The Resus Room

In this Roadside to Resus, we take the 2026 Fifth Universal Definition of Myocardial Infarction back to the patients we see in the ED and pre-hospital setting. We start with the key question, when does myocardial injury become an infarction? From there, we work through the new primary, secondary and procedure-related MI categories—and why finding the cause matters more than attaching a number to t...

This month we have three really clinically relevant papers that take us from a very common ED presentation, through an everyday diagnostic dilemma, and then right into a high-risk paediatric airway. We start with abdominal pain in older adults and ask whether the history and examination are giving us as much reassurance as we think. The paper looks at how CT use, diagnostic yield, admission and su...

We assess the pupils in almost every significantly unwell or injured patient - but how much are they really telling us? It is easy to document 'pupils equal and reactive' and move on, yet a changing pupil may be one of the earliest outward signs of a developing intracranial catastrophe. Equally, anisocoria in a completely well patient may be longstanding and entirely benign. In this Roadside to Re...

Welcome back to September 2026's Papers of the Month, and this month we've got three papers that are really focused on the practical end of emergency and prehospital care. First up, we're looking at what happens after we've performed a prehospital RSI. We put a huge amount of emphasis on getting the induction right, but what about maintaining adequate anaesthesia afterwards? This paper looks at in...

This month we've got another really varied mix of papers that all have the potential to influence everyday emergency and prehospital practice. We start by asking a question that's becoming increasingly relevant as prehospital critical care teams develop ever more advanced capabilities: are all those extra interventions costing us precious scene time, and if so, how much? We then move into post-car...

Tracheostomy and laryngectomy emergencies are classic high-acuity, low-frequency situations. They do not happen every day, but when they do, airway problems can develop quickly, and the wrong intervention can make things significantly worse. In this episode, we work through the practical approach to these patients, starting with the most important distinction: a patient with a tracheostomy may sti...

Welcome back to July's Papers of the Month. This month we've got three papers that tackle some of the biggest questions we face in emergency and critical care medicine. They're all very different studies, but each one looks at an intervention that many of us use, or at least think about, on a regular basis. First up, we look at ARISE FLUIDS, a major trial examining one of the longest-running debat...

Face mask ventilation is one of those skills that can easily be overlooked. It's often seen as the simple bit of airway management — something that sits below the glamour of videolaryngoscopy, fibre-optics and endotracheal intubation. But the reality is that excellent face mask ventilation is one of the most important airway skills we have. In this episode, we take a deep dive into bag-valve-mask...

This month's episode takes us deep into trauma care, but not just the medicine we deliver but also the systems, circumstances and social factors that shape who survives and who doesn't. We start by looking at a remarkable paper from Gaza describing the use of ultrasound-guided pericardiocentesis, large-bore drainage and intrapericardial tranexamic acid as definitive management for penetrating card...

Anaphylaxis is one of those conditions we think we have got pretty well sorted. Recognise it early, give adrenaline, support the airway and circulation, and crack on. And in fairness, for the vast majority of patients, that approach works really well. But in this Roadside to Resus episode we take a step back and ask a pretty uncomfortable question, have we actually been thinking about anaphylaxis...

This month's Papers of the Month is a real mix of papers that challenge some of the things we think we know, whilst also highlighting just how important systems and processes are in improving patient care. We start with intracerebral haemorrhage and the tricky issue of blood pressure management. We've all been taught that early, aggressive blood pressure reduction is key, but this paper raises som...

Timely and effective defibrillation is fundamental to excellent outcomes in cardiac arrest care. But there is a growing body of evidence suggesting that how we deliver those shocks may matter just as much as when we deliver them. Over the last few years we've seen increasing interest in alternative defibrillation strategies, particularly AP pad positioning and double sequential external defibrilla...

This month we're heading firmly into the prehospital and community space, looking at how we make decisions when the diagnostics are limited and the system around us is evolving. We start with a really practical question around traumatic pneumothorax. How good are we, clinically, at spotting the patients who actually need urgent decompression? This paper takes a hard look at the performance of the...

Decision making sounds like a slightly academic, niche topic… but in reality, it sits underneath every single thing we do in emergency and pre-hospital care. Every patient contact, every test we order, every treatment we start and every one we choose not to – is a decision made in an environment that is time critical, information-light and full of uncertainty. In this episode we take a step back a...

March's Papers of the Month is here and we've got three absolute crackers to get stuck into. First up, we head prehospital to explore pseudo-pulseless electrical activity. This review challenges us to rethink how we approach organised electrical activity without a pulse. We discuss the role of POCUS, the concept of treating profound shock rather than "arrest," and what this means for decision-maki...

This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial...

Welcome back to February's Papers of the Month! We start this month looking a the right place to perform a prehospital anaesthetic. Traditionally we've been taught it should be somewhere with 360-degree access to allow the greatest safety, which means intubating in an ambulance and other locations are a no-go. But does it actually reduce complications, and what about other locations and situations...

Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm....

Welcome to January's Papers of the Month, which marks 10 years of the podcast! First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quan...

Welcome to this special edition of Roadside to Resus where we're diving into some of the progressive and practice-defining developments in pre-hospital emergency care. This episode brings together a superb group of clinicians, educators and leaders who are shaping the future of PHEM across the UK, and we caught up with them at the recent Faculty of Pre-hospital Care Conference entitled 'The Wider...

December brings us to the final Papers of the Month for 2025 and we're finishing the year with three studies that challenge assumptions across critical care and resuscitation! This time questioning the role of arterial lines in shock, looking at the true prognostic value of end-tidal CO₂ in cardiac arrest and finally to airway management in neonates. We start in the ICU with the EVERDAC trial, a l...

Whether you're just stepping into your first cardiac arrest or you've been running them since the days of paddles, this one's for you. The 2025 resuscitation guidelines have landed after further collaboration between ILCOR, the ERC and the Resuscitation Council UK and in this episode we break down exactly what's new, what's stayed the same, and how it all fits into day-to-day practice. Across the...

This month we've got four cracking UK-led studies that really speak to how pre-hospital and emergency medicine continue to evolve, not just in the kit and skills we use, but in how we think about the whole patient journey. We'll start with a paper fromAnaesthesia with Pallavicini et al., exploring pre-hospital central venous access for patients in haemorrhagic shock. Drawing on London's Air Ambula...

How, when and why to make the call… The pre-alert is one of the most powerful and sometimes most painful parts of emergency care. It can feel like the Spanish Inquisition, trigger tension between pre-hospital and ED teams, or drop another challenge into an already overflowing department. But done well, a pre-alert isn't an irritation; it's an opportunity to line up critical care for the next patie...

This month we've got three really interesting papers that shine a light on aspects of cardiac arrest management that many of us will recognise from clinical practice. First up, we look at the feasibility of arterial line placement during ongoing cardiac arrest in the Emergency Department. In our SPEAR episode we talked about the balance between securing invasive monitoring versus the potential dis...