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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 5
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.

May 21, 2018

The management of a cardiac arrest can be stressful at the best of times, but add into that the patient being a child and you have the potential for an overwhelmingly stressful situation.

Fortunately the major resuscitation bodies have some sound guidance on the management of paediatric arrests. In this episode we run through some of those guidelines and also the evidence base on the topic (scant at best!). We also touch on conveyance of the prehospital paediatric arrest, bringing familiy into the resuscitation area and knowing when to cease resuscitation.

We hope the podcast helps you prepare that little bit more for the next case you might see and that it may also ease the stress of such an emotive case.

Simon, Rob & James

May 10, 2018

Professor Simon Carley from St. Emlyns caught up with us at the superb Trauma Care Conference and talked through his top papers in trauma from the last 12 months.

There's something for everyone from diagnosing arterial injuries, blood pressure targets in the head injury patient, to i.v. contrast all the way through to imaging in kids.

If you haven't already, make sure you go and check out the St Emlyn's blog that underpins the talk that Simon gave. And if you're looking for a great value conference to suit all health care disciplines then make sure to keep an eye out for tickets when they go on sale for Trauma Care 2019.

A huge thanks to Simon C for his time recording the podcast and we'd love to hear any comments or feedback.

Enjoy!

Simon L & Simon C

References & Further Reading

For all the papers pop over to the St Emlyn's blog for the hyperlinks and abstracts

May 1, 2018

Dare we say it, we think this month's papers podcast is the best yet, we've got 3 superb papers and topics to consider!

The literature has been pretty airway heavy this month so we've got 3 papers on and around the topic for you.

First up we have a look at a really interesting paper from London HEMS looking at the risks v benefit of prehospital rapid sequence intubation in patients who are awake but hypotensive, is RSI a much needed move or something we should be looking to avoid prehospitally.

Airways-2 will soon be published looking at supraglottic airway management compared to intubation as first line airway management in out of hospital cardiac arrest, but JAMA has just published a paper comparing bag-mask ventilation vs endotracheal intubation in the same situation. It'll be interesting to see if this papers results fall inline with Airways-2.

Finally we take a look at a systematic review trying to give us the answer to direct or video laryngoscopy in emergency endotracheal intubation outside the OR.

Have a listen but most importantly have a look at the papers yourself and let us know your thoughts.

Enjoy!

Apr 23, 2018

Evidence based medicine (EBM) allows us to deliver the best care to our patients and understanding the concepts involved is crucial.

Over the last 18 month we've been building an online course to give people a sound understanding of EBM and we thought we'd give you a free taster of what it's all about.

Have a listen to one of our episodes here on statistics and if you want to find out more have a read below about the full course at www.CriticalAppraisalLowdown.co.uk

Enjoy!

SimonRob & James

 

Apr 18, 2018

For this episode we’ve been lucky enough to catch a number of the speakers from the traumacare conference.

First up, conference organiser Caroline Leech (EM + PHEM consultant) gave us a few minutes of her time to talk about the latest major trauma key performance indicators from NICE.

Nicola Curry (Consultant Haematologist) spoke about transfusion in trauma and the use of massive haemorrhage protocols. Importantly, she covers the evidence behind the current strategies and where future research opportunities exist.

Stuart Reid (EM + PHEM consultant) covered the ways of optimising timely transfer of major trauma patients. This had an inter-hospital focus, but there were certainly some elements which can be applied to a primary patient transfer.

David Raven (EM consultant) provided an update to the ongoing work with the HECTOR project. We’ve previously heard about their amazing course but this time he was able to let us know about the “silver trauma safety net” which is being used by the ambulance service in the West Midlands. This aims to provide appropriate recognition and triage of trauma in the elderly population.

Finally, Elspeth Hulse (anaesthetic SpR) gave us a timely reminder about the identification and management of organophosphate poisoning - really useful from both and EM and PHEM perspective.

Thanks again to Caroline for the invite to the conference and keep and eye out for a special podcast in the next few weeks where Simon Carley will be running through his top 10 trauma papers of 2017/18 (we were going to try and condense it, but there was way too much good stuff!)

Enjoy!

SimonRob & James

References & Further Reading

Trauma Care

St Emlyns

HECTOR

Apr 8, 2018

In this episode Rob takes us through a case he saw recently that brought about some invaluable learning.

We're not going to give you anymore clues than that!

Enjoy!

Simon & Rob

References & Further Reading

(anonymised to keep the anticipation!)

Article 1
 
Article 2
 
Article 3
 
Article 4
 
Apr 1, 2018

 

Welcome back to April's papers of the month.

We've got 3 papers this month that look to challenge our work up strategies for the critically unwell. First up we look at a paper on the Ottawa subarachnoid haemorrhage rule, specifically considering if we can decrease scanning in patients with a suspected SAH and what application of the rule might mean for our practice.

Next up we look at a paper that might shine some real doubt on the use of IO access in our patients in cardiac arrest.

Lastly we look at a validation paper for the PERC rule for those patients with a suspected pulmonary embolus and this paper brings about some interesting points on external validity

Once again we'd really encourage you to have a look at the papers yourself and we've love to hear any thoughts or feedback you have.

Enjoy!

Simon & Rob

 References

Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. Perry JJ. CMAJ. 2017  

Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Kawano T. Ann Emerg Med. 2018 

Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. Freund Y. JAMA. 2018

 CORE EM; IO in Cardiac Arrest

 

 

Mar 20, 2018

Gaining control of the airway in a critically unwell patient is a key skill of the critical care team and littered with potential for difficulty and complications.

NAP4 highlighted the real dangers faced with their review of complications of airway management in the UK, lessons have been learnt and practice has progressed. As always there is room to improve on current practice and a recent paper published in Anaesthesia describes a comprehensive strategy to optimise oxygenation, airway management, and tracheal intubation in critically ill patients in all hospital locations.

In this podcast we cover;

  • Why this matters to all involved in critically unwell patients, not just those delivering RSI
  • Recap of RSI, the procedure and its indictions
  • Headlines from NAP4
  • Strategies highlighted to optimise airway management and oxygenation
  • How this impacts our prehospital and inhospital practive

We'd love to hear your thoughts so please leave your comments below or contact us via twitter @TheResusRoom

Enjoy!

Mar 12, 2018

How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient?

Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them.

In the podcast we cover the following;

  • Whats the big deal with crystalloids
  • Previous trials on fluid administration
  • NEJM papers on crystalloids
  • Myburgh's editorial

Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below.

We'd love to hear any thoughts and comments below.

Enjoy!

Mar 1, 2018

Welcome to March's papers of the month. We know we're biased but we've got 3 more superb papers for you this month!

First up we review a paper looking at oxygen levels in patient's with a return of spontaneous circulation following cardiac arrest, is hyperoxia bad news for this patient cohort as well as the other areas we've recently covered?

Secondly we have a look at a paper reviewing the association between time to i.v. furosemide and outcomes in patients presenting with acute heart failure, you may want to have a listen to our previous podcast on the topic first here.

Lastly, when you see a pregnant patient with a suspected thromboembolic event, can you use a negative d-dimer result to rule out the possibility? We review a recent paper looking at biomarker and specifically d-dimers ability to do this. 

We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here.

Enjoy!

Simon & Rob

References & Further Reading

Association Between Early Hyperoxia Exposure AfterResuscitation from Cardiac Arrest and Neurological Disability: A Prospective Multi-Center Protocol-Directed Cohort Study. Roberts BW. Circulation. 2018

The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspectedvenous thromboembolism during pregnancy and puerperium. Hunt BJ. Br J Haematol. 2018

Time to Furosemide Treatment and Mortality in PatientsHospitalized With Acute Heart Failure. Matsue Y . J Am Coll Cardiol. 2017

MDCALC; Framingham Heart Failure Diagnostic Criteria

REBEL.EM; Door to Furosemide in AHF

Modified Rankin Scale

Feb 22, 2018

So the three of us are back together and going to take on Sepsis!

It's vital to have a sound understanding of sepsis. It has a huge morbidity and mortality but importantly there is so much that we can do both prehospital and in hospital to improve patient outcomes.

In the podcast we cover the following;

  • Definitions
  • Scale of problem
  • Different bodies; NICE/Sepsis Trust/3rd international consensus definition including qSOFA
  • Handover and pre alerts
  • Treatment; Sepsis 6
  • The evidence base behind treatment
  • Contentious areas
    •  Prehospital abx
    • Fever control
    • Steroids
    • ETCO2

We hope the podcast helps refresh your knowledge on the topic and brings about some clarity on some contentious points. As always don't just take our word for it, go and have a look at the primary literature referenced below.

Enjoy!

SimonRob & James

References & Further Reading

Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Kumar. Critical Care Medicine. 2006

Prognostic value of timing of antibiotic administration in patientswith septic shock treated with early quantitative resuscitation. Ryoo SM. Am J Med Sci. 2015 

The association between time to antibiotics and relevant clinicaloutcomes in emergency department patients with various stages of sepsis: a prospective multi-center study. de Groot B. Crit Care. 2015

Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Puskarich MA. Crit Care Med. 2011

Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E. N Engl J Med. 2001

Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Nguyen HB. Crit Care Med. 2004 

The prognostic value of blood lactate levels relative to that of vitalsigns in the pre-hospital setting: a pilot study. Jansen TC Crit Care. 2008

Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Jones AE. JAMA. 2010

Lower versus higher hemoglobin threshold for transfusion in septic shock. Holst LB. N Engl J Med. 2014

A randomized trial of protocol-based care for early septic shock. ProCESS Investigators. N Engl J Med. 2014

Trial of early, goal-directed resuscitation for septic shock. Mouncey PR. N Engl J Med. 2015

Goal-directed resuscitation for patients with early septic shock. ARISE Investigators. N Engl J Med. 2014

Acetaminophen for Fever in Critically Ill Patients with SuspectedInfection. Young P. N Engl J Med. 2015

NICE; Sepsis: recognition, diagnosis and early management

The Sepsis Trust

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Singer M. JAMA. 2016

NHS E; Improving outcomes for patients with sepsis. A cross-system action plan

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Alam N. Lancet Respir Med. 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic ShockVenkatesh B. N Engl J Med. 2018

PHEMCAST; End Tidal Carbon Dioxide

Current clinical controversies in the management of sepsis. Cohen J. J R Coll Physicians Edinb. 2016

St Emlyns; qSOFA 

RCEM; Severe Sepsis and Septic Shock Clinical Audit 2016/2017 National report

RCEM & UK Sepsis Trust; Toolkit: Emergency Department management of Sepsis in adults and young people over 12 years- 2016

Feb 12, 2018

On a not infrequent basis we will come across patients in hospital who have a CT head scan that appears to show an unsurvivable event. Having sourced opinion from our neurosurgical and neurology colleagues we may well be given the advice to withdraw care for the patient.

It has become increasingly recognised that prognosticating in such patients at an early stage is extremely difficult with numerous cases surviving what was initially thought to be an unsurvivable event, with a good neurological outcome.

This joint document from the Intensive Care Society, Royal College of Emergency Medicine, Neuro Anaesthesia and Critical Care Society of Great Britain & Ireland and the Welsh Intensive Care Society gives new guidance for such perceived devastating brain injuries and will challenge many peoples thinking on the topic with additional questions being asked on resource utilisation.

In this podcast Caroline Leech, EM and PHEM Consultant in Coventry, discusses the guidelines and the implications they hold for our practice.

As always make sure you read the document yourself, we would love to hear your thoughts.

Enjoy!

Simon & Caroline

References

Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement 

A case for stopping the early withdrawal of life sustainingtherapies in patients with devastating brain injuriesManara AR. J Intensive Care Soc. 2016

Feb 1, 2018

Welcome back, we've got 3 absolute beauties of papers for you this month!

You'll have struggled not to have heard about the ADRENAL trial, a trial of iv steroids in the sickest of patients with septic shock. We also have a look at a trial that many have been quoting as sound evidence for the utility of pH during the prognostication of patients in cardiac arrest. Finally we have a look at a paper that may shed some concern on the use of Double Sequential Defibrillation that we covered recently on the podcast...

We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here.

Enjoy!

Simon & Rob

References & Further Reading

TheBottomLine; ADRENAL

St Emlyns; ADRENAL

Adjunctive Glucocorticoid Therapy in Patients with Septic ShockVenkatesh B. N Engl J Med. 2018

External Defibrillator Damage Associated With Attempted Synchronized Dual-Dose CardioversionGerstein NS. Ann Emerg Med. 2018

Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study. Shin J. Crit Care. 2017

 

Jan 22, 2018

In this episode we cover a paper that you have to know about!

The use of tranexamic acid(or TXA) has become widespread in the case of major trauma and post partum haemorrhage. This time we discuss a recent paper that asks us if giving it within 3 hours is enough, or whether we need to be even more specific regarding its urgency of administration in order to save lives from bleeding.

There is a superb podcast over at our buddies site PHEMCAST which covers an interview with one of the authors and we'd highly recommend listening to that!

Enjoy!

Simon & Rob

References

Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Gayet-Ageron A. Lancet. 2017

Jan 12, 2018

Prehospital Care is evolving rapidly and is one of the most exciting and dynamic specialties to be involved with at the moment.

As a reflection of it's progress the Faculty of Pre Hospital Care held  its first scientific conference this week. We were lucky enough to be invited by Caroline Leech, EM & PHEM Consultant and the person responsible for organising this superb event, to interview some of the superb speakers at the event.

Here are the speakers we were lucky enough to catch up with and the topics they discuss

Matt Thomas – Hyperoxia: when oxygen is harmful

Jo Manson – The hyperacute inflammatory response to trauma

Rob Moss – FPHC Consensus Statement - Spinal

Malcolm Russell – FPHC Consensus Statemnent – External Haemorrhage

Tim Nutbeam – Pre-hospital research: what do we not know? 

David Menzies – Impact brain apnoea & motorsport

Stacey Webster – Calcium in pre-hospital blood transfusion: the missing link

Rod Mackenzie Injury prevention, control & recovery

A huge thanks to all involved in the conference for having us at the conference and we hope to see you all next year!

SimonRob & James

 
References and links
 
 
FPHC Consensus statement guidelines
 

Ionised calcium levels in major trauma patients who received blood in the Emergency DepartmentWebster S. Emerg Med J. 2016

TOP-ART

Jan 1, 2018

Happy New Year!!

Welcome back to the podcast and what we hope will be a superb year. We've got three excellent papers that are extremely relevant to our practice and will have an impact on practice.

First up it's a paper looking at the benefit of iv versus oral paracetamol in the Emergency Department, something we do really frequently but what does the evidence say? Next we have a look at the difference that topical TXA could make to epistaxis in terms of bleeding cessation. Lastly we look at a systematic review looking at adenosine versus calcium channel blockers for SVT.

Very soon we'll be releasing our Critical Appraisal Lowdown course, so keep an eye out for that.

And finally a huge thanks to our sponsors ADPRAC for all of the support with TheResusRoom.

Enjoy!

Simon & Rob

 

 

 

Dec 11, 2017

Handover matters.

Handover of patient care occurs at multiple points in the patient's journey and is a crucial point for transference of information and inter professional working.

Whether it's the big trauma in Resus with the prehospital services presenting to the big crowd, right the way through to the patient coming to minors who looks like they will be going home shorty, each of these transactions of information needs to be done correctly.

Handover can be stressful though and different parties will have different priorities that they are trying to juggle. In this podcast we explore handover, some of the barriers and issues that exist. We have a look at the evidence that exists on it's importance, impact and associated techniques. We also look at tools that exist that can be used to facilitate effective handover.

As ever make sure you look at the articles mentioned in the podcast yourself and we would love to hear your thoughts.

Enjoy!

SimonRob & James

References & Further Reading

Information loss in emergency medical services handover of trauma patients. Carter AJ. Prehosp Emerg Care. 2009

Maintaining eye contact: how to communicate at handover. Dean E. Emerg Nurse. 2012

The handover process and triage of ambulance-borne patients: the experiences of emergency nursesBruce K. Nurs Crit Care. 2005

Handover from paramedics: observations and emergency department clinician perceptions. Yong G. Emerg Med Australas. 2008 

Review article: Improving the hospital clinical handover between paramedics and emergencydepartment staff in the deteriorating patient. Dawson S. Emerg Med Australas. 2013

Dec 1, 2017

You've got a critically unwell patient who needs an RSI. You've got lots of things to think about but specifically do you ramp them up or keep them supine, additionally do you use a checklist or are those things a complete waste of time? This month we have a look at 2 papers which should shed some light on the subject.

We also look at a systematic review and meta-analysis which hopefully helps us answer a question we've been looking at on the podcast for quite some time: in the the context of a cardiac arrest that has gained a ROSC, if the ECG is not diagnostic of a STEMI but the history is suggestive of a cardiac event, should the patient go straight to the cathlab for PCI?

As always don't just take our word for it but go and have a look at the papers yourself and we would love to hear your thoughts.

A Multicenter Randomized Trial of a Checklist for Endotracheal Intubation of Critically Ill Adults. Janz DR. Chest. 2017

Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis. Khan MS. Resuscitation. 2017

JC: Should non ST elevation ROSC patients go to cath lab? St.Emlyn’s

CHECK-UP Checklist; The Bottom Line 

Nov 20, 2017

Traumatic Cardiac Arrest; for many of us an infrequent presentation and it that lies the problem.

In our previous cardiac arrest podcast we talked about the approach to the arresting patient, however in trauma the approach change significantly.

We require a different set of skills and priorities and having the whole team on board whilst sharing the same mental model is key.

Have a listen to the podcast and let us know your thoughts. The references are below but if you only read one thing take a look at the ERC Guidelines on traumatic cardiac arrest which we refer to.

Enjoy!

SimonRob & James

References & Further Reading

Resuscitation to Recovery Document

Roadside to Resus; Cardiac Arrest

ERC Guidelines; Traumatic Arrest

Traumatic cardiac arrest: who are the survivors? Lockey D. Ann Emerg Med. 2006

Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest. Wah W. Am J Emerg Med. 2017 

Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. Beck B. Resuscitation 2017.

An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. Seamon MJ. J Trauma Acute Care Surg. 2015

EAST guidelines 2015; ED Thoracotomy

Nov 10, 2017

If you talk to people about the topic of thrombolysis in PE they'll tell you about the controversy of the submassive category, but there's a universal acceptance that thrombolysing massive PE's is well evidenced and straight forward.

In this episode we delve back into the literature and not only explore massive PE thrombolysis, but also the gold standard to which it is judged upon, heparin.

Have a listen to the podcast and as always we would love to hear your thoughts.

Enjoy!

Simon & Rob

References & Further Reading

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. A Scientific Statement From the American Heart Association. 2011

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1438862/pdf/jrsocmed00257-0051.pdfValue of anticoagulants in the treatment of pulmonary embolism: a discussion paper. Paul Egermayer. Journal of the Royal Society of Medicine 1981.

Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. BARRITT DW. Lancet. 1960

Treatment of pulmonary embolism in total hip replacement. Johnson R. Clin Orthop Relat Res. 1977

PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. Dalla-Volta S. J Am Coll Cardiol. 1992 

Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Goldhaber SZ. Lancet. 1993

Nov 1, 2017

Welcome back to November's papers podcast!

This month we've got some great topics to discuss.

We look at another paper on the topic of oxygen therapy, this time a hug article from JAMA on oxygen therapy in the context of acute stroke and the impact on disability.

Next up we look at a fascinating case report of a extradural haematoma that was drained via an I.O. needle prior to surgical evacuation.

Lastly we follow up on our previous podcast on PE; the controversy, which looked at the prevalence of PE in those patients presenting with undifferentiated syncope. This paper puts a great counter to the conclusions arrived at in that Prandoni paper.

Enjoy!

Simon & Rob

References & Further Reading

Temporising extradural haematoma by craniostomy using an intraosseous needle. Bulstrode H. Injury. 2017 

Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. Oqab Z. Am J Emerg Med. 2017 

Oct 16, 2017

Last time in Roadside to Resus we discussed cardiac arrest with a view to obtaining a return in spontaneous circulation, ROSC.

However gaining a ROSC is just one step along the long road to discharging a patient with a good neurological function back into the community. In fact ROSC is really where all of the hard work really starts!

In this podcast we talk more about the evidence base and algorithms that exist to guide and support practice once a ROSC is achieved. We'd strongly encourage you to go and have a look at the references and resources yourself listed below and would love to hear your feedback in the comments section or via twitter.

Enjoy!

SimonRob & James

References & Further Reading

Resuscitation to Recovery Document

Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. Niklas Nielsen. N Engl J Med 2013

Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Dumas F. Circ Cardiovasc Interv. 2010

Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Sandroni C. Resuscitation. 2013

Roadside to Resus; Cardiac Arrest

PCI following ROSC; TRR

Oct 6, 2017

This podcast covers some highlights from the talks at the BASICS and The Faculty of Pre-Hospital Care 2017 Conference.

We were lucky enough to be invited by Caroline Leech to cover the day and managed to grab a couple of minutes with a handful of the superb speakers;

Dr. Tom Evens; Elite sports for high performance clinicians

Dr. Les Gordon; Pre-hospital management of hypothermia

Dr. Helen Milne; Retrieval and transfer medicine

Surgeon Commander Kate Prior; The battlefield

Dr Chris Press; Prehospital management of diving emergencies

Miss Aimee Yarrington; Obstetric Emergencies

Professor Mark Wilson; Pre-hospital Care, where are we going?

 

Thanks to all involved for making the podcast and for a great day at the conference, and to PHEMCAST for the collaboration!

Simon, Rob & Clare

 

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