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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: Page 2
Jun 14, 2023

This is the first of two episodes looking at pneumothoraces. In this episode we're going to start out by taking a look at traumatic pneumothoraces.

Traumatic pneumothoraces are present in about a fifth of multiple trauma patients, so it's not infrequent to come across them and they can obviously occur in those with isolated chest injury too. Thoracic trauma occurs in around two thirds of multi-trauma cases and is classified as the primary cause of death in a quarter of trauma patients.

The clinical assessment carries with it a fair amount of dogma, including looking for tensions with tracheal deviation, so we'll be running through what the signs we should look for actually mean.

Then we'll move on to a detailed discussion about investigation strategies before finally looking at the guidelines and evidence on the topic, including which we have to intervene with, which we probably shouldn't and those in which there is much uncertainty...

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

ps; if you’re interested in getting your site involved with the CoMITED Trial then email comited-trial@bristol.ac.uk 

Jun 1, 2023

Welcome back to the podcast and to the first episode in collaboration with our new sponsors Zoll, a huge thanks to them in their support of free open access medical education!

First off this month we return to the topic of rib fractures; with an apparent shift in practice to the surgical fixation of multiple rib fractures, we take a look at an early vs late approach and consider the impact these results may have on trauma systems.

Next up it's a prehospital RCT assessing the use of a prehospital strategy including a single troponin to rule out acute coronary syndrome. Will this prove safe when compared to an in hospital strategy and what impact does it have on prehospital resources?

Finally we look at ventilation rates in cardiac arrest management. For as long as we can remember the guidance has been to ventilate at ten breaths per minute, but will a strategy involving a faster ventilatory rate yield better results?

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

Simon & Rob

May 18, 2023

The last time we took a good look at head injuries was back in 2018 in our Roadside to Resus episodes and for all of the foundational stuff on incidence, assessment, management and loads more  make sure you go and check that episode out. 

But this episode is one of our new UPDATES episodes, because we’re pretty old now… and whilst we’ve been having a go at this for a while evidence and guidelines will have progressed, which clearly have implications on how we manage certain cases and that’s where these come in! So they’ll focus mainly on the last 5 years of practice.

The new NICE head injury guidance has just been released and it’s the first major overhaul since 2014.  Now we know it’s a UK guideline, but there’s some really key practice updates and evidence in there that’s relevant irrespective of where you find yourself listening this! 

So in this episode we're going to be having a look at the most recent TXA evidence, with in terms of indications, timing and dosing. We'll be having a look at the risk of intracerebral injury with regards to anticoagulants and antiplatelet agents and a few other bits and pieces that can help us inform and improve our care.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

May 1, 2023

This month we start off with a paper looking at the first pass success rate of intubation in cardiac arrest when performing continual CPR versus pausing.

We then come on to two really interesting diagnostic papers and our prehospital accuracy for identifying certain injuries; we take a look at the accuracy of HEMS clinicians in assessing the stability of a pelvic ring and subsequent application of a pelvic binder. And then we look at the accuracy of prehospital clincians in assessing for all life and limb threatening injuries.

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

Simon & Rob

Apr 17, 2023

Being in a situation of being unable to intubate and unable to oxygenate is an absolute time critical emergency. 

Focus needs to be paid to the techniques and strategy to deal with this situation. But we also need to consider steps to ensure it occurs at a low frequency and our decision making and recognition of the situation happens quickly and simply.

In the episode we’re going to be talking about a number of other aspects that are relevant for all emergency providers, irrespective of whether you intubate or not, along with how those aspects translate into everyday practice. 

We'll be covering bits around patient positioning, optimising simple ventilation via a BVM & supraglottics, all the way through to needle cricothyroidotomy and surgical airways.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Apr 1, 2023

Welcome back to the podcast!

This month we start off thinking about sepsis, specifically fluid management and whether a restrictive approach to fluid resuscitation in combination with earlier vasopressors is advantageous over a liberal approach.

Next we have a look at a study evaluating the diagnostic benefit of ultrasound in the prehospital setting.

Finally we have a think about the benefit that traumatic brain injury patients may benefit from with regards to beta blocker therapy.

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

Simon & Rob

Mar 16, 2023

So NOF's aren't the most glamorous of topics to cover on a podcast, but the difference we can make to patients but refining our care is huge. 

Neck of femur fractures have a high and increasing incidence. They occur predominantly in frail patients who have the greatest risk of complications, both from the injury and medical interventions. 

In this episode we'll be running through their presentation, discuss both the clinical and radiological diagnostics. We'll also be looking in depth about both pharmacological and non-pharmacological methods of pain relief and have a think about where fascia-iliaca compartment blocks sit with regards to pre and in- hospital practice. 

Finally we'll move on to the definitive surgical approach and in-hospital care.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Mar 1, 2023

Welcome back to the podcast!

ECMO-CPR is a growing conversation in the world of cardiac arrest management. This month we have a look at a paper which adds some great evidence to the overall picture; with an RCT on ECPR in refractory of out of hospital cardiac arrest. How will this compare to the amazing results from the ARREST trial?

Next up is a really informative paper looking at the utility of ultrasound in suspected testicular torsion in children, this may make a difference to your investigation strategy.

Lastly we look a a paper describing the journey of a quality improvement project on paramedic intubation and see the phenomenal results that the method led to.

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

Simon & Rob

Feb 20, 2023

So in this episode we’re going to be covering crush injury. 

When you think about it, visions of falling rocks, industrial accidents and high speed RTCs may come to mind, but actually a crush injury can be sustained in a huge variety of ways without such vivid circumstances.

Definitions according to the Faculty of Prehospital Care are that;

‘A crush injury is a direct injury resulting from crush. 

Crush syndrome is the systemic manifestation of muscle cell damage resulting from pressure or crushing’

So in the episode we’re going to run through all of the bits that we normally cover, from pathophysiology, to presentation and onto treatment. We'll also be looking at the controversy and evidence behind tourniquet use, fluid therapy, electrolyte management and much, much more!

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Feb 1, 2023

Welcome back!

Three more papers for you this month to inform and improve our care in acute and critical illness.

First up and following on from the recent DoseVF paper, we take a look at a study looking at the combined effect of vector change, esmolol and capping adrenaline administration in refractory VF with regards patient out ones. Could this be associated with even better patient outcomes?

Secondly we take a look at the utility of fentanyl lozenges in providing effective analgesia to patients in remote settings. Does this have potential for both prehospital and in-hospital patients prior to iv access.

Finally we cover a paper looking at prehospital management of acute behavioural disturbance; the need for restraint, the need for sedation and the subsequent effects on the patients.

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

Simon & Rob

Jan 16, 2023

Welcome back to our first Roadside to Resus episode for 2023!

We're back with the huge topic that is COPD. In this episode we're going to delve into the depths of the topic, helping us to deliver the best possible care for this frequently encountered presentation.

Along with the standard coverage from incidence, to pathophysiology, to presentation and treatment, we'll also be covering those topics that you've specifically asked for;

  • The mechanism behind hypercapnoeic respiratory failure, in those patients given to much oxygen
  • Is there a role for end tidal CO2 interpretation in those spontaneously ventilating in acute exacerbations of COPD
  • How do we tease out those for home care versus those that require hospital admission
  • What is the role of Magnesium in these patients

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Jan 1, 2023

Welcome to 2023 and a very happy New Year!

We hope you managed to get some time with your loved ones over the festive period and we're back with the podcast again to kick off the new year.

First up, we take a look at a paper assessing whether there is benefit to treatment with thrombolytics or anticoagulants for patients in cardiac arrest due to a presumed MI.

Next up we look at the potential harm in administering steroids to patients with COVID-19 nor requiring supplemental oxygen.

Finally, we take a look at a paper assessing the potential use of point of care lactate in predicting the need for in-hospital blood product resuscitation.

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

Simon & Rob

Dec 16, 2022

So following on from our Bradycardia episode, we're going to look in detail at cardiac pacing.

Setting up emergency pacing in those compromised bradycardia patients can make a significant difference to patient outcomes, and doing so in a timely and slick fashion can be a real challenge.

In this episode we'll be discussing all forms of pacing, strategies for ensuring the greatest likelihood of success and the details of setup and analgesia/sedation strategies for external pacing.

Once again we'd love to hear any comments or questions either via the website or social media.

Enjoy!

Simon, Rob & James

Dec 1, 2022

Welcome back to 200th episode of the podcast! A huge thank to all of you for your support and engagement.

Three more papers for you this month to challenge thinking across a board range of Emergency Care. First up we take a look at DOSE VF, an RCT look at the best defibrillation strategy for refractory VF.

Next we take a look at another RCT looking at the potential benefit of dexamethasone, in order to reduce pain in patients suffering with renal colic.

Last up, we've talked a lot about the importance of first pass success in advanced airway management, but what (if any) is the association with mortality in prehospital RSI?

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

Simon & Rob

Nov 18, 2022

Acute Behavioural Disturbance (ABD), one of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients.

There is no widely accepted definition of ABD. Really it’s an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of;

  • Delirium
  • Severe agitation and aggressive behaviour
  • Autonomic dysfunction

In this episode we're going to run through ABD, it's causes, the approach and investigation. Excellent management of these cases relies upon high quality team working, planning, communications and strategies to keep all involved safe and we'll be discussing each of those in turn.

Enjoy!

Simon, Rob & James

 

Nov 1, 2022

Welcome back to the podcast and to November's Papers Of The Month.

First up we're taking a look at a paper that challenges the current American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines that recommend when right ventricular myocardial infarction, that patients are not administered nitrates due to the risks of compromise of cardiac output. 

Secondly we look at an RCT, with some really clever blinding, that looks at different BP targets for intubated and ventilated patients in ICU who have sustained a cardiac arrest.

Finally we take a look at a paper focussing on healthcare professionals’ perceptions  of interprofessional teamwork in the emergency critical incidents.

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

Simon & Rob

Oct 17, 2022

We’ve covered tachycardias, both narrow and broad before, but we need to complete the set.  So this time we’ll be looking at the slower end of the spectrum, with bradycardias.

Bradycardias can be a physiological state in athletes, but they can also be of significant concern.

They occur due to a multitude of reasons, some cardiac and some not and they can require no treatment at all right up to those peri-arrest patients where you’ll be cracking open your critical care drugs and starting to pace them externally before getting them to definitive care.

In this episode we take an in-depth look at the cause, electrophysiological pathways, assessment and treatments for bradycardias.

Enjoy!

Simon, Rob & James

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

 

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