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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 1
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

Dec 14, 2023

We know it's the festive season but we thought we’d try and cover an issue from which there appears to be no escape and is a particular problem at this time of year, queuing!

Whether we like it or not, this has become a factor for all of us working in emergency care, whether its delays getting your patient into the department, queueing down the corridor into ED, a prolonged stay in ED for an appropriate ward, or even in a physical queue to get out of the ED and onto an appropriate bed!

We are looking after our patients for significantly longer than we’re used to and this pushes the patient and the clinician into an area of care in which we have limited experience and comfort.

Rather than accepting delays and ignoring their inevitable impact on patient care, we need to move towards equipping ourselves with the skills and knowledge to fill that care vacuum and ensure that excellence in patient care continues throughout their time with the ambulance service.

So with that in mind, in this episode we’re going to think about some of the considerations and interventions that are required to ensure our patients remain safe and comfortable throughout their queueing experience. And to do that we’re going to draw on the concept of prolonged field care.

An article by Aehbric O’Kelley and Tom Mallinson recently authored a paper published in Journal of paramedic practice entitled “Prolonged field care principles in UK paramedic practice”. That article really provided the idea and stimulus for this episode, so thanks to them for all of the hard work and once you’ve listened to us waffle on you should head across to their paper for a far more eloquent explanation of it all!

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

Simon, Rob & James

Dec 1, 2023

We've talked about Aortic Dissection before in our Roadside to Resus episode and the huge difficulties in picking out these rare but potentially devastating cases and this month we've got a fantastic paper on the topic! The DAShED study looks at patients presenting with symptoms that could be suggestive of aortic dissection and helps us understand the diagnostic challenge and approach to acute aortic syndrome, along with testing the characteristics of a number of decision tools.

Next up we look at a paper from Bendszus, an RCT of medical versus thrombectomy and medical treatment for acute ischaemic strokes with a large infarct, with some really powerful results.

Finally we look at a paper that shows some staggeringly different ROSC rates for patients in cardiac arrest depending on the size of the ventilation bag used!

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

Simon & Rob

Nov 15, 2023

Blood gases are really commonly used in ED, Critical Care, Respiratory Medicine and Prehospitally. In fact, you’d do well to walk 10 meters in an ED without being given one to sign off! But it’s for good reason, because they give you additional information about what’s going on from a respiratory and metabolic perspective in the patient.

And it’s probably worth mentioning at this point, this episode is going to be pretty ‘science-heavy’, there should be something in here for everyone; from the clinician that's been looking at these things for the last 30 years, to those that haven't started interpreting gases.

So arterial blood gases can tell you about the efficacy of the patients ventilation in terms of their partial pressures of oxygen and carbon dioxide levels and also from a metabolic perspective about other disorders of their acid-base balance. 

In the episode we'll be covering the following;

-Overview of blood gases

-Respiratory & metabolic sides of the gas

-Acidaemia

-Alkalaemia

-Bicarbonate or base excess?

-Compensation

-Oxygenation

-Anion gaps

-System of interpretation

-Venous gases

-Clinical application & examples of interpretation

We'll be referring to the equation listed on our webpage, so make sure you go and have a look at that and all the references listed.

Once you've listened to the podcast make sure you run through the quiz below to consolidate the concepts covered with some more gas examples and of course get you free CPD certificate for your TheResusRoom portfolio!

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

Enjoy!

Simon, Rob & James

Nov 1, 2023

Well this has been a huge month for Emergency Medicine and Critical Care in terms of papers!

We start off looking at REBOA; many resuscitationist's favourite concept or device with the much awaited UK-REBOA trial. What does the paper mean for practice in our Resus Rooms? Is this about to become a key part of trauma management? The paper is fascinating and one of the most though provoking we've discussed in a while.

Next up we look at CROYSTAT-2, another such anticipated trial looking at whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol.

Finally we look at a paper which describes a taxonomy of key performance errors in intubation and may inform our review and improvement of intubation in the ED.

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

Simon & Rob

Oct 16, 2023

In this episode we’re going to cover the ‘atraumatic’ or ‘spontaneous’ pneumothoraces and focus on some new key guidelines from the British Thoracic Society which came out in July this year and also look at the relevant evidence on the topic.

There are pretty significant changes in the BTS guidance, it’s no longer about finding a pneumothorax, working out if it’s primary or secondary and then acting dependant on the size. It's now moved more towards looking at how the patient is clinically, taking into account the symptomatology, any big risk characteristics, whether it’s primary or secondary and then thinking about the patients wishes and priorities and nuancing the management plan towards those. 

This episode builds on some of the concepts we discussed in our Traumatic Pneumothorax podcast, so make sure you give that one a listen before clicking play on this one!

We'll be looking at the presentation, evidence, management and follow up, along with some trials that you can get involved in to help develop practice even further.

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

Enjoy!

Simon, Rob & James

Oct 1, 2023

Welcome back!

This month we kick off looking at an RCT which looks at whether we should convey patients with a ROSC from a likely cardiac cause (without a STEMI in their ECG) to a cardiac arrest centre, or whether they would be as well served at their local Emergency Department. This paper has huge potential implications for service design for cardiac arrest patients.

Next up we look at another RCT evaluating if patients with a suspected uncomplicated appendicitis who have urgent surgical intervention benefit in terms of a reduced perforation rate, when compared with those who have surgery within 24 hours.

Lastly we take a look at the use of bicarbonate, calcium and magnesium in cardiac arrest and see if there use is supported in a huge cardiac arrest registry.

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

Simon & Rob

Sep 19, 2023

Delivering excellent End of Life Care in the Emergency Care is a real challenge but also a huge privilege and has formed some of the most rewarding parts of our careers to date.

We've been really keen to End of Life Care as a topic for a while now. Many, if not all of you, will have been out to these patients or received them in your ED. 

They aren’t simple cases to manage, with lots of issues around scope of practice, lack of alternative care pathways, confusion surrounding legal documentation and many studies have identified a lack of education around palliative care.

In this episode we’ll do our best to demystify those medico-legal terms, talk about care pathways and options that may be available to us, have a think about how we can talk with patients about death and then go on to discuss the clinical care we might need to deliver and the wider holistic nature of caring for these patients and their loved ones.

We're lucky enough to be joined by Ed Presswood, who's a palliative care consultant and clearly an expert on the topic. We gained a massive amount from this episode and we hope you find it really useful too.

You'll find the hyperlinks to some fantastic resources on the topic over on the webpage at TheResusRoom.

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

Enjoy!

Simon, Rob & James

Sep 15, 2023

Welcome back to the podcast, coming to you all the way from Australia!

Rob and James were fortunate enough to be invited to deliver the keynote and an airway masterclass at this year's Australian College of Paramedicine International Conference.

At what was an amazing meeting, they were lucky enough to be able to catch up with some of the fantastic speakers to hear the key parts of their talks. In this episode you'll hear from;

Richard Armour, Mobile Intensive Care Ambulance Paramedic at Ambulance Victoria and PhD Candidate at Monash University; Identifying patients requiring chest compressions at overdose prevention sites

Nick Roder, MICA Flight Paramedic Educator, Ambulance Victoria and Teaching Associate, Monash University; Intubation in the setting of airways and inhalation burns

Dr Tegwyn McManamny, Intensive Care Paramedic and Lead Patient Review Specialist, Ambulance Victoria; Care of the Older Person - Delirium and Paramedic Detective

Olivia Hedges, Palliative Care Connect Lead, Ambulance Victoria; Palliative Care Connect Program

Chelsea Lanos, Advanced Care & Community Paramedic Researcher; Organ donation after out-of-hospital cardiac arrest in Canada - a potential role for paramedics

A huge thanks to ACP for the invite, Zoll for the support of the podcast and conference and to the fantastic speakers for giving ip their time to talk to us. We'll be back with another Roadside to Resus episode for you next week on End of Life Care.

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Rob & James

Sep 1, 2023

Welcome back to the podcast!

We're back with three really interesting papers after our summer break, with some great points to think about with regards to our practice and patient outcomes.

First up we take a look at the CT FIRST study which looks at the benefit of whole body CT in patients presenting with a ROSC after their out of hospital cardiac arrest with no obvious cause. Should we be more liberal in our imaging requests in this patient cohort?

Next up we have a think about thrombolysis for massive PEs. When it comes to these patients we have to consider the very real potential complications of thrombolysis and that can often dissuade us from treating them. This paper looks at an alternative dose in thrombolysis and describes some really interesting results.

Finally we take a look at a CT study which is scanning trauma patients after they have died. What injury patterns do they find, which injuries would have been amenable to treatment and are there any lessons on practice to be learnt?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Simon & Rob

Aug 1, 2023

Welcome back, this is our last podcast before our short summer break!

We start off having a look at the physiological effects of prolonged resuscitation with a supraglottic device compared with endotracheal intubation, which raises some really interesting questions about our ongoing ventilation strategy in resuscitations.

Next up we look at an RCT comparing RSI to DSI in critically injured patients and the effect on peri-intubation hypoxia.

Finally we take a look at the practice of lateral canthotomy for retrobulbar haemorrhage/orbital compartment syndrome. How effective is the procedure and how competent are EM clinicians compared to Opthalmogists?

Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September!

Simon & Rob

Jul 14, 2023

So in this episode we’re going to run though the primary survey in trauma. This clinical assessment helps us identify and treat life threatening injuries and to rapidly intervene and correct them, so getting it right really matter1. 

How this is done is hugely dependant upon the setting (either pre or in-hospital) as it is affected by the access to the patient, the number of people there to contribute to care and the challenges that the scene or hospital environment might hold.

We run through a model of primary survey that looks to gain as much information as possible in a rapid and effective pattern and discuss the slightly different approaches we all take, along with  rationale behind them.

Finally we cover the communication of the primary survey to the team, strategies that we can undertake to achieve this and how this can affect the momentum and onwards care of the patient. 

We found this a really useful topic to consider in some depth and we hope it's of use to you too!

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

Enjoy!

Simon, Rob & James

Jul 1, 2023

There have been some huge trials released over the last month and we've got three brilliant papers to discuss!

First up we take a look at an RCT on video versus direct laryngoscopy for patients requiring emergency intubation with the DEVICE trial. The VL versus DL debate has been ongoing for quite some time now, so is this a final nail in the coffin for DL?

Next up we take a look at an RCT of prehospital TXA use in patients at risk of bleeding from major trauma in the PATCH trial. The results seen in the trial look at a glance to oppose those seen in CRASH-2, so is this the end of TXA in this cohort of patients?

Finally we have a great paper giving us further information on whether we should we be initiating immediate antihypertensive treatment for patients admitted to hospital with asymptomatic hypertension.

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

Simon & Rob

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

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