The Resus Room

So following on from the Roadside to Resus episode on intubation there were a lot of questions from listeners that we didn't have the opportunity to answer. These included some clinical aspects and also some really tricky issues around competency, governance and importantly who should and shouldn't be intubating. We've separated this out from the main episode as a lot of the conversations are heavily opinion based and only our view on the topic.  This is our first episode of this style and we'd love to hear any comments or feedback and also know if this is something you'd like to hear again for future topics. Enjoy! Simon, Rob & James

Intubation is a key part of advanced airway management. Although some of you out there may not intubate, we’ll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes. Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and learn the skill. This brings into question who should these limited opportunities to train go to, what defines competence, which patients now would benefit from intubation. In this episode we’re going to cover these topics and more, including talking through how to fine your intubation technique as much as possible. We’re coming at this episode with our collective neonatal, ED and PHEM practice which all involve advanced airway management and it’s fair to say that we’re all passionate about delivering intubation and adv

Welcome to October’s papers of the month! Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We’ve looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms. Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests and think further about the decision making that goes into these complex decisions. Finally we take a look at a huge trial assessing the use of balanced fluids versus Normal Saline in critically ill patients and gain more information about the strategy we should employ. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest! There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!! Some of the treatments we’ll discuss for patients with ACS can have a huge affect on morbidity and mortality and we can make a real difference to our patients. The ESC guidelines are a fantastic resource to take a look at and we've listen the papers that form the evidence we cover in the podcast. We worry about missing ACS and conversely, with so many ‘suspected ACS patients’, we also worry about overly suspecting it and the subsequent burden of admissions and investigations that it may mean. We’re going to cover the approach to ACS in this episode in our standard format, all the way from definit

Welcome back after our summer hiatus to September’s Papers Podcast! Firstly we take a look at two different strategies for managing agitation in the Emergency Department, to achieve rapid control. Is haloperidol and midazolam, or ketamine alone, a better strategy? Then we take a look at the results from RECOVERY-RS. We covered the design of the trial at it’s conception last year and this trial essentially looks to answer whether a strategy of high flow nasal oxygenation, CPAP or conventional oxygenation is best for our patients with suspected or confirmed COVID-19 when they present with hypoxia. Lastly we turn to Rob and take a look at his recent publication on the use of cervical collars when dealing with a patient able to self extricate from a motor vehicle collision; how will the application of a collar or commands help with excessive movement? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Welcome to August 2021’s papers podcast! Three more great papers for you this month which have challenged and informed our practice. First up we look Impact of ambulance deceleration with patients lying flat vs 30 degrees head up on intracranial pressure in patients with a head injury. Next, is a patient with a refractory VF arrest more likely to have a positive finding on coronary angiography than one with non-refractory VF? And finally, in patients with blunt chest wall injury, does the presence of a flail chest indicate a worse morbidity and mortality compared to rib fractures alone? And what do the findings mean for our clinical examination focus? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. We're giving you all a summer break from us and we'll be back again with our Papers of the Month and Roadside to Resus episodes in September. Enjoy! Simon and Rob

So welcome back to another Roadside to Resus episode! Pre alerts are a key part of the interface between pre hospital and in hospital care of the critically unwell patient, when made and received in an effective manner they can really benefit the patient and the system. But too often we hear of friction associated with pre alerts and recent discussions on social media has really highlighted this. In this episode we explore the pre alert, the guidance that exists already on the topic, the challenges of both making and receiving those pre alerts and our four major questions; why we pre alert, what we should pre alert, how to pre alert and when to pre alert. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Another month and 3 more papers! First up we have a look at a paper that has grabbed a lot of recent headlines in the form of TTM2. So we now seem to have the answer to whether comatose patients following out of hospital cardiac arrest benefit from therapeutic hypothermia over maintenance of normothermia. Next up we take a look at a paper which adds some real value to our assessments of maxillofacial injuries and can help inform our assessment of the likelihood of fracture and need for imaging. Lastly we take a look at the whether iv vs io access in cardiac arrest might make a difference to outcomes when it comes to the use of adrenaline. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon and Rob

So this time we're going to be talking about subarachnoid haemorrhage. So this is going to be a short and punchy look at a really important and interesting topic in subarachnoid haemorrhage. We run through the approach to headache and then focus on the specific features and findings that we should be looking for with regards subarachnoid haemorrhage. We then consider who we should be investigating further, what value a CT head brings and the sticky subject of who should be going on to have a lumbar puncture. Finally we consider the the management once the diagnosis of SAH is reached and how we can ensure the best outcomes for our patients. At the time of recording NICE has published its draft version of Subarachnoid Haemorrhage Caused by a Ruptured Aneurysm; diagnosis and management, which will be a great resource once finalised. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

This month we've got three papers that have challenged our practice both from an in-hospital and pre-hospital perspective. Firstly we consider a paper that looks at admission saturations for patients with exacerbations of COPD and compare this to the BTS guidance on oxygen therapy, regarding altering oxygen saturations for those proven not to be hypercapnoeic. Should we be aiming for 88-92% or 94-98%? Next we look at a paper from the team at KSS looking at dispatch to older trauma victims and consider whether current triggers for HEMS dispatch are set at the appropriate level to catch those in this cohort that may benefit from critical care interventions. Lastly we look at a paper evaluating the QRS width in PEA cardiac arrests and consider firstly whether a broad QRS complex is predictive of hyperkalaemia and secondly whether we would treat patients based off this finding? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon and Rob

So the Resuscitation Council UK have today published new guidelines on resuscitation based on the European Resuscitation Council 2021 Guidelines and recommendations from the International Liaison Committee on Resuscitation. We were lucky enough to catch up with two key members of both ERC and RCUK, Gavin Perkins and Jasmeet Soar, gaining their valuable insights into the new guidelines. As well as this Simon, Rob and James pick out some other key points from the guidelines and discuss how these may translate into systems and practice. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to May's Papers of the Month Podcast! Three more papers for you on three varied topics. We start off with the use of end tidal carbon dioxide in the content of prehospital head injuries.Taking a look at a paper delving a bit deeper into the utility of end tidal CO2 when compared with arterial CO2 measurements on arrival in ED, in patients having received a prehospital anaesthetic; how accurate is end tidal and what level should we be aiming for? Next we consider the importance of frailty in the outcomes of our older trauma patients and the ability of three different screening tools in identification of this cohort of high risk patients presenting to our hospitals. Finally we take a look at a treatment which some prehospital services have already employed and others are considering; the use of CPAP for patients presenting with acute respiratory distress. Does the evidence support its use? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simo

So last month we considered Maternal Emergencies and the approach and interventions we can make in order to minimise complications during pregnancy and during childbirth. As promised this month we're looking at the next step along the process and focussing on Newborn Life Support. Dealing with newborns has the potential to be really stressful but hopefully by concentrating on the fundamentals and guidelines we'll all be able to approach the situation with greater confidence. Let us know any thought and comments you have on the podcast. Enjoy! Simon, Rob & James

Well if last month was based on cardiac arrest, this month takes a deeper look at airways! First up we take a look at a paper that benchmarks the use of video laryngoscopy, specifically with the C-MAC and gives some really useful information from a Swiss HEMS service on first-pass success, the relevance of operator experience on success and factors that alter intubation success. Next up we're looking at blood in the airway with epistaxis...okay it's a tenuous link, but it pretty much works! The NOPAC study looks at the use of TXA in atraumatic epistaxis and compare it to placebo use, will TXA come up trumps in this setting? Finally we take a look at the use of scalpel cricothyroidotomy within the London HEMS service over a 20 year period, with a number of things we can learn from this experience. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So this is the first of a pregnancy related double-header, with the focus being firmly set on the mother this month and next month we’ll focus in on NLS. This month though we’re going to be discussing maternal emergencies. Now many conditions that could fall into this category but, as much as we love a good yarn, we really can’t be here all day, so we’ve decided to focus on are the conditions that we are more likely to come across in either prehospital or EM practice. Those conditions in which we can make a really big difference to either the mum or the baby. We’re talking antepartum haemorrhage, postpartum haemorrhage, cord prolapse, breech presentation and shoulder dystocia, all after we've set the scene on assisting with an uncomplicated delivery. So what would be really good is if we could find someone to bring in some prehospital maternal experience too. Ideally, someone qualified as a midwidfe and paramedic…and we're incredibly lucky to have just that in Aimee Yarrington, who has joined us for the podca

So this month we've got a cardiac-arrest-fest for you! With 3 papers centered on the management of cardiac arrest, with some key points that will help inform and improve our practice. First up we have a think about where patients with a presumed cardiac cause of their arrest should be transported to. Trauma networks in the UK have changed destinations for patients, but is there a patient benefit transporting this patients to a cardiac arrest centre and if so how much? Next we look at the potential benefit to nurse-led cardiac arrests with a study that might change some thoughts on how we best run and collaborate our cardiac arrests. Finally we take a look at an open access paper from SJTREM, looking at the use of serum markers to help us prognosticate in hypothermic cardiac arrest and in these really challenging cases there is some great stuff to take from the paper. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Welcome back to the podcast and our next Roadside to Resus episode, this time we’re taking a look at Diabetic Ketoacidosis, DKA. In this episode we’ll be getting our heads around the pathophysiology that underpins DKA, consider the clinical picture and severity of patients that present and look at both the in-hospital and pre-hospital management of these patients including topics such at fluid choice, insulin boluses and nasal ETCO2 for diagnosis of DKA. Let us know any thought and comments you have. Enjoy! Simon, Rob & James

So three very different papers for you this month... We start off having a look at a paper on the HINTS examination. This exam came to prominence a few years ago as a way to distinguish between central and peripheral causes of vertigo with a pretty amazing sensitivity and specificity. Since then many EM clinicians have brought it onto their practice and this paper seeks to assess how good the test is at the bedside in real life practice. Next up we take a look at a paper assessing the injury patterns in trapped patients and consider the prevalence of injuries both with regard to spinal and other injury patterns and then consider the impact that this holds with respect to extrication. Finally we have a look at a paper focussing on the inhospitable management of hypertension; the treatment strategies and the outcomes comparing those being treated during their inpatient stay versus this left untreated with some surprising outcomes... Once again we'd love to hear any thoughts or feedback either on the website or

So in this episode we’re going to have a deeper think about advanced airway management and specifically supraglottic use in the prehospital and ED environment.  Many prehospital service have seen the removal of intubation from their scope of practice, and that’s understandably been received with mixed thoughts. But this isn’t the end of ‘expert advanced airway care for all; in fact far, far from it… we’ve all heard people talking about ‘whacking in an i-gel’, but really utilising a supraglottic device to its maximal potential can make a huge difference to our critically unwell patients.  We'll be running through an overview of supraglottic devices, the evidence surrounding their use, patient selection, patient positioning and size selection, placing a supraglottic device, troubleshooting and finally ongoing ventilation with a supraglottic device. We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Happy New Year! Well 2020 certainly wasn't what we were all expecting, so here's hoping for a phenomenally better 2021. We've got some really exciting episodes for you this year including Supraglottic Airways, Neonatal Resuscitation, Diabetic Emergencies, New Resuscitation guidelines and much much more! We're kicking off the podcast year with three really interesting papers! First up we consider the importance of first pass success of both supraglottic airways and endotracheal intubation in the context of cardiac arrest; a lot of attention has been shone recently on question of which approach we should consider after bag valve mask ventilation, but how important is the first pass of either of the approaches to the outcomes of our patients? Next up we have a look at a paper that challenges the use of TXA in our patients with a severe traumatic brain injury after the publication of CRASH 3. Finally we have another look at the mantra of 'GCS 8-intubate' with a systematic review which draws together all of the ev