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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: Page 1
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

Dec 15, 2021

Critically unwell patients often present with inadequate oxygenation and ventilation, in this episode we’re going to explore some of the physiology of critical illness, look at how we can improve oxygenation and ventilation, take a look mechanical ventilation and have a think about how we can deliver this to a really high level.

We’ll be covering the following;

  • Type 1 & 2 respiratory failure
  • Breathing assessment
  • Optimising patients own ventilation
  • Mechanical ventilation
  • Modes of ventilation
  • Setting up a ventilator; tidal volume, RR, FiO2, I:E ratios, dead space
  • End tidal CO2
  • Optimising oxygenation & ventilation
  • Hand ventilation
  • Ventilation in cardiac arrest

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

Enjoy!

Simon, Rob & James

Dec 1, 2021

Welcome back to December’s paper of the month podcast!

In the first paper this month we take a look at a paper that assesses the utility of CT scans for patients presenting with fever of an unknown origin; could this help us identify the source more frequently and if so how often?

Next, we often focus on the specific of medical management in cardiac arrest, but what impact does witnessing a cardiac arrest have on bystanders and could this affect the way we interact and behave on scene?

Lastly we consider those patients that require a prehospital anaesthetic following return of spontaneous circulation from a medical cardiac arrest. Does the choice of induction agent between midazolam and ketamine affect the likelihood of hypotension and other complications?

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

Simon & Rob

Nov 15, 2021

Being involved in Emergency Care, by it’s very nature, sadly means that we will have to break bad news to patients and families both in the prehospital & in-hospital setting.

Breaking bad news well has benefits to both the recipient of that news and also to the provider delivering it. Teaching and education on the topic can be difficult to access and not always prioritised.

In this episode we run through some of the evidence around breaking bad news, techniques and structures to follow and talk about the practicalities of adopting these, along with our own varied personal thoughts and styles.

We hope listening to the podcast gives you an opportunity to reflect on how we could all work and improve on breaking bad news and also helps to make the process a little bit easier.

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

Enjoy!

Simon, Rob & James

Nov 1, 2021

Welcome back to the papers of the month podcast!

First up we take a look at a paper assessing the importance of symptoms and sings in suspected Cauda Equina cases and consider which factors we should be giving weight to, including whether a PR is appropriate.

Next up we take a look at a paper looking at electrical injuries presenting to the Emergency Department, the risk of significant injury and the appropriate investigations to perform on both high and low energy voltage injuries.

Lastly we take a look a paper looking at the use of vasopressin and steroids in in-hospital cardiac arrest and see what effect in has in the latest RCT.

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

Enjoy!

Simon & Rob

Oct 25, 2021

So following on from the Roadside to Resus episode on intubation there were a lot of questions from listeners that we didn't have the opportunity to answer. These included some clinical aspects and also some really tricky issues around competency, governance and importantly who should and shouldn't be intubating.

We've separated this out from the main episode as a lot of the conversations are heavily opinion based and only our view on the topic. 

This is our first episode of this style and we'd love to hear any comments or feedback and also know if this is something you'd like to hear again for future topics.

Enjoy!

Simon, Rob & James

Oct 14, 2021

Intubation is a key part of advanced airway management.

Although some of you out there may not intubate, we’ll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes.

Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and learn the skill. This brings into question who should these limited opportunities to train go to, what defines competence, which patients now would benefit from intubation.

In this episode we’re going to cover these topics and more, including talking through how to fine your intubation technique as much as possible. We’re coming at this episode with our collective neonatal, ED and PHEM practice which all involve advanced airway management and it’s fair to say that we’re all passionate about delivering intubation and advanced airway management to the highest level possible. 

We hope this episode gives a further opportunity to consider the topic in great depth and reflect upon how we can all contribute to improving practice.

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

Enjoy!

Simon, Rob & James

Oct 1, 2021

Welcome to October’s papers of the month!

Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We’ve looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms.

Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests and think further about the decision making that goes into these complex decisions.

Finally we take a look at a huge trial assessing the use of balanced fluids versus Normal Saline in critically ill patients and gain more information about the strategy we should employ.

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

Enjoy!

Simon & Rob

Sep 15, 2021

So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest!

There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!!

Some of the treatments we’ll discuss for patients with ACS can have a huge affect on morbidity and mortality and we can make a real difference to our patients. The ESC guidelines are a fantastic resource to take a look at and we've listen the papers that form the evidence we cover in the podcast.

We worry about missing ACS and conversely, with so many ‘suspected ACS patients’, we also worry about overly suspecting it and the subsequent burden of admissions and investigations that it may mean. We’re going to cover the approach to ACS in this episode in our standard format, all the way from definition, patho-physiology, assessment, investigations and management and cover aspects that are both new information and a sound revision of the topic.

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

Enjoy!

Simon, Rob & James

Sep 1, 2021

Welcome back after our summer hiatus to September’s Papers Podcast!

Firstly we take a look at two different strategies for managing agitation in the Emergency Department, to achieve rapid control. Is haloperidol and midazolam, or ketamine alone, a better strategy?

Then we take a look at the results from RECOVERY-RS. We covered the design of the trial at it’s conception last year and this trial essentially looks to answer whether a strategy of high flow nasal oxygenation, CPAP or conventional oxygenation is best for our patients with suspected or confirmed COVID-19 when they present with hypoxia.

Lastly we turn to Rob and take a look at his recent publication on the use of cervical collars when dealing with a patient able to self extricate from a motor vehicle collision; how will the application of a collar or commands help with excessive movement?

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

Enjoy!

Simon & Rob

Aug 1, 2021

Welcome to August 2021’s papers podcast!

Three more great papers for you this month which have challenged and informed our practice.

First up we look Impact of ambulance deceleration with patients lying flat vs 30 degrees head up on intracranial pressure in patients with a head injury.

Next, is a patient with a refractory VF arrest more likely to have a positive finding on coronary angiography than one with non-refractory VF?

And finally, in patients with blunt chest wall injury, does the presence of a flail chest indicate a worse morbidity and mortality compared to rib fractures alone? And what do the findings mean for our clinical examination focus?

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

We're giving you all a summer break from us and we'll be back again with our Papers of the Month and Roadside to Resus episodes in September.

Enjoy!

Simon and Rob

Jul 19, 2021

So welcome back to another Roadside to Resus episode!

Pre alerts are a key part of the interface between pre hospital and in hospital care of the critically unwell patient, when made and received in an effective manner they can really benefit the patient and the system. But too often we hear of friction associated with pre alerts and recent discussions on social media has really highlighted this.

In this episode we explore the pre alert, the guidance that exists already on the topic, the challenges of both making and receiving those pre alerts and our four major questions; why we pre alert, what we should pre alert, how to pre alert and when to pre alert.

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

Enjoy!

Simon, Rob & James

Jul 1, 2021

Another month and 3 more papers!

First up we have a look at a paper that has grabbed a lot of recent headlines in the form of TTM2. So we now seem to have the answer to whether comatose patients following out of hospital cardiac arrest benefit from therapeutic hypothermia over maintenance of normothermia.

Next up we take a look at a paper which adds some real value to our assessments of maxillofacial injuries and can help inform our assessment of the likelihood of fracture and need for imaging.

Lastly we take a look at the whether iv vs io access in cardiac arrest might make a difference to outcomes when it comes to the use of adrenaline.

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

Enjoy!

Simon and Rob

Jun 16, 2021

So this time we're going to be talking about subarachnoid haemorrhage. So this is going to be a short and punchy look at a really important and interesting topic in subarachnoid haemorrhage.

We run through the approach to headache and then focus on the specific features and findings that we should be looking for with regards subarachnoid haemorrhage. We then consider who we should be investigating further, what value a CT head brings and the sticky subject of who should be going on to have a lumbar puncture.

Finally we consider the the management once the diagnosis of SAH is reached and how we can ensure the best outcomes for our patients.

At the time of recording NICE has published its draft version of Subarachnoid Haemorrhage Caused by a Ruptured Aneurysm; diagnosis and management, which will be a great resource once finalised.

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

Enjoy!

Simon, Rob & James

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