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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: 2024
Jul 16, 2024

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 safely managed in the community.

This was a hugely valuable episode for us all to research and bring clarity to a complicated topic, we hope it does the same for you too!

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

Simon, Rob & James

Jul 1, 2024

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 respiratory complications.

Lastly we take a look at the benefit of performing a CT head scan in the Emergency Department for patients with a first fit. At times this can feel like a significant utilisation of resources, but what is the yield of positive scans and impact on patient care?

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

Simon & Rob

Jun 18, 2024

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 chance that we ever come across a major incident, can be difficult to motivate yourself to do.

But this is probably an area that investing a bit of time in, really thinking about how you would act in a major incident, could make a phenomenal difference to what may be one of the most, if not the most challenging clinical days of your career.

In the episode we run through Ten Second Triage (TST) and the Major Incident Triage Tool (MITT). They replace the previous triage methodologies and are to be implemented by the end of this month. We also cover some other aspects of planning and approach for being the first responder at a major incident, and we were lucky enough to gain some insights to the new triage process from Phil Cowburn, an EM & PHEM consultant who was involved in their development.

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

Simon, Rob & James

Jun 1, 2024

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 understand a bit more about the need for this.

Secondly; sepsis screening tools are commonplace in most emergency services and departments, but how do they compare against senior clinician gestalt?

Finally we look at the association of gastric distension in cardiac arrest and the rates of ROSC, should we be concentrating more on decompression of gastric volume intra-arrest?

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

Simon & Rob

May 15, 2024

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 knowledge than running the medical aspects of the arrest. To do them with excellence you need to anticipate every single objective/obstacle that could stand in your way, including the medical interventions involved and the challenges of that unique case and environment. 

In this episode we run through the aspects of a cardiac arrest right from the initiation of the case to the clearing/transfer to onwards care. We talk about the use of immediate, urgent and definitive plans and then run through how these translate into both in-hospital and prehospital arrests.

We personally got a lot out of preparing and thinking about this episode, so we hope you find it useful too!

We’d love to hear any thoughts or feedback on this slightly different style of episode either on the website or via X @TheResusRoom!

Simon & James

May 1, 2024

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 secondary analysis of DOSE-VF and reveals what really happen to these 'refractory VFs' by interrogating the defibrillators. What difference will it make to our strategy for recurrent and refractory VF?

Next up we take a look at elderly patients presenting to the Emergency Department with abdominal pain with an analysis of the features that predict a serious abdominal condition.

Lastly we look at the how different pressures exerted to the facemask when ventilating neonates can make in terms of bradycardia and apnoea.

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

Simon & Rob

Apr 15, 2024

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 potentially avoidable long-term disability for our patients and on top of that its a major cause of healthcare litigation.

And we’re not talking about a delay in weeks being a problem here, we’re talking about hours to days, with big  potential complications like impaired bowel/bladder/sexual dysfunction or lower limb paralysis - so you can see why litigation is a big part of some missed cases.

In this episode we run through the the signs, symptoms, investigations and treatment with a strong reference back to the underlying anatomy and disruption.

We also cover the recently published national Cauda Equina Pathway, which is a great resource but poses some real challenges in it’s implementation!

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

Simon, Rob & James

Apr 1, 2024

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 patients with closed limb injuries. Which one, or combination, would you think would be most efficacious…

Lastly, following on from our most recent Roadside to Resus episode, we take a look at a paper on the association between end tidal CO2 levels and mortality in prehospital patients with suspected traumatic brain injury. This paper highlights really well the need understand the fundamentals that contribute to ETCO2 when applying to clinical practice. 

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

Simon & Rob

Mar 14, 2024

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 fall foul of some traps…

ETCO2 is a non-invasive measurement of the partial pressure of CO2 in expired gas at the end of exhalation. Ideally we’d like to know what’s really going on arterially with the partial pressure of arterial CO2 but we can use the end tidal because that’s an easy reading to get from exhaled breath, when it will most closely resemble the alveolar CO2 concentration.

Its value is reflective of ventilation but also really importantly is affected by the circulation, the circuit and how it’s applied. In the podcast we run through all of these aspects, its application to clinical care and also some of its pitfalls. 

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

Simon, Rob & James

Mar 1, 2024

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 standard care with some pretty staggering results!

Lastly we take a look at a paper exploring decision making in prehospital trauma, specifically with regard to blood transfusion. This is a great paper to focus on the complexities of decision making, understand decision making strategies, recognise areas of weakness and consider how aspects of these can be used educationally and to improve emergency care for our patients.

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

Simon & Rob

Feb 14, 2024

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!

Whilst current practice is good, there are some aspects of care that we can improve on and make a real difference to outcomes in these patients, with those first on scene or at the bedside in a phenomenally important position to deliver life saving care.

In this episode we’ll be talking predominantly about refractory VF but the strategy will transfer to how we can also deal with refractory VT cardiac arrests. 

We'll be running through all of the following;

  • VF incidence
  • Mechanisms behind VF
  • Refractory and recurrent VF
  • Defibrillation strategies
  • Pharmacological strategies
  • PCI in arrest
  • ECMO

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

Simon, Rob & James

Feb 1, 2024

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 myocardial infarction. Should we be restrictive in our approach, saving a valuable resource, or is it validated to transfuse more liberally in terms of the patients outcome?

Finally we take a look at a paper looking to tease out the predictors of post intubation hypotension in those getting a prehospital anaesthetic following trauma, with some interesting associations and factors to looks out for.

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

Simon & Rob

Jan 15, 2024

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 challenge of the origin of the fever a real challenge, along with the added difficult of gaining some tests. Differentiating those with a benign disease from those with a life threatening presentation can be a daunting challenge.

The numbers of presentations to healthcare providers are staggering. Paediatric fever has been reported to represent as high as 15-25% of all presentations in primary care and emergency departments, so massive numbers. Thankfully the prevalence of serious infections in children is low and is estimated at <1% in primary care settings in industrialised countries, although it has been suggested that for ED attendances the prevalence of serious illness could be as high as 25%.

So we thought with this common but tricky presentation that it was about time we tackled the topic. We'll be running through;

  • A definition
  • Patholphysiology
  • Relevance of the severity of the fever
  • Febrile seizures
  • Clinical assessment
  • NICE guidelines
  • Duration of fever
  • Management
  • Antipyretics

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

Simon, Rob & James

Jan 1, 2024

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 presentations.

Lastly we look at prognostic scores following out of hospital cardiac arrests with a study that compares four different scores. If reliable they have significant scope to help us to both prognosticate and give valuable information to family and loved ones on their presentation to ED.

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

Simon & Rob

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