The Resus Room

Well the year has flown by and it's already time for December's Papers of the Month Podcast! Head injuries are a huge work load for those of us involved in Emergency Care. Identifying those at risk of deterioration from a traumatic brain injury is a priority, as early intervention and prognostication can make a huge difference to patient outcomes. CT scanning is relatively easy to access and with it investigation creep has lowered our threshold of investigation and use of radiology resources; first up we have a look at a paper that looks at the potential benefits from employing a number of different guidelines in identifying the patients with traumatic brain injury, whilst comparing the risk of over investigation. Next up we have a look at the commonly made diagnosis of urinary tract infection in the older population and a review paper that will help you make the right diagnosis when it's present and not over diagnose when not. Finally we have a think about the potential benefit of a fluid bolus during induct

Angioedema is something we'll all encounter in the acute setting, whether we recognise it or not... Understanding the different causes and mechanisms is imperative to ensuring the patients get treatment that is not only effective, but in extremis potentially lifesaving. In this episode we talk through the condition; from clinical presentation, causative agents, mechanisms of action, differentials and the evidence base of treatment. Get in touch with any comments on the podcast, ensure to read the papers that are referenced yourself and draw your own conclusions. Enjoy! Simon & Rob  

As care on our emergency and urgent care demand is on an ever upwards course, whilst alongside this the scope of what we can potentially deliver to patients is also increasing. In order to meet this demand and to deliver the best care possible to our patients we will need to look for other solutions. We were lucky enough to be invited to the First Community Emergency at the Royal Society of Medicine in London, hosted by the Physician's Response Unit. This event looked at the current challenges and explored solutions and opportunities for more collaborative working. In this podcast you'll hear from Tony Joy about the concept and practice of Community Emergency Medicine. You'll hear from Gareth Davies on the history of Pre Hospital Emergency Medicine, both challenges and achievements. Finally you'll hear from Bill Leaning, PRU clinical manager & HEMS paramedic about how to go about setting up a service. Please let us know any thoughts or feedback, and we'll be back with another podcast on a clinical topic f

We've got some papers this month that focus on our sickest patients! If you had a patient that you found in cardiac arrest and you believed they had a PE, would you thrombolyse them during the arrest, and how much more likely do you think they would be to survive? Our first paper looks at exactly this question. Second up we consider the potential harms associated with adrenaline administration to those in traumatic arrest. Finally, when RSI'ing a patient and considering your pharmacological cocktail, how likely are you to reach for the fentanyl and how much concern would you have over the risk of this rendering the patient haemodynamically unstable? We take a look at a recent review on the topic and get Dr. Ian Ferguson's insights as the lead author. Make sure to get in touch with any comments on any of the reviews, and importantly make sure you check out the papers and draw your own conclusions. Enjoy! Simon & Rob  

So an incredibly important paper, CRASH-3 has just been published in the Lancet, which looks at the treatment of head injuries with Tranexamic Acid (TXA). TXA has been shown to save lives in trauma patients at the risk of major haemorrhage, with the notable exclusion of those with head injuries, CRASH-2. TXA has been shown to save lives in those with post parts haemorrhage, WOMAN trial. Time to treatment with TXA has been shown to be hugely influential in it's ability to decrease blood loss and save lives. So has TXA now been shown to save lives in head injuries? In this episode we run through the paper and are lucky enough to have an interview with the lead author, Professor Ian Roberts. Have a listen, read the paper and as always we’d love to hear any thoughts or comments you have on the website and via twitter, and take a look at the references below to draw your own conclusions. Enjoy! Simon, Rob & James References The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects

Welcome to October '19 papers podcast. You can't go far without the topic of TXA as a treatment for anything that bleeds being mentioned! With the publication of CRASH-2 and the WOMAN trial practice has crept such that administration in gastro-intestinal bleeding is seen fairly frequently. However, current guidelines don't recommend the use of TXA in GI bleeding, so this month we have a look at a systematic review which looks to answer whether it's administration is supported by the evidence, before we get a definitive answer from the HALT-IT trial. Next up, following on from our Burns Roadside to Resus podcast, we take a look at a paper that quantifies the potential benefit of thorough first aid in the management of paediatric burns, a really key paper on the topic, with really powerful results. Finally, we all know that Sepsis is a core area of our practice, but at times it may feel like the attention on those that could possibly have severe sepsis displaces the ability to care for other critically ill pati

So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes.  There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the following; Definition Aetiology Hypovolaemic shock Neurogenic shock Obstructive shock Cardiogenic shock Physiology; Traumatic coagulopathy Other diagnostics Controlling external haemorrhage Pelvic binders REBOA Avoiding coagulopathy BP targets & permissive hypotension Fluid choices & supporting evidence TEG/ROTEM Calcium TXA Vasopressors Preventing hypothermia Relieving obstruction Interventional radiology Damage control surgery As always we’d love to hear any thoughts or comments you have on the website and v

We start off this month with a much talked about paper in the pre-hospital services, what benefit does Pre Hospital Critical Care bring to cardiac arrest victims? We are lucky enough to have the inside thoughts of the lead author, this a really interesting piece of work and will no doubt lead to further discussions, for more information from the author take a look at his thesis here. Next up we take a look at the utility of troponins in patients that have suffered cardiac arrest, can we use them to evaluate how likely it was that an MI precipitated the arrest? Last up we have a look at a novel approach of ruling out stroke as the cause of acute dizziness. We'd love to hear your thoughts and comments. Enjoy! Simon & Rob  

Following on from our previous Roadside to Resus episode on Stroke, in this episode we look at the rapidly evolving area of stroke management.  In the last 2 decades stroke management has progressed beyond recognition and keeping up with the evidence and available therapies is a significant challenge. We cover the following treatments, looking at the risks and benefits of each, with the goal of being able to offer our patients the best possible outcomes; Aspirin Thrombolysis; both prehospitally and in hospital Thrombectomy Decompressive Hemicraniectomy Normoxia Euglycaemia Acute blood pressure management As always we’d love to hear any thoughts or comments you have on the website and via twitter. Enjoy! Simon, Rob & James References Tissue plasminogen activator for acute ischemic stroke. National Institute of Neurological Disorders and Stroke rt-PA.Stroke Study Group. N Engl J Med. 1995  Aspirin in Stroke;NNT Stroke Thrombolysis; Life in The Fast Lane Effects of Prehospital Thrombolysis in Stroke Patie

Well the summer has definitely hit and we hope you get a chance for a break... making sure you spend spend some time listening to our Heat Illness episode on a beach somewhere! It's a wide variety of papers for you this month; Should we be looking to immediately cardiovert acute onset AF in the ED? What difference does glucagon make to clearing oesophageal foreign bodies? How important is our diagnostic accuracy in ED to the patients morbidity and mortality? And finally we cover a paper looking at the requirement for urgent tracheal intubation in trauma patients, and are lucky enough to get some thoughts from the lead author Dr. Kate Crewdson. We'd love to hear your thoughts and comments. Enjoy! Simon & Rob  

Stroke is a common presentation to all Emergency Health care providers, with around 150,000 strokes occurring in the UK each year! Our impact and treatment can be hugely significant and in this podcast we’re going to conver the topic in some depth, and importantly cover some of the new Guidance published by NICE in their ‘Stroke and transient ischaemic attack in the over 16’s diagnosis and initial management’ document that was published in May of this year. We'll be running through Definition Pathophysiology Territories Risk factors Assessment; both prehospitally and in hospital Stroke mimics Investigations As always we’d love to hear any thoughts or comments you have on the website and via twitter. Enjoy! Simon, Rob & James References Stroke & Dizziness; PHEMCAST RCEMLearning; RCEM Belfast Vertigo Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline.Published: 1 May 2019 Acute Stroke Lecture notes; LITFL Stroke Thrombolysis; LITFL Are you at risk o

Welcome back! This month we're finishing off our theme of syncope with a paper that looks to answer the big question; in those with undifferentiated syncope, does hospitalisation result in better outcomes when compared to discharge? We have a look at a paper reviewing the feasibility of live streaming video from scene using the 999 caller's mobile phone, a fantastic utilisation of technology and a really exciting area; we also get the thoughts of one of the co-authors, Richard Lyon, Associate Medical Director for KSS. Finally we take a look at a paper reviewing the time on scene in cardiac arrests, that suggests if no ROSC is gained, rapidly getting off scene is in our patients' interest. We'd love to hear your thoughts and comments. Enjoy! Simon & Rob

If you live in the UK you may be fooled in to thinking that Heat Illness isn't really something we need to worry about...but you'd be wrong! Each year there are 800 deaths due to Heat Illness and figures in more temperate climates are significantly more. In this podcast we tackle the topic of Heat Illness, all the way through Heat Cramps, Heat Syncope, Heat Exhaustion and to Heat Stroke. We'll cover the following; Definition, clinical spectrum and categories Scale of the problem Thermoregulatory physiology Impact of hyperthermia Clinical findings Those at greatest risk Acclimatisation Differentials Management 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, and most importantly, we hope we haven't missed the summer heat wave...! Enjoy Simon, Rob & James 

Status Epilepticus in children, lying and standing blood pressures in syncope or presyncope and decompressing paediatric tension pneumothoraces. You'll no doubt have seen and heard about the two papers published this month in the Lancet, both Consept and Eclipse look at the use of keppra vs phenytoin as a second line anti convulsant therapy for children in status epilepticus. We take a look at both papers, and have a think about what this means for practice. There has been a large amount of focus on the optimal position for needle decompression of tension pneumothoraces in adults, but an open access paper from SJTREM looks at the best position in children, take a look at the paper here. Finally, should all patients with a presentation of syncope/presyncope be getting a lying and standing blood pressure, or is it an ineffective test? Make sure you take a look at the papers yourself, remembering that the paper from SJTREM on paediatric pneumothoraces is totally open access. We'd love to hear your thoughts and c

Drowning is a huge worldwide problem, and here in the UK there are around 350 accidental deaths from drowning each year. From the patient who is potentially well enough for discharge on scene, all the way through to the resuscitation and prognostication of a cardiac arrest due to drowning, the topic carries a number of unique questions and challenges. In this podcast we run through; The scale of the problem Modes of drowning Prognostic factors Extrication Advanced Life Support in Drowning Termination of resuscitation Medical management 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  

So first up a huge welcome to SJTREM, the free open access journal who we've teamed up with in the delivery of the podcast, every paper they publish is available online to read for free. Each month we'll be covering one of their papers in our Papers of the Month episodes, giving you the opportunity to review the literature yourself, come to your own conclusions and join the conversation. SJTREM have made our podcast a sustainable venture and together we look forward to promoting review and discussion of the best evidence and education, to all, for free! This month we'll be looking at an analysis of REBOA and having a think about whether it is benefiting those patients that are receiving it. We take a look at paper that reviews what we really know about the use of ETCO2 in cardiac arrest and have a think about how much importance we should put on it. Finally we take a look at the utility of prehospital blood gases; should this be the standard of care, or is it a step too far?Make sure you take a look at the pa

'Patients with GCS scores of 8 or less require prompt intubation', that's what ATLS tells us. The mantra of GCS 8, intubate has pervaded teaching for those involved in the management of patients with a reduced GCS (Glasgow Coma Scale). But on reflection it would seem slightly odd that the gain or loss of a single point on the Glasgow Coma Scale could simply account for a change in the decision as to whether a patient would benefit from intubation and ventilation. So should the patient with a GCS of 9 be best managed without a definitive airway, but when that slips to 8 we should reach for the portex®? In this podcast we take a deeper look at the GCS, we have a think about the role that it was designed to perform and consider how it should best be applied to acutely ill patients when considering protecting their airway. The podcast is based upon the blog from the TEAM Course blog(Training in Emergency Airway Management), make sure to go and have a look at the post and other resources available on that site. En

So we've got a massively important paper that we're going to kick off April's Papers of the Month podcast with, which is the RCT we've been waiting for; whether patients who have a ROSC should go to the cath lab, without a stemi, if the presumed cause is a coronary event? We've covered this topic in the past, for a background take a listen to PCI following ROSC and our December '17 papers of the month podcast. Next up, on the topic of over-testing, we have a look if we should be sending troponins and BNP's on our patients attending with syncope. Lastly, having spoken recently about the importance of ED airway registry's, we take a look at an open access paper from SJTREM that describes the practice, success and complication rates of ED advanced airway management. As always make sure you take a look at the papers yourselves and draw you own conclusions, we'd love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading Coronary Angiography after Cardiac Arrest without ST-Segment Elevation

We were lucky enough to be back at the fantastic TraumaCare Conference last week. There were a whole host of fantastic talks on offer and the Emergency Medicine stream, arranged by our very own Rob Fenwick, included a pro/con debate on whether Emergency Medicine should be managing the trauma airway. During that debate a number of important papers were raised on the evolution and improvement in advanced airway management. In this podcast we'll run through some of the most important points from that talk. Make sure you take a look at the papers yourself and come to your own conclusions. Enjoy! Simon & Rob    

We've got a broad array of topics and papers for you this month! First up we look at a paper from the NEJM assessing the potential benefits in providing ventilations to patients undergoing an RSI. Next we look at patients presenting with both syncope and pre-syncope to the emergency department, this paper quantifies the risk that we should be apportioning to these two different presentations. Finally, we look at a paper that suggests the manual pulse check in CPR is dead, and that the time has come for doppler and ultrasound to replace it! As always make sure you take a look at the papers yourselves and draw you own conclusions, we'd love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. Casey JD. N Engl J Med.2019  Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope. Bastani A. Ann Emerg Med.2019 Comparison of manu