The Resus Room

Welcome to May's papers of the month podcast. Hope you are all well and keeping safe. This month James joins Simon to discuss some of the great work published following the London Trauma Conference, all available in the hyperlinks on the website. First up we have a look at the incidence of prehospital hypotension and hypoxia in patients with suspected traumatic brain injury and the ways in which w...

Fractures of the pelvis are found reasonably often in major trauma, but they're a really challenging presentation. They are difficult to assess and accurately diagnose in the prehospital setting, mortality rates are high, particularly in patients with haemodynamic instability and there are often associated injuries. Associated mortality from patients with pelvic fractures who reach hospital is rep...

So COVID-19 has produced a multitude of challenges to healthcare providers, the response to these challenges has been phenomenal. One uncertainty is the strategy we should employ for hypoxic respiratory failure and several high quality guidelines have presented conflicting advice for the severely hypoxic patient. The Warwick Clinical Trials Unit has already begun recruiting patients to their RECOV...

First we hope you're all well. The world has changed dramatically over the the last few weeks and you are all doing a phenomenal job of providing healthcare under extremely challenging circumstances. We are determined to add a bit of normality to life with a non-COVID-19 papers of the month, full of bad jokes and some EBM. This month we're looking at intubation of acute alcohol intoxication in ED....

Excellent practice is led by following the high quality evidence based medicine, and there have been a lot of great papers published in the last 12 months! We were kindly invited to the Faculty of Pre Hospital Care Annual Scientific Conference to give a talk on the top 10 papers over the last year. Sadly, but completely understandably, the conference had to be cancelled due to COVID-19. In this po...

We've got a great spread of topics for you this month, stretching all the way from Prehospital Critical Care, to core Emergency Medicine topics. Those of us seeing 'non-specific' complaints will appreciate how difficult they can be to diagnose and manage effectively. We have a look at a paper that helps characterise this group and give some context to their mortality risk. This may well help infor...

Figures for the year ending September 2019 showed a 7% rise in offences involving knives or sharp instruments recorded by the police (to 44,771 offences). This is 46% higher than when comparable recording began (year ending March 2011) and the highest on record.  The news is sadly littered with cases of knife crime and terror and whilst we may have thought of stabbings as confined to small pockets...

Welcome back! Three very different topics and papers for you this month. First up we have a look at the risk/benefit of sending troponins on patients aged 65 years an older when presenting with non-specific complaints; does this help their work up, or is this a classic case of over-testing? Next up we take a look at the causes of our patients presenting to the ED with a reduced level of consciousn...

Seizures are defined as a "paroxysmal electrical discharge of the neurones in the brain resulting in a change of function or behaviour". All of us involved in Emergency Care will encounter patients with seizures which can occur for a number of reasons, with Epilepsy affecting 1 in 100 people in the UK. Being able to identify the cause, terminate ongoing seizures and provide ongoing investigation a...

Happy New Year!! We hope you've all had a great Christmas and New Year and that you managed to get some well earned time off over the festive period.  2019 saw us publish more insights from lead authors of the latest and most influential studies in Emergency Medicine and Critical Care, and we're really excited to say that we'll be delivering you even more in 2020 with some excellent RCTs, internat...

REBOA, ECMO, Thoracotomy? Where should we be focussing our attention in the world of Pre-hospital care? We were lucky enough to be invited to the London Trauma Conference on the Prehospital Day supported by the Norwegian Air Ambulance Foundation. The day focussed on the areas we can make a real impact to the outcomes of our pre-hospital critical care patients. We grabbed a few minutes time of the...

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...

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...

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 Medici...

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...

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 tr...

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...

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 su...

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 t...

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 b...

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 diag...

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...

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...

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 cov...

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 bot...