The Resus Room

Welcome back to September’s Papers of the Month. We’ve got three cracking studies for you this time, each tackling really core questions in pre-hospital and emergency care and each giving us plenty to chew over when it comes to the evidence base and what it means for our practice. First up, we’re heading down under to Sydney with the PRECARE pilot feasibility study on pre-hospital extracorporeal CPR for refractory cardiac arrest. Now, we all know survival from refractory OHCA is pretty dismal with conventional CPR alone, and that the big limiting factor with ECPR is time to flow. So could we meaningfully shorten that window by bringing ECMO to the roadside rather than the hospital? This study tested whether pre-hospital physicians could safely and effectively deliver ECPR on scene and the results are some of the fastest low-flow times yet reported. But of course, feasibility is only one piece of the puzzle… Next, we’re back in the UK with a service evaluation from Devon Air Ambulance looking at endotracheal i

Welcome back! First up a paper to challenge the way we think about rhythm recognition in cardiac arrest to start with, looking at the rate of VF identified on echo but not on the defibrillator. We have a huge amount of strategies to rule out acute coronary syndrome in the UK, our next paper looks at the clinical effectiveness of these, whilst also giving us some hugely important information about the incidence of ACS in those presenting to Eds. Finally we look at a paper quantifying the effect of hypertonic saline in those patients with a TBI. Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom. We'll be taking a short break over the summer, but will be back in September with another Papers of the Month and Roadside to Resus, until then have a fantastic summer! Simon & Rob

This is a pretty special episode! If you're involved in cardiac arrest management or care of critically unwell patients then there's some ground breaking practice we'll be discussing with the two founders of the SPEAR course; Jon Barratt; Lt Col, British Army Emergency Medicine and PHEM Consultant, University Hospitals of the North Midlands Clinical Lead - Research and Clinical Innovation, Yorkshire Air Ambulance MERIT Consultant, West Midlands Ambulance Service Senior Lecturer, Academic Department of Military Emergency Medicine Paul Rees; Surgeon Commander Royal Navy Consultant, East Anglian Air Ambulance & Barts Heart Centre Lead for Resuscitation Barts Health NHS Trust Reader in Cardiology & Resuscitation, University of St Andrews & QMUL London Defence Lead for Endovascular Resuscitation SPEAR co-founder Ultimately in the episode we navigate through to the delivery of endovascular resuscitation both pre and in-hospital, building on the fundamentals of care and logistics which enable its del

Welcome back to Papers of the Month! Three more papers to both inform and challenge our practice across the spectrum of emergency care. First up we look at a systematic review and meta-analysis on noradrenaline vs adrenaline for our medical post-ROSC patients; what evidence exists out there and should we all be delivering noradrenaline as our first line treatment for those with shock? Next up a paper to really challenge the treatment algorithm for status epilepticus in paediatrics, with an RCT of midazolam and ketamine versus midazolam alone. There are some huge differences here in the form of termination rates and some great discussion to be had around the specifics of the paper and how that might translate into future practice. Finally we look at a paper assessing the impact of i.m. versus i.v. metoclopramide for migraines and acute severe headaches. The paper looks at the impact of length of stay within the Emergency Department and also the efficacy of the treatment. Once again we’d love to hear any though

It’s something we all encounter in emergency and prehospital care, probably more than anything else, yet it’s a topic we’ve not given a full episode to… until now! Up to 70% of prehospital patients and 60–90% of ED attendees report pain, with half of all ED presentations having pain as the primary complaint. That’s millions of patients across Europe every year and we’re not always optimising our approach! In this episode, we’re diving deep into acute pain management; from understanding the complex biopsychosocial definition of pain, right through to tailored pharmacological and non-pharmacological strategies, plus everything in between. We’ll be looking at how we define and assess pain and the importance of validating patient experience. Then we’ll work through management options: from paracetamol to ketamine, NSAIDs to regional anaesthesia, and talk through barriers like bias, opiophobia, and the persistent inequalities in analgesic delivery. We'll also shine a light on special groups;  from paediatrics to c

Welcome back to June 2025's papers podcast! Having been cynical about CPR feedback devices in the past we take a look at a recent paper on their use and their potential impact to both ROSC and survival for patients, when compared to standard practice; is it time to integrate them more definitively into our practice? Next up we take another look at the use of adrenaline in traumatic arrest. We've covered this before and there's some interesting data and discussion to be had around the topic and the paper. Finally, we all know about the unprecidented pressure on ED’s and all forms of healthcare at the moment. Many patients waiting for hours and hours to be seen. But there may be systems and routes by which others can be identified with lower acuity presentations that may not need to wait overnight for long periods, and our final paper looks at this with a paper on 'deflection'. Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Welcome back! In this episode, we’re diving deep into something we all think we know, the Glasgow Coma Scale. The GCS has been a fundamental part of assessing patients with altered consciousness for over 50 years. You’ll find it in trauma scores, neurology exams and practically every prehospital and ED handover. But here's the thing, is it as reliable and useful as we think? In this episode, we’ll explore the origins of the scale, what it was designed for and how it’s been used (and maybe misused...) since. We take a look at how reproducible it really is, particularly when different clinicians score the same patient. Spoiler alert: it’s not always as consistent as you might hope! We’ll also unpack the individual components; eyes, voice, motor and ask if they all carry equal weight, or are some more prognostically useful than others? Because a GCS of 4 isn’t always the same GCS of 4, depending on how you get there… We’ll be looking at real-world implications, how we make decisions around airway management, ima

Welcome back to the podcast! We've got three papers this month covering the breadth of Emergency Care presentations and locations; from prehospital arrests, ketamine for analgesia in trauma and those complex elderly patients presenting with abdominal pain. First up we look at the use of prehospital thrombolysis for out of hospital cardiac arrest, something some critical care services are using for suspected PEs and MIs. But what are the outcomes for these patients and how accurate are the clinical suspicions that lead to the thrombolysis? Next up we look at an excellent prehospital RCT, PACKMaN, on the use of ketamine vs morphine for patients with pain following trauma. Is ketamine safe? Is it superior? And what is the side effect profile of each of these approaches? We're also lucky enough to have the lead author, Mike Smyth, come on to give his thoughts on the paper and what it might mean for clinical practice Finally we have a think about abdominal pain in the elderly population. Without a cause for the pa

Opioid toxicity is a major and growing challenge across the UK and beyond, with nearly 10 deaths every day from opioid overdose and over a million adults using Class A drugs annually, the impact on emergency services is enormous. In this episode, we’re diving deep into the recognition and management of acute opioid toxicity in the emergency setting, including the reversal using naloxone. We’ll run through; The scale of the problem, including the rise of novel synthetic opioids like fentanyl and nitazenes. A breakdown of opioid pharmacology, including receptor types, potencies, and onset of action. How to identify classic and mixed presentations of opioid overdose. Best practice on naloxone dosing, routes of administration, and when to start infusions. The risk of acute withdrawal and how to manage it with care. How to approach mixed overdoses, cardiac arrests involving opioids, and nebulised naloxone. And finally, the importance of holistic care, safeguarding, and onward referral to support recovery. Whethe

Welcome back to April's Papers of the Month! First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at the use of three bedside scoring systems; HINTS, TriAGe+ and ABCD2 scores in ED for patients presenting with possible posterior circulatory strokes. How accurate are they and can we reliably incorporate into our practice? Next up is traumatic cardiac arrest. This has obviously got a very high mortality rate. One of the interventions that might improve mortality (for some mechanisms and patients) is a resuscitative thoracotomy, however this is a really significant intervention and we want to ensure we are targeting it a

Welcome back to The Resus Room! This time, we’re diving into the fascinating and often overlooked world of electrical injuries. From household mishaps and workplace accidents to tasers and even lightning strikes, electrical injuries can range from minor shocks to life-threatening cardiac arrests. As always, we’ll be taking you through the full spectrum of care, from first contact at the roadside to critical management in resus. And let’s be honest, there’s a real lack of clear guidance out there when it comes to managing these cases. So, we’ve done the legwork, scoured the literature, and we’re here to make sense of it all. In this episode, we’ll cover: Pathophysiology; how electricity interacts with the body and why not all shocks are created equal. Classification; what makes a low-voltage injury different from a high-voltage one, and why that matters. Prehospital & ED Management; who needs an ECG, who needs admission, and what to do with those tricky "seemingly fine" patients. Special cases; tasers, li

Welcome back to March 2025's papers podcast! We start off this month with a fascinating paper looking at the experiences of relatives who were witness to unsuccessful resuscitation. We often talk on the podcast about the impact of medical or technical interventions, but this paper offer us an opportunity to consider the huge impact of our non-technical elements of practice and reflect on how we can best support relatives whilst still performing resuscitation to the best of our abilities. Next up we look at a paper deriving and validating a new adult trauma triage score The sBATT that predicts early mortality and need for intervention. Lastly we have a think about the use of adrenaline in out of hospital traumatic cardiac arrests; what association does it have on outcomes? Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Cardiac Arrest in pregnancy affects around 1: 12-30,000 women in the developed world. As you’d expect the risk of death for mother and child is extremely high, but some causes of arrest are reversible and we can make a real impact with our care and treatment of these cases Now it goes without saying that these are some of the most emotive, complex and technically challenging Resuscitations that you could think to be involved in; by definition young female arrest with unborn babies involved. Thankfully this is not going to be a case that many of us see, but with the stakes so high and potential to impact on the outcome of two patients, it’s an area that’s worth real consideration, preparation and mental rehearsal in case we are one of the few that may need to deal with it! In this episode we’re going to run through all the same stuff that you’d expect; pathophysiology of pregnancy, aetiology and the way in which we should approach these arrests. But then we’re lucky enough to be joined by Caroline Leech, an EM

Welcome back to February 2025's papers podcast! This month we're exploring papers on seizure management, oxygen strategies in trauma, along with transfusion strategies in patients with traumatic brain injuries. First up we look at at a paper exploring the potential benefit of adding ketamine into the strategy for treating patients with status epilepticus. Does it help to more reliably terminate seizures and what can we take from the paper? Trauma courses frequently mention the use of high flow oxygen in the management of trauma patients. But recent evidence in non-trauma patients has questioned whether we should be more targeted with oxygen therapy to optimise outcomes in other conditions. We take a look at an RCT looking to answer the question of which out of liberal or targeted oxygen therapy in trauma is the best approach. Finally we look at another RCT, this time focussing on traumatic brain injury and the transfusion strategy we should take to those who are anaemic. This is a really interesting paper, wi

Welcome back to the first Roadside to Resus episode for 2025!! In this episode, we’re diving into a seasonally appropriate, and really paediatric common presentation for anyone involved in emergency care….Bronchiolitis.  Now although it’s one of the most common respiratory illnesses affecting kids, bronchiolitis can easily cause confusion and concern around the severity of illness, whether to convey/admit/discharge, and also which treatments are indicated and which aren’t, including the perennially hot topic of bronchodilators. In this episode we’re going to and delve into all of those aspects & explore the evidence and guidelines that are out there for bronchiolitis, including the NICE guidelines on the topic. So, whether you're on the frontlines of paediatric emergency medicine or just brushing up on your knowledge, this episode…hopefully…will be packed with practical insights to enhance your care in those patients with bronchiolitis or even the differentials! Once again we’d love to hear any thoughts o

Happy New Year!!! We hope you've had some time off over the festive period and now we're back to kick start the new year with three more great papers. Syncope is common presentation to the Emergency Department, accounting for 1% of presentations. Without a clear precipitant of the event it can be challenging to identify those patients who have a higher risk of associated morbidity and mortality, and furthermore those who would benefit from further investigation and observations. Our first paper looks at syncope risk-stratification tools and sheds some light on their utility. Acute exacerbations of COPD with acute type 2 respiratory failure and frequently treated with non-invasive ventilation (NIV), with high flow nasal oxygenation a treatment normally for patients in type 1 respiratory failure. However our second paper is a fantastic RCT looking at the the application of either NIV or high flow nasal oxygenation in those type 2 COPD exacerbations, are both options for our patients? Finally, since the advent o

This is an episode we've been wanting to cover for a long time now! In it we explore the challenges in entering and developing in prehospital critical care, which translate into pretty much developing in any new role both in and out of health care. We cover some pretty personally challenging experiences and the strategies that both clinicians new to prehospital critical care may find useful to employ. We also discuss how supervisors can use these techniques to both guide and support new clinicians.  The four main areas discussed are; Decision making Prioritisation of tasks Leadership Incorporating evidence based medicine into practice We wrap up exploring how reflection can be used to accelerate growth as a clinician but also the risks of over-reflection! We really hope you enjoy the episode and would love to hear any thoughts or feedback on the episode both on the website and via social media. Simon & James

A really strong line up of papers to bring this year's evidence round up to a close! First up we take a look at a paper evaluating the utility of pulse oximetry (along with several other diagnostic tests) in identifying vascular injury following trauma, a really interesting look at an approach we didn't know much about. Next up we run through PARAMEDIC-3, a huge RCT looking at the best vascular access strategy for patients in cardiac arrest, will the result of this paper change our approach? And finally we look at a paper focussing on intubation success rate in US EMS services according to intubation rate. Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Motor vehicle collisions or road traffic collisions are a massive problem worldwide. Data from the World Health Organisation reports that there are around 1.2 million deaths every year and this is the leading cause of death internationally for children and young adults aged 5-29 years.  In the UK there are around 1,500 deaths annually and also around 60,000 patients with significant and life changing injuries, which is 7 patients every hour!! So anything we can do to improve patient care following an MVC is definitely a worthwhile venture. We’ve looked at Extrication here on the podcast before but we’re back on it again because today the Faculty of Pre Hospital Care have released their Consensus Statement on Extrication Following a Motor Vehicle Collision.  The statement builds on the work from the EXIT project and the research that has helped inform our understanding of multiple factors of extrication. The statement will inform a change of practice for both clinicians and non-medical responders and in this e

Welcome back to the podcast and to November's Papers of the Month! We start off looking at the rate of pneumothoraces in patients following ROSC after a medical cardiac arrest. What is the incidence? Are there any risk factors? And how might this affect our index of suspicion and imaging practice? We've spoken before about how difficult vertigo can be as a presentation to the Emergency Department; really common, often benign but with differentials that include posterior circulatory strokes, tumours and infections. Our second paper looks at a clinical risk score for patients presenting with vertigo to the ED and consider how this might affect practice. And finally we take a look at a great paper focussing on pre-alerts to the ED; consider current barriers, understanding and ways that we could improve the process both for the patients and staff. Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob