The Resus Room

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 contri...

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 preh...

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-tra...

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 r...

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...

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...

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 abo...

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...

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 presentatio...

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...

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....

Welcome back! Three more papers for you this month to inform and improve our care in acute and critical illness. First up and following on from the recent DoseVF paper, we take a look at a study looking at the combined effect of vector change, esmolol and capping adrenaline administration in refractory VF with regards patient out ones. Could this be associated with even better patient outcomes? Se...

Welcome back to our first Roadside to Resus episode for 2023! We're back with the huge topic that is COPD. In this episode we're going to delve into the depths of the topic, helping us to deliver the best possible care for this frequently encountered presentation. Along with the standard coverage from incidence, to pathophysiology, to presentation and treatment, we'll also be covering those topics...

Welcome to 2023 and a very happy New Year! We hope you managed to get some time with your loved ones over the festive period and we're back with the podcast again to kick off the new year. First up, we take a look at a paper assessing whether there is benefit to treatment with thrombolytics or anticoagulants for patients in cardiac arrest due to a presumed MI. Next up we look at the potential harm...

So following on from our Bradycardia episode, we're going to look in detail at cardiac pacing. Setting up emergency pacing in those compromised bradycardia patients can make a significant difference to patient outcomes, and doing so in a timely and slick fashion can be a real challenge. In this episode we'll be discussing all forms of pacing, strategies for ensuring the greatest likelihood of succ...

Welcome back to 200th episode of the podcast! A huge thank to all of you for your support and engagement. Three more papers for you this month to challenge thinking across a board range of Emergency Care. First up we take a look at DOSE VF, an RCT look at the best defibrillation strategy for refractory VF. Next we take a look at another RCT looking at the potential benefit of dexamethasone, in ord...

Acute Behavioural Disturbance (ABD), one of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients. There is no widely accepted definition of ABD. Really it's an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of; Delirium Severe agitation and aggressive behaviour Autono...

Welcome back to the podcast and to November's Papers Of The Month. First up we're taking a look at a paper that challenges the current American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines that recommend when right ventricular myocardial infarction, that patients are not administered nitrates due to the risks of compromise of cardiac output.  Secondly we look at an R...

We've covered tachycardias, both narrow and broad before, but we need to complete the set.  So this time we'll be looking at the slower end of the spectrum, with bradycardias. Bradycardias can be a physiological state in athletes, but they can also be of significant concern. They occur due to a multitude of reasons, some cardiac and some not and they can require no treatment at all right up to tho...

Welcome back to the podcast! First up this month we're going have a think about fluid therapy, following an RCT focussing on those patients attending ED with moderate severity acute pancreatitis; are we flooding them with fluid & should we ease off? Next we take a look at a paper evaluating the intubation performances between CCPs and physicians in prehospital anaesthesia of trauma patients. Lastl...

Despite all the improvements that we have seen in trauma care over the past 20 or more years RTCs are still, sadly, a really common cause of both death and disability, with the number of deaths annually in the UK sitting somewhere between 1500-1900 per annum. Survivors, who have serious injuries and are left with ongoing disabilities, total 22,000 people per year. So anything we can do to improve...

Welcome back to the podcast! It's brilliant to be back after our summer break and we've got three great papers for you. First up we take a look at a paper looking at the association the a geriatric assessment can make on the mortality of patients aged 65 years and older, admitted with significant injuries to our UK major trauma centres. Next up we take a look at a newly proposed method to simple c...

Welcome back! This month we take a look at 3 papers covering the breadth of Emergency Care. First up we look at a paper evaluating outcomes for patients discharged on scene by an EMS service; how many reattend ED, how many require ICU care and what is the associated mortality rate? NEXUS and Canadian c-spine rules both incorporate the presence of c-spine tenderness when deciding whether to image t...

So when people talk about patients having a high lactate we think about them being sick, it can at times be easy to slip into thinking that this equals sepsis or maybe ischaemia. And whilst the presence of a high lactate in the context of infection and ischaemia is important to note, there is a lot more to interpreting a raised lactate than may first be apparent... So in this episode we're going t...