, 2018

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 Virginia Beckett – an Obstetrics and Gynaecology consultant who is a member of the mMOET working group and has recently published on the topic of cardiac arrest in pregnancy. She was talking on the topic of resuscitative hysterotomy.
• Sam Cooper – a Critical Care Paramedic from Derbyshire, Leicestershire and Rutland Air Ambulance who discussed a case of prehospital amputation and the learning points that arose from it.
• Dr Rob Lloyd – an Emergency Medicine trainee, blogger and fellow podcaster who has an interest in performance psychology. He talked about Mental Toughness, framed by his experiences working in a hospital deep in a South African township.

Once again, our thanks to Caroline Leech for being instrumental in the organisation of today and inviting us up. We’re already looking forward to next year….

Enjoy!

SimonRob & James

References

PonderMed

Diphoterine

A video showing a similar demonstration to the one at the conference showing why Diphoterine works and the limitations of water

Pre-hospital Obstetric Emergency Training; POET

VA Beckett, M Knight, P Sharpe, 2017, 'The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 124, no. 9, pp. 1374-1381

Realtime simulation of peri-mortem c-section; Bradford Teaching Hospital

K. M. Porter, 2010, 'Prehospital amputation', Emergency Medicine Journal, vol. 27, no. 12, pp. 940-942

Caroline Leech, Keith Porter, 2016, 'Man or machine? An experimental study of prehospital emergency amputation', Emergency Medicine Journal, vol. 33, no. 9, pp. 641-644

 

Nov 20, 2018

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 retrieval services. She gave us some key tips when dealing with paediatric patients.
  • Ian Dunbar – a technical and medical rescue consultant with years of experience in the UK Fire and Rescue Service and ongoing involvement with British Touring Car Championship and the FIA. He did some myth busting around extrication from vehicles.
  • Professor Mike Tipton – a leading figure in extreme physiology who is the Associate Head of Research at the Extreme Environments Laboratory in Portsmouth, is trustee/director of Surf Life Saving GB, sits on the medical committee for the RNLI and was awarded an MBE for services to physiological research in extreme environments. Mike spoke on the topic of drowning.

Massive thanks to Dr Caroline Leech who put together this brilliant programme and extended the invitation to us. We hope you enjoy the podcast and extract some learning to inform your practice.

Enjoy!

SimonRob & James

References

Resus Council UK; Prehospital Resuscitation

Michael J. Shattock, Michael J. Tipton, 2012, '‘Autonomic conflict’: a different way to die during cold water immersion?',The Journal of Physiology, vol. 590, no. 14, pp. 3219-3230 

Faculty of Pre-Hospital Care and Basics Conference

Nov 8, 2018

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 other it has the potential to hinder the view on laryngoscopy and decrease first pass success.

The founding evidence for cricoid pressure has always been a little soft. In this podcast we look at the background of cricoid pressure and then run through this key paper, discussing the implications it holds for both pre and in-hospital advanced airway management.

As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you.

Enjoy!

Simon, Rob & James

References

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anaesthesia: The IRIS Randomized Clinical Trial. Birenbaum A. JAMA Surg 2018

Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA Lancet.1961

Safer Prehospital Anaesthesia 2017;AAGBI

JC: Cricoid Pressure and RSI, do we still need it?St Emlyn’s

Cricoid: To press, or not to press?(Hinds and May)

 

Nov 1, 2018

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 interest to all those involved in paramedicine and prehospital critical care.

Make sure you take a look at the papers themselves and form your own opinions. We'd love to hear any thoughts and feedback you have.

Enjoy!

Simon & Rob

References & Further Reading

How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation? Kim SY. Resuscitation.2018

A novel method of non-clinical dispatch is associated with a higher rate of criticalHelicopter Emergency Medical Service intervention. Munro S .Scand J Trauma Resusc Emerg Med.2018

Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Kawano T. Ann Emerg Med.2018

Oct 15, 2018

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 responder management, all the way through to the critical care that maybe required for the sickest of burns patients. 

In the podcast we cover

  • Burn type and burn severity

  • The importance of history

  • Assessing burn extent

  • Assessing burn depth

  • The A-E assessment and specifics regarding the burns patient

  • NAI, antibiotics, tetanus cover, analgesia, special circumstances eyes & chemicals

  • Conveyance and destination

As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you.

Enjoy!

Simon, Rob & James 

 

References

British Burn Association First Aid Clinical Practice Guidelines

BBA Clinical Practice Guideline for Management of Burn Blisters

BBA Clinical Practice Guideline for Deroofing Burn Blisters

RCEMLearning; Major Trauma, Burns

National Burn Care Referral Guidance

WHO; fact sheet on burns

NHS Standard Contract for Specialised Burns Care (All Ages) Schedule 2- The Services A. Service Specification

LITFL; burns

Clinical review: The critical care management of the burn patient. Jane A Snell. Crit Care 2013

Fluid resuscitation in major burns. Mitra B ANZ J Surg. 2006

How well does the Parkland formula estimate actual fluid resuscitation volumes? Cartotto RC. J Burn Care Rehabil. 2002

Fluid resuscitation management in patients with burns: update. Guilabert P. Br J Anaesth. 2016

ISBI Practice Guidelines for Burn Care 2016

 

Oct 1, 2018

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 they take anticoagulants may be a little on the excessive side, we review a paper that looks at the yield of positive scans in this cohort.

As ever don't just take our word for it, go and have a look at the papers yourself, we would love to hear any comments or feedback you have.

Enjoy!

Simon & Rob

References & Further Reading 

IntramuscularMidazolam, Olanzapine, Ziprasidone, or Haloperidolfor TreatingAcuteAgitationin the Emergency Department. Klein LR. Ann Emerg Med. 2018

Performanceof the CURB-65Scorein PredictingCritical CareInterventionsin PatientsAdmitted With Community-AcquiredPneumonia.Ilg A. Ann Emerg Med.2018

Incidenceof intracranial bleedingin anticoagulatedpatientswith minor head injury: a systematic review and meta-analysis of prospective studies. Minhas H. Br J Haematol.2018

Sep 14, 2018

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 at a paper assessing Emergency Medicine clinicians' ability to predict hospital admission at the time of triage, should we be making early calls on the destination of our patients?

Finally we have a look at the potential role of esmolol in cases of refractory VF and a paper that reports twice the survival rates in those that receive it!

As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.

Enjoy!

Simon & Rob

References & Further Reading

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. Henry E. Wang, MD. 2018

Emergency medicinephysicians' abilityto predicthospital admissionat the timeof triage. Vlodaver ZK. Am J Emerg Med.2018

Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patientswith refractory ventricular fibrillationDriver BE. Resuscitation.2014

King Laryngeal Tube

 

Aug 28, 2018

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 endotracheal tube when advancing from simple airway techniques. The study was a huge undertaking with many speculating over how the results would change practice, including discussion of how it may affect paramedic's practice of intubation, all of which we cover in the podcast.

Before you listen to the podcast make sure you have a look at the paper yourself, have a listen to PHEMCAST's previous episode which covers the study design and have a look at the infographics on the website which summarise the primary outcome and secondary analysis and which we refer to in the interview with Professor Benger.

In the podcast we refer to Jabre's paper which can be found below and we also covered in May's papers podcast. Have a listen to the interview and let us know any thoughts or feedback you have, we're sure this one will create a lot of discussion!

Simon, Rob & James

References & Further Reading

Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. The AIRWAYS-2 Randomized Clinical Trial. Benger J. JAMA. 2018

PHEMCAST; the LMA

Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomised Clinical Trial. Jabre P. JAMA. 2018

TEAM Course

Aug 1, 2018

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 this patient cohort that assesses the ability to translate POCUS into a mortality benefit.

Finally we look at a delphi study published in the EMJ which explores expert opinion upon multiple aspects of paediatric traumatic arrests. The results are fascinating and may inform some of the CRM used in the next case you see.

As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.

Enjoy!

 

Simon & Rob

References & Further Reading

Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Sprigg N. Lancet. 2018

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With UndifferentiatedHypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Atkinson PR. Ann Emerg Med. 2018

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and managementRickard AC. Emerg Med J. 2018

St Emlyns JC; Tich Tich Boom?

First10EM; TXA in ICH (TICH-2) 

Jul 25, 2018

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 which showed a higher survival rate in those receiving adrenaline when compared to placebo. This has been accompanied with a firm debate over the secondary outcomes, which include the rate of survival with a favourable neurological outcome (mRS 0-3), which showed no statistically significant difference between the two treatment arms, but in pure numbers gave a higher proportion of favourable outcomes in the adrenaline group.

The trade off for this increased survival is the significant number of survivors with a poor neurological outcome.

The question on everyone's lips then being; should we continue to administer adrenaline in cardiac arrest given the findings from this study?

In the podcast we run over the main findings of the paper and are lucky enough to speak to the lead author Professor Gavin Perkins about the paper and some of the questions we and you have had following publication of the paper. A huge thanks to Gavin for taking the time to do this.

Have a listen, enjoy, and let us know any thoughts or feedback you have

Simon, Rob & James

References & Further Reading

PARAMEDIC2; Warwick University Clinical Trials Unit

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Perkins GD. N Engl J Med. 2018

PARAMEDIC2 Protocol

Testing Epinephrine for Out-of-Hospital Cardiac ArrestCallaway CW. N Engl J Med. 2018

First10EMParamedic 2: Epinephrine harms/helps in out of hospital cardiac arrest

REBEL Cast Ep56 PARAMEDIC-2: Time to Abandon Epinephrine in OHCA?

Jul 16, 2018

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 protective anaesthesia and hyperosmolar therapy, to give a sound overview of the management of these patients.

As always we welcome feedback via the website or on Twitter and we look forward to hearing from you.

Enjoy!

Simon, Rob & James

References & Further Reading

Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis. Chauny JM. J Emerg Med. Jul 26 2016

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned? Boone MD. Surg Neurol Int. 2015

Life in the fast lane; hypertonic saline

Life in the fast lane; Traumatic brain injury

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality. T Lawrence. BMJ Open. 2016

Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. M.Majdan. The Lancet. 2016

The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. Gale SC. J Trauma. 2005

What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Rotheray KR. Resuscitation. 2012

NICE Head Injury Guidelines 2014

MDCALC Canadian Head Injury

TheResusRoom; The AHEAD Study

TheResusRoom; Anticoagulation, head injury & delayed bleeds

Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement 

A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuriesManara AR. J Intensive Care Soc. 2016

Jul 2, 2018

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 trauma patients.

We strongly suggest you source the papers and come to your own conclusions and we'd love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.

Enjoy!

Simon & Rob

References & Further Reading

Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhageJeong N. Am J Emerg Med. 2018 

Association between intra- and post-arrest hyperoxia on mortality in adults with cardiac arrest: A systematic review and meta-analysis. Patel JK. Resuscitation. 2018

Straight leg elevation to rule out pelvic injury. Bolt C. Injury. 2018

Jun 20, 2018

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 difficult to remain current with the latest best practice.

So what options are available to us, how do we use them and what’s the evidence. Here’s the line-up for this months’ podcast:

  • Haemorrhage control ladder
  • Evidence based guidelines on haemorrhage control
  • Direct pressure
  • Enhanced pressure dressings
  • Haemostatic agents and wound packing
  • Tourniquets
  • Case studies

As always we welcome feedback via the website or on Twitter and we look forward to your engagement.

Enjoy!

SimonRob & James

 

References & Further Reading

Bennett, B. L & Littlejohn, L. (2014) Review of new topical hemostatic dressings for combat casualty care. Military Medicine. Volume 179, number 5, pp497-514.

Lee, C., Porter, K. M & Hodgetts, T. J. (2007) Tourniquet use in the civilian prehospital setting. Emergency Medicine Journal. Volume 24, pp584-7. 

Nutbeam, T & Boylan, M. (2013) ABC of prehospital emergency medicine. Wiley Blackwell. London.

Shokrollahi, K., Sharma, H & Gakhar, H. (2008) A technique for temporary control of haemorrhage. The Journal of Emergency Medicine. Volume 34, number 3, pp319-20.

Trauma! Extremity Arterial Hemorrhage; LITFL 

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Rolf Rossaint. Critical Care 2016.

NICE 2016. Major Trauma; Assessment and Initial Management

FPHC 2017; Position statement on the application of Tourniquets

 

 

Jun 1, 2018

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 paper we have a look at this exact scenario, the difference in patient outcomes and some of the resource implications to the service.

Next up we have a look at apnoeic oxygeationn. We've covered this a number of times before and most recently in our Roadside to Resus episode on RSI. This time we have a look at the most recent systematic review and meta-analysis on the topic to see if there is more definitive evidence of benefit with this technique.

Lastly we've found a paper that suggests a place for prognosticating off pH in cardiac arrest, is this something we should be adopting?

Have a listen but most importantly have a look at the papers yourself and let us know your thoughts.

Enjoy!

Simon & Rob

References & Further Reading

Low-level troponin elevations following a reduced troponin I cutoff: Increased resource utilization without improved outcomes. Becker BA. Am J Emerg Med. 2018 

Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-Analysis. Oliveira J E Silva L. Ann Emerg Med. 2017 

Association between acidosis and outcome in out-of-hospital cardiac arrest patients. Lin CC. Am J Emerg Med. 2018.

May 21, 2018

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 the resuscitation area and knowing when to cease resuscitation.

We hope the podcast helps you prepare that little bit more for the next case you might see and that it may also ease the stress of such an emotive case.

Simon, Rob & James

May 10, 2018

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 conference to suit all health care disciplines then make sure to keep an eye out for tickets when they go on sale for Trauma Care 2019.

A huge thanks to Simon C for his time recording the podcast and we'd love to hear any comments or feedback.

Enjoy!

Simon L & Simon C

References & Further Reading

For all the papers pop over to the St Emlyn's blog for the hyperlinks and abstracts

May 1, 2018

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.

Airways-2 will soon be published looking at supraglottic airway management compared to intubation as first line airway management in out of hospital cardiac arrest, but JAMA has just published a paper comparing bag-mask ventilation vs endotracheal intubation in the same situation. It'll be interesting to see if this papers results fall inline with Airways-2.

Finally we take a look at a systematic review trying to give us the answer to direct or video laryngoscopy in emergency endotracheal intubation outside the OR.

Have a listen but most importantly have a look at the papers yourself and let us know your thoughts.

Enjoy!

Apr 23, 2018

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!

SimonRob & James

 

Apr 18, 2018

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 opportunities exist.

Stuart Reid (EM + PHEM consultant) covered the ways of optimising timely transfer of major trauma patients. This had an inter-hospital focus, but there were certainly some elements which can be applied to a primary patient transfer.

David Raven (EM consultant) provided an update to the ongoing work with the HECTOR project. We’ve previously heard about their amazing course but this time he was able to let us know about the “silver trauma safety net” which is being used by the ambulance service in the West Midlands. This aims to provide appropriate recognition and triage of trauma in the elderly population.

Finally, Elspeth Hulse (anaesthetic SpR) gave us a timely reminder about the identification and management of organophosphate poisoning - really useful from both and EM and PHEM perspective.

Thanks again to Caroline for the invite to the conference and keep and eye out for a special podcast in the next few weeks where Simon Carley will be running through his top 10 trauma papers of 2017/18 (we were going to try and condense it, but there was way too much good stuff!)

Enjoy!

SimonRob & James

References & Further Reading

Trauma Care

St Emlyns

HECTOR

Apr 8, 2018

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!)

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Apr 1, 2018

 

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 look at a validation paper for the PERC rule for those patients with a suspected pulmonary embolus and this paper brings about some interesting points on external validity

Once again we'd really encourage you to have a look at the papers yourself and we've love to hear any thoughts or feedback you have.

Enjoy!

Simon & Rob

 References

Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. Perry JJ. CMAJ. 2017  

Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Kawano T. Ann Emerg Med. 2018 

Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. Freund Y. JAMA. 2018

 CORE EM; IO in Cardiac Arrest

 

 

Mar 20, 2018

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 management, and tracheal intubation in critically ill patients in all hospital locations.

In this podcast we cover;

  • Why this matters to all involved in critically unwell patients, not just those delivering RSI
  • Recap of RSI, the procedure and its indictions
  • Headlines from NAP4
  • Strategies highlighted to optimise airway management and oxygenation
  • How this impacts our prehospital and inhospital practive

We'd love to hear your thoughts so please leave your comments below or contact us via twitter @TheResusRoom

Enjoy!

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