Welcome back to November's Papers Podcast! We've got 3 great papers for you again this month.
First up we take a look at a paper that looks to quantify the amount of experience needed to be a proficient intubator, in this case in arrest. Next we have a look at a paper which shows a significant difference in mortality in cardiac arrest dependant on the intravascular access route used. Finally we have a look a really interesting paper in the dispatch method of a HEMS service which we be of real interest to all those involved in paramedicine and prehospital critical care.
Make sure you take a look at the papers themselves and form your own opinions. We'd love to hear any thoughts and feedback you have.
Enjoy!
Simon & Rob
References & Further Reading
How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation? Kim SY. Resuscitation.2018
A novel method of non-clinical dispatch is associated with a higher rate of criticalHelicopter Emergency Medical Service intervention. Munro S .Scand J Trauma Resusc Emerg Med.2018
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
With bonfire night approaching we thought it would be a good time to have a think about burns.
However burns are a significant issue at all times of year with around 130,000 presentations to UK EDs annually, 10,000 cases are admitted to hospital, 500 of these have severe burns and 200 of these will die. But most importantly intervention that we make can make a big difference to both morbidity and mortality, really affecting outcomes.
Throughout this episode we'll be covering the essential first responder management, all the way through to the critical care that maybe required for the sickest of burns patients.
In the podcast we cover
Burn type and burn severity
The importance of history
Assessing burn extent
Assessing burn depth
The A-E assessment and specifics regarding the burns patient
NAI, antibiotics, tetanus cover, analgesia, special circumstances eyes & chemicals
Conveyance and destination
As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you.
Enjoy!
Simon, Rob & James
References
British Burn Association First Aid Clinical Practice Guidelines
BBA Clinical Practice Guideline for Management of Burn Blisters
BBA Clinical Practice Guideline for Deroofing Burn Blisters
RCEMLearning; Major Trauma, Burns
National Burn Care Referral Guidance
WHO; fact sheet on burns
NHS Standard Contract for Specialised Burns Care (All Ages) Schedule 2- The Services A. Service Specification
LITFL; burns
Clinical review: The critical care management of the burn patient. Jane A Snell. Crit Care 2013
Fluid resuscitation in major burns. Mitra B ANZ J Surg. 2006
How well does the Parkland formula estimate actual fluid resuscitation volumes? Cartotto RC. J Burn Care Rehabil. 2002
Fluid resuscitation management in patients with burns: update. Guilabert P. Br J Anaesth. 2016
ISBI Practice Guidelines for Burn Care 2016
Welcome back to October's Papers Podcast, this month we move airway from advanced airway management and bring you a broad array of papers.
First up we have a look at the relative success of a variety of pharmacological strategies for managing the acutely agitated patient in ED. Next up we have look at the well know CURB-65 score and it's ability to predict the need for critical care interventions. Lastly, we may all feel at times that performing a CT head on those well patients solely because they take anticoagulants may be a little on the excessive side, we review a paper that looks at the yield of positive scans in this cohort.
As ever don't just take our word for it, go and have a look at the papers yourself, we would love to hear any comments or feedback you have.
Enjoy!
Simon & Rob
References & Further Reading
IntramuscularMidazolam, Olanzapine, Ziprasidone, or Haloperidolfor TreatingAcuteAgitationin the Emergency Department. Klein LR. Ann Emerg Med. 2018
Performanceof the CURB-65Scorein PredictingCritical CareInterventionsin PatientsAdmitted With Community-AcquiredPneumonia.Ilg A. Ann Emerg Med.2018
Incidenceof intracranial bleedingin anticoagulatedpatientswith minor head injury: a systematic review and meta-analysis of prospective studies. Minhas H. Br J Haematol.2018
So we're back with September's papers of the month a little later than usual but we wanted to give you a little time to digest AIRWAYS-2... before we give you some more prehospital research on advanced airway management in cardiac arrest!
The American version of AIRWAYS-2, PART, has just been released in JAMA, looking at the laryngeal tube versus endotracheal intubation as a primary strategy for advanced airway management. The paper is fascinating accompaniment to AIRWAYS-2.
Next we have a look at a paper assessing Emergency Medicine clinicians' ability to predict hospital admission at the time of triage, should we be making early calls on the destination of our patients?
Finally we have a look at the potential role of esmolol in cases of refractory VF and a paper that reports twice the survival rates in those that receive it!
As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.
Enjoy!
Simon & Rob
References & Further Reading
Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. Henry E. Wang, MD. 2018
Emergency medicinephysicians' abilityto predicthospital admissionat the timeof triage. Vlodaver ZK. Am J Emerg Med.2018
Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patientswith refractory ventricular fibrillation. Driver BE. Resuscitation.2014
King Laryngeal Tube
So we're back from our summer hiatus with a real treat. The long awaited AIRWAYS-2 paper has just been released and we've been lucky enough to speak with the lead author, Professor Jonathan Benger, about the paper and discuss what the findings mean for cardiac arrest management.
AIRWAYS-2 looks at the initial advanced airway management strategy for paramedics attending out of hospital cardiac arrests, essentially whether or not the aim should be to place a supraglottic airway device or an endotracheal tube when advancing from simple airway techniques. The study was a huge undertaking with many speculating over how the results would change practice, including discussion of how it may affect paramedic's practice of intubation, all of which we cover in the podcast.
Before you listen to the podcast make sure you have a look at the paper yourself, have a listen to PHEMCAST's previous episode which covers the study design and have a look at the infographics on the website which summarise the primary outcome and secondary analysis and which we refer to in the interview with Professor Benger.
In the podcast we refer to Jabre's paper which can be found below and we also covered in May's papers podcast. Have a listen to the interview and let us know any thoughts or feedback you have, we're sure this one will create a lot of discussion!
Simon, Rob & James
References & Further Reading
Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. The AIRWAYS-2 Randomized Clinical Trial. Benger J. JAMA. 2018
PHEMCAST; the LMA
Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomised Clinical Trial. Jabre P. JAMA. 2018
Welcome to August's papers of the month.
So this is our last offering for the summer until whilst we take a short break until September, so we had to finish off we 3 great papers!
First up we look at the drug of the moment (or decade...) in tranexamic acid and the effect that it has on outcomes in primary intracerebral haemorrhage.
Next, what role does point of care ultrasound (POCUS) hold in the patient presenting with undifferentiated shock? We look at a randomised control trial of POCUS in this patient cohort that assesses the ability to translate POCUS into a mortality benefit.
Finally we look at a delphi study published in the EMJ which explores expert opinion upon multiple aspects of paediatric traumatic arrests. The results are fascinating and may inform some of the CRM used in the next case you see.
As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.
Enjoy!
Simon & Rob
References & Further Reading
Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Sprigg N. Lancet. 2018
Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With UndifferentiatedHypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Atkinson PR. Ann Emerg Med. 2018
Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Rickard AC. Emerg Med J. 2018
St Emlyns JC; Tich Tich Boom?
First10EM; TXA in ICH (TICH-2)
Drugs in cardiac arrest are controversial. Prehospital research is notoriously difficult to perform. PARAMEDIC2 has just published in the New England Journal of Medicine and is a multi centre randomised placebo controlled trial looking at adrenaline (or epinephrine depending on which side of the pond you reside) in out of hospital cardiac arrest, no mean undertaking and a landmark paper.
The paper has gained a huge amount of traction online with multiple blogs discussing the primary outcome which showed a higher survival rate in those receiving adrenaline when compared to placebo. This has been accompanied with a firm debate over the secondary outcomes, which include the rate of survival with a favourable neurological outcome (mRS 0-3), which showed no statistically significant difference between the two treatment arms, but in pure numbers gave a higher proportion of favourable outcomes in the adrenaline group.
The trade off for this increased survival is the significant number of survivors with a poor neurological outcome.
The question on everyone's lips then being; should we continue to administer adrenaline in cardiac arrest given the findings from this study?
In the podcast we run over the main findings of the paper and are lucky enough to speak to the lead author Professor Gavin Perkins about the paper and some of the questions we and you have had following publication of the paper. A huge thanks to Gavin for taking the time to do this.
Have a listen, enjoy, and let us know any thoughts or feedback you have
Simon, Rob & James
References & Further Reading
PARAMEDIC2; Warwick University Clinical Trials Unit
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Perkins GD. N Engl J Med. 2018
PARAMEDIC2 Protocol
Testing Epinephrine for Out-of-Hospital Cardiac Arrest. Callaway CW. N Engl J Med. 2018
First10EMParamedic 2: Epinephrine harms/helps in out of hospital cardiac arrest
REBEL Cast Ep56 PARAMEDIC-2: Time to Abandon Epinephrine in OHCA?
Head injury worldwide is a significant cause of morbidity and mortality.
Besides prevention there isn't anything that can be done to improve the results from the primary brain injury, there is however a phenomenal amount that can be done to reduce the secondary brain injury that patients suffer, both from a prehospital and in hospital point of view.
In the podcast we run through head injuries, all the way from initial classification and investigation, to specifics of treatment including neuro protective anaesthesia and hyperosmolar therapy, to give a sound overview of the management of these patients.
As always we welcome feedback via the website or on Twitter and we look forward to hearing from you.
Enjoy!
Simon, Rob & James
References & Further Reading
Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis. Chauny JM. J Emerg Med. Jul 26 2016
Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned? Boone MD. Surg Neurol Int. 2015
Life in the fast lane; hypertonic saline
Life in the fast lane; Traumatic brain injury
Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality. T Lawrence. BMJ Open. 2016
Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. M.Majdan. The Lancet. 2016
The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. Gale SC. J Trauma. 2005
What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Rotheray KR. Resuscitation. 2012
NICE Head Injury Guidelines 2014
MDCALC Canadian Head Injury
TheResusRoom; The AHEAD Study
TheResusRoom; Anticoagulation, head injury & delayed bleeds
Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement
A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuries. Manara AR. J Intensive Care Soc. 2016
Welcome to July's papers podcast.
There has been a plethora of superb and thought provoking papers published this month and we've got the best 3 that caught our eye for you.
In this episode we look at the potential benefit of early vs late endoscopy in patients presenting with an acute upper GI bleed. Next we look at both intra and post ROSC hyperoxia and the associated outcomes. Finally we have a look at the utility of straight leg raise as a test to rule out potential pelvicfractures in out trauma patients.
We strongly suggest you source the papers and come to your own conclusions and we'd love to hear any comments either at the foot of this page or on twitter to @TheResusRoom.
Enjoy!
Simon & Rob
References & Further Reading
Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage. Jeong N. Am J Emerg Med. 2018
Association between intra- and post-arrest hyperoxia on mortality in adults with cardiac arrest: A systematic review and meta-analysis. Patel JK. Resuscitation. 2018
Straight leg elevation to rule out pelvic injury. Bolt C. Injury. 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:
As always we welcome feedback via the website or on Twitter and we look forward to your engagement.
Enjoy!
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.
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
NICE 2016. Major Trauma; Assessment and Initial Management
FPHC 2017; Position statement on the application of Tourniquets
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!
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
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!
References & Further Reading
For all the papers pop over to the St Emlyn's blog for the hyperlinks and abstracts
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!
References & Further Reading
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!
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!
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!
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
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;
We'd love to hear your thoughts so please leave your comments below or contact us via twitter @TheResusRoom
Enjoy!
References & Further Reading
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;
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!
References & Further Reading
| Fluid | Na | K | Cl | Ca | Mg | Lact | Acet | Glucon | Dext | Osmol mOsm/L |
| 0.9% N Saline | 154 | 0 | 154 | 0 | 0 | 0 | 0 | 0 | 0 | 308 |
| Lactated Ringers | 131 | 5 | 11 | 2.7 | 0 | 29 | 0 | 0 | 0 | 273 |
| Hartmanns | 129 | 5 | 109 | 4 | 0 | 29 | 0 | 0 | 0 | 278 |
| Plasma Lyte | 140 | 5 | 98 | 0 | 3 | 0 | 27 | 23 | 0 | 280 |
Constituents measured in mEq/L Reference; University Texas
Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018
Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018
Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018
REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?
PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation
JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn’s
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!
MDCALC; Framingham Heart Failure Diagnostic Criteria
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;
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!
Trial of early, goal-directed resuscitation for septic shock. Mouncey PR. N Engl J Med. 2015
NICE; Sepsis: recognition, diagnosis and early management
NHS E; Improving outcomes for patients with sepsis. A cross-system action plan
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh 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
RCEM; Severe Sepsis and Septic Shock Clinical Audit 2016/2017 National report
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!
Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement
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!
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 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!