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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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The Resus Room
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Now displaying: 2022
Oct 1, 2022

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 management of significant chest wall trauma.

Enjoy!

Simon & Rob

Sep 15, 2022

Despite all the improvements that we have seen in trauma care over the past 20 or more years RTCs are still, sadly, a really common cause of both death and disability, with the number of deaths annually in the UK sitting somewhere between 1500-1900 per annum.

Survivors, who have serious injuries and are left with ongoing disabilities, total 22,000 people per year.

So anything we can do to improve care to these patients is definitely worth looking at and learning about!

Extrication is the process of injured (or potentially injured) patients being removed from vehicles involved in road traffic collisions. The fundamentals behind extrication have been based upon protecting the spine and not worsening an injury of it, but at the potential cost of other time critical injuries and with limited to no sound evidence base.

The EXIT project brings evidence to the practice of extrication and in this podcast we discuss the findings and implications for practice with the lead author Tim Nutbeam, Clare Bosanko (an EM & PHEM consultant) along with the three of us.

We also get the opportunity to hear from Freddie, a patient extricated from a high energy RTC and hear his perspective on Extrication.

Enjoy!

Simon, Rob & James

Sep 1, 2022

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 decompressions.

Finally we take a look at the diagnosis and management of TMJ dislocations and guarantee there will be a new technique in there for all of you!

Simon & Rob

Aug 1, 2022

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 how might that affect our clinical assessment?

Finally we take a look at a paper focussing on the risk of laryngospasm in paediatric sedation; what is the risk, which factors make it more likely to occur, and what can we do to mitigate it's risk?

Enjoy!

Simon & Rob

Jul 18, 2022

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, consider the mechanisms behind it’s formation and breakdown and think about the causes of raised lactate. We'll then put this all together and have a think about how we can interpret and lactate levels ensuring we give the best treatment to our patients!

Enjoy!

Simon, Rob & James

Jun 21, 2022

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 majority of cases we gain this access to the vasculature through intravenous access and a peripheral cannula. That means that iv access is a very common procedure in emergency care. The great news is that the equipment is cheap, there are multiple sites for insertion and it’s often feasible regardless of the patients age or presenting complaint. Compared to all the other options for drug administration, iv access and administration of drugs via the IV route, results in 100% bioavailability of all medicines because it avoids the first pass metabolism in the liver, and distribution around the body is rapid because it bypasses the need for absorption into the vasculature.

So that’s all good, so why are we doing an episode on intraosseous access then? Well, iv access and we as clinicians, are not infallible. And as we’re all too aware, gaining IV access can be challenging. There are other patient factors to like iv drug use, the morbidly obese and paediatric patients when everything is just smaller and more unfamiliar. So all of these factors increase the technical difficulty of iv cannulation. If we add to that some of the environmental issues we might find in the prehospital setting - so poor lighting or difficult patient access, it’s not a huge leap to realise that it would be great to have an alternative vascular access option available to a broad range of emergency care providers. And this is where IO access comes in.

So what will we be covering in this episode;

-A recap on the anatomy of bones

-Indications for IO access

-The evidence on IO access and administration

-Insertion site

-Needle selection

-Contraindications

-Case examples

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Jun 1, 2022

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 answer that ever-difficult question of when to stop?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

 

May 16, 2022

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 follwership is a patient, or patients, that we’re trying to deliver the best care and outcomes for and that effective leadership and followership are key to achieving.

Now leadership and followership comes in a variety of places but for this episode we’re mainly going to look at the importance and way in which leadership and follower ship manifests itself in high acuity cases such as traumas and cardiac arrests but the concepts are translatable to all sorts of cases and parts of healthcare.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

May 1, 2022

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?

Finally we look at the potential for remote supervision of pre-hospital ultrasound, has technology moved the bar in what can be achieved?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Apr 19, 2022

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 we get on with that!

Hopefully in this podcast we will try and improve your knowledge of these conditions and we’ll also discuss a couple of cases to bring out some key points.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Apr 1, 2022

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 Emergency Medicine!

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Mar 8, 2022

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 the mics to three incredible colleague;

Gemma Richmond has worked for the Yorkshire Ambulance Service for 20 years. She joined as an Emergency medical technician and spent 10 years working on a DCA. She then took a full time position with the Yorkshire Hazardous Area Response Team and during that time qualified as a paramedic and remained there for 8 years. She is now currently seconded to work on the Yorkshire Air Ambulance as a HEMS paramedic

After leaving full time military service Clare Fitchett qualified as a Paramedic with South Central Ambulance Service in 2013. She joined Thames Valley Air Ambulance in 2018 and has been working as a trainee and then qualified Critical Care Paramedic since.

Finally Vicki Brown, who has been in the ambulance service for 20 years. She became a HEMS paramedic in 2006, joined Great Western Air Ambulance in 2012 and is currently working as an Advanced Practitioner Critical Care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Mar 1, 2022

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 challenges, and also offer us an opportunity to mentally mode how we can best prepare and decision make in these cases.

Simon & Rob

Feb 15, 2022
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 tachycardia episode!! Again we’ll be covering everything from the underlying electrophysiological abnormality, all the way through to the assessment and treatment of patients with these life threatening presentations.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

 

Feb 1, 2022

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 extrication affect spinal movements from road traffic collisions; will it make a difference to your extrication method and speed?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Jan 17, 2022

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 the normal stuff like definitions, clinical context and electrical pathways. Then we have a think about those terms and concepts like node dependance, AVRT, AVNRT, WPW etc, and then we come back to the fundamentals of delivering excellent care and how we can use a structure of interpretation to decide how best to treat our patient both pre and in-hospital. 

We’ve tried to really nail down and describe some of the concepts in a way that should make this topic a lot easier to understand and most importantly help us all deliver excellent care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

Jan 1, 2022

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 at another excellent RCT comparing the use of a bougie to a stylet in adult emergency intubations; which will lead to a great first pass success and will the results lead to a change in or practice and teaching?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

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