The Resus Room

Those of us who are a bit longer in the tooth have spent most of our careers not scanning everyone who sustained a head injury on warfarin, but in 2104  NICE published guidance  suggesting we do just that. At times, with the huge burden we place on our radiology services, it is difficult not think we're over doing things with all of these scan requests, especially when the patient has no adverse s...

A lot of our podcasts have focussed on prognostic factors in arrest to help with the decision making of continuing or stopping resuscitation in cardiac arrest. There would appear to be a huge variety in practice as to when resuscitation is ceased, and in that way having explicit guidance to unify practice can at times seem appealing. In this episode we have a look at a recent paper covering the to...

Happy New Year!!! The publishing world seems to have wound down a bit for the festive break, but 4 papers caught out eye that can add some further context to practice in the Resus Room. Firstly we take a look at two papers looking at the conversion from non-shockable to shockable rhythms in cardiac arrest, both the likelihood and the associated prognosis. Next up we have a look at a paper focussin...

As the years tick by our healthcare systems work harder and harder to ensure that acute coronary syndromes are picked up as they present to our Emergency Departments, the evolution of high sensitivity troponins and their application have been key to this. The utility of a test however is dependant upon it's application to the appropriate patient. In a heavily burdened system it can at times seem s...

So my talk at the  ICS SOA 2016 conference  on whether ED should be allowed to intubate certainly provoked some discussion, which was fortunate as it was the purpose of the talk! If you haven't listened to it yet, stop listening to this and have a listen to the talk  here  first. In this quick debrief between Rob and myself we have a think about the feedback and where to go from here. We'd love to...

RSI delivered by EM clinicians is common place throughout the globe, in the UK however it still seems a contentious topic, with recent data showing only 20% of ED RSIs being performed by EM clinicians. I was lucky enough to be asked to talk at the ICS SoA 2016 conference on the topic of EM doctors carrying out RSI's in the UK and this podcast is a copy of that talk. I hope it provides some context...

Welcome to December's Papers of the month where we'll be looking at the papers recently published that have caught our eye. First up, what happens when clinicians override clinical decision rules for PE? Are we better than the the rules? Next we have a look at a review article that runs through the back ground literature on subsegmental PE's, their diagnosis and management. And finally we have a l...

Patients frequently present to the Emergency Department either with direct concern following an upper gastro intestinal bleed, or with a history that points towards the diagnosis. When these patients are haemodynamically unstable or with ongoing high volume bleeding the decision to admit or discharge becomes simple. But when the episode has settled, deciding whether they are safe to be discharged...

It's never long before the topic of pulmonary embolism makes it back into the controversial lime light and a recent paper on the association of PE with syncope is the lastest reason. The PESIT trial, just published in the New England Journal of Medicine certainly grabs your attention when you read the abstract, with the implication that PE's are a major and hugely missed cause of the presentation...

This month the literature seems to be focussed on cardiac arrest In this podcast we'll cover a paper looking at the significance of chest compression rate, ultrasound for prognostication (and to a lesser extent identification of tamponade) and finally a systematic review and meta-analysis of PCI following ROSC. The PCI paper follows on nicely from our  previous podcast on the topic , so make sure...

Stroke thrombolysis has definitely put the spotlight back on to the topic of stroke over the last few years. Stroke thrombolysis has led to restructuring of stroke care in the UK and has helped drive investment in stroke care. The evidence base that underpins thrombolysis has been controversial to say the least and can be difficult to comprehend. Review article: Why is there still a debate regardi...

Risk assessment, testing and risk management form the very heart of Emergency Medicine and Critical Care. Being aware of the evidence surrounding a topic is key to delivering high level care but without an understanding of the underpinning concepts it's application is extremely limited. Understanding how a test result changes a patient's likelihood of a disease can be described with likelihood rat...

This month we cover a paper looking at the role of early craniectomy for raised intracranial pressure, the outcomes associated with advanced airway managements in prehospital cardiac arrest and lastly at the utility on ETCO2 and consider if it's application decreases adverse respiratory events. This month our great sponsors  ADPRAC  our giving away a £30 iTunes voucher to spend on education/entert...

This week the British Thoracic Society have released an updated version of their guidelines on asthma. The document covers all aspects from diagnosis, treatment and follow up, in this podcast we briefly run through some of the aspects covered in the acute management section. Make sure you have a look at the full document that can be found here  https://www.brit-thoracic.org.uk/document-library/cli...

In 2014 NICE updated their guidelines on  Head Injury: assessment and early management . This included specific guidance for those patients on warfarin Guidance regarding the ongoing observation of these patients is not contained within the guideline but as with much of Emergency Medicine variation between departments and regions vary in the threshold to admit patients with a normal CT head due to...

Here's a look at some of the papers that caught our eye this month. We cover a paper looking at the the potential benefits of ketofol over propofol for conscious sedation, the role of aggressive blood pressure reduction in haemorrhage stroke and finally a really interesting paper of PE thrombolysis in cardiac arrest. This month our great sponsors  ADPRAC  our giving away a £50 iTunes voucher to sp...

Where does the role of a chest X-ray lie in major trauma? With the ever increasing use of CT and ultrasound in the resus room what role does the old school CXR hold? How many injuries will it pick up? How many will it miss? And when is the extra delay justified? This podcast looks at a recent paper on the topic and some related national guidelines. Enjoy! References Prevalence and Clinical Import...

Burns are a common presentation to the ED and can result in a significant degree or morbidity and mortality. In this podcast we talk through the approach and treatment of burns along with some controversies in the literature regarding assessment of burn depth and fluid management. Enjoy! References The Parkland formula under fire: is the criticism justified?  Blumetti J, et al. J Burn Care Res. 20...

Here's a look at some of the papers that caught our eye this month. In this podcast we cover a paper looking at the significance of findings with the history, physical exam and imaging in subarachnoid haemorrhage to inform your work up.  We look at another paper focussing on total body versus selective CT scanning in trauma and lastly a paper looking at the validation of the DECAF score to predict...

If you've had an MI with a STEMI or a new LBBB the decision to go to the cath lab is pretty straight forward. If you've collapsed with a cardiac arrest of presumed cardiac aetiology (the majority of them) and gained a ROSC (return in spontaneous circulation) then the decision to go the the lab immediately is pretty variable and can depend of the clinicians involved, the ECG or the system within wh...

I haven't always read papers and with the time pressures of training and life it's impossible for us to be on top of all of the literature. But over the last few years I've come across some papers that I wish others had told me about. For some of you this will all be a recap but for others hopefully it will spark an interest and get you to have a look at the papers yourself. We all know that it is...

So the long awaited new NICE Guidelines on Sepsis have just been released. I'm no sepsis expert, I'm not on a panel involved with the guidelines but I am someone who is going to be trying to use these guidelines everyday at work with multiple patients and I'm not the only one....we all are! In this podcast we run through some of the main points brought up in the new guidelines. Talk about some pot...

We have a look at papers covering platelet transfusions for patients on antiplatelets who suffer intracerebral bleeds, the optimal dose for procedural sedation with ketamine in children, a new meta-analysis on the sensitivity of early CT in suspected sub arachnoid haemorrhage and finish up with an amazing case report regarding a hypothermic cardiac arrest Make sure you go and have a look at the pa...

Sedation is becoming an ever more significant part of our work in the Emergency Department. At the end of May 2016 the Royal College of Emergency Medicine Published the  RCEM Sedation Audit  of 2015-2016 that covered more than 8,000 ED sedations throughout the UK (involving more than 190 ED's). There are some pearls to take out of this great piece of work in which there would seem to be some signi...

Carbon Monoxide poisoning is definitely one of those differentials that you consider when the patients books into ED with '?carbon monoxide poisoning'...... but how much do we really think about it in a patient that hasn't been sent down to the ED with this specific thought in mind? Rob Fenwick talks us through the key points of Carbon Monoxide poisoning and some recent evidence on the topic which...