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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: June, 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.

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