The Resus Room

This month we've got three papers covering a wide variety of topics and practice in emergency care. First up we'll be looking at whether pre-charging the defibrillator prior to rhythm analysis in cardiac arrest can decrease our hands-off time. Next we take a look at a paper that can help inform our assessment and investigation of trauma patients; looking at the risk of concomitant injuries with regards to specific levels of spinal trauma. Finally have a think about how different methods of extrication affect spinal movements from road traffic collisions; will it make a difference to your extrication method and speed? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So in this episode we run through narrow complex tachycardias, not I hear you say a perfect visual topic for an audio platform like a podcast, but hold your horses… No matter what your level, or your depth of understanding of narrow complex tachycardias, we really hope this will offer some extra knowledge and contemplation for both those of you, like us, that have been treating patient with NCT for decades, right through to those of you that are completely new to the topic. We run through all the normal stuff like definitions, clinical context and electrical pathways. Then we have a think about those terms and concepts like node dependance, AVRT, AVNRT, WPW etc, and then we come back to the fundamentals of delivering excellent care and how we can use a structure of interpretation to decide how best to treat our patient both pre and in-hospital. We've tried to really nail down and describe some of the concepts in a way that should make this topic a lot easier to understand and most importantly help us all deliver excellent care. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Happy New Year! Well we've got three really excellent papers to start off your new year with! First up we take a look at the complication rates seen when performing a prehospital thoracostomy; how frequent are complications and what could this information hold in improving our ongoing practice? Next up we take a look at an RCT on the use of Calcium in the context of cardiac arrest. Can it's inotropic and vasopressor effects translate into better outcomes for our patients? Lastly we take a look at another excellent RCT comparing the use of a bougie to a stylet in adult emergency intubations; which will lead to a great first pass success and will the results lead to a change in or practice and teaching? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Critically unwell patients often present with inadequate oxygenation and ventilation, in this episode we're going to explore some of the physiology of critical illness, look at how we can improve oxygenation and ventilation, take a look mechanical ventilation and have a think about how we can deliver this to a really high level. We'll be covering the following; Type 1 & 2 respiratory failure Breathing assessment Optimising patients own ventilation Mechanical ventilation Modes of ventilation Setting up a ventilator; tidal volume, RR, FiO2, I:E ratios, dead space End tidal CO2 Optimising oxygenation & ventilation Hand ventilation Ventilation in cardiac arrest Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to December's paper of the month podcast! In the first paper this month we take a look at a paper that assesses the utility of CT scans for patients presenting with fever of an unknown origin; could this help us identify the source more frequently and if so how often? Next, we often focus on the specific of medical management in cardiac arrest, but what impact does witnessing a cardiac arrest have on bystanders and could this affect the way we interact and behave on scene? Lastly we consider those patients that require a prehospital anaesthetic following return of spontaneous circulation from a medical cardiac arrest. Does the choice of induction agent between midazolam and ketamine affect the likelihood of hypotension and other complications? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Being involved in Emergency Care, by it's very nature, sadly means that we will have to break bad news to patients and families both in the prehospital & in-hospital setting. Breaking bad news well has benefits to both the recipient of that news and also to the provider delivering it. Teaching and education on the topic can be difficult to access and not always prioritised. In this episode we run through some of the evidence around breaking bad news, techniques and structures to follow and talk about the practicalities of adopting these, along with our own varied personal thoughts and styles. We hope listening to the podcast gives you an opportunity to reflect on how we could all work and improve on breaking bad news and also helps to make the process a little bit easier. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to the papers of the month podcast! First up we take a look at a paper assessing the importance of symptoms and sings in suspected Cauda Equina cases and consider which factors we should be giving weight to, including whether a PR is appropriate. Next up we take a look at a paper looking at electrical injuries presenting to the Emergency Department, the risk of significant injury and the appropriate investigations to perform on both high and low energy voltage injuries. Lastly we take a look a paper looking at the use of vasopressin and steroids in in-hospital cardiac arrest and see what effect in has in the latest RCT. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

So following on from the Roadside to Resus episode on intubation there were a lot of questions from listeners that we didn't have the opportunity to answer. These included some clinical aspects and also some really tricky issues around competency, governance and importantly who should and shouldn't be intubating. We've separated this out from the main episode as a lot of the conversations are heavily opinion based and only our view on the topic. This is our first episode of this style and we'd love to hear any comments or feedback and also know if this is something you'd like to hear again for future topics. Enjoy! Simon, Rob & James

Intubation is a key part of advanced airway management. Although some of you out there may not intubate, we'll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes. Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and learn the skill. This brings into question who should these limited opportunities to train go to, what defines competence, which patients now would benefit from intubation. In this episode we're going to cover these topics and more, including talking through how to fine your intubation technique as much as possible. We're coming at this episode with our collective neonatal, ED and PHEM practice which all involve advanced airway management and it's fair to say that we're all passionate about delivering intubation and advanced airway management to the highest level possible. We hope this episode gives a further opportunity to consider the topic in great depth and reflect upon how we can all contribute to improving practice. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome to October's papers of the month! Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We've looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms. Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests and think further about the decision making that goes into these complex decisions. Finally we take a look at a huge trial assessing the use of balanced fluids versus Normal Saline in critically ill patients and gain more information about the strategy we should employ. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

So this time we're going to be looking at the HUGE topic of acute coronary syndrome (ACS)! ACS ranges from patients who appear well at the time of their presentation, to those that have arrhythmias, haemodynamic instability, to those that are in cardiac arrest! There are around three quarters of a million ED chest pain attendances per year for acute chest pain and it accounts for around 25% of ED medical admissions!! Some of the treatments we'll discuss for patients with ACS can have a huge affect on morbidity and mortality and we can make a real difference to our patients. The ESC guidelines are a fantastic resource to take a look at and we've listen the papers that form the evidence we cover in the podcast. We worry about missing ACS and conversely, with so many 'suspected ACS patients', we also worry about overly suspecting it and the subsequent burden of admissions and investigations that it may mean. We're going to cover the approach to ACS in this episode in our standard format, all the way from definition, patho-physiology, assessment, investigations and management and cover aspects that are both new information and a sound revision of the topic. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back after our summer hiatus to September's Papers Podcast! Firstly we take a look at two different strategies for managing agitation in the Emergency Department, to achieve rapid control. Is haloperidol and midazolam, or ketamine alone, a better strategy? Then we take a look at the results from RECOVERY-RS. We covered the design of the trial at it's conception last year and this trial essentially looks to answer whether a strategy of high flow nasal oxygenation, CPAP or conventional oxygenation is best for our patients with suspected or confirmed COVID-19 when they present with hypoxia. Lastly we turn to Rob and take a look at his recent publication on the use of cervical collars when dealing with a patient able to self extricate from a motor vehicle collision; how will the application of a collar or commands help with excessive movement? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Welcome to August 2021's papers podcast! Three more great papers for you this month which have challenged and informed our practice. First up we look Impact of ambulance deceleration with patients lying flat vs 30 degrees head up on intracranial pressure in patients with a head injury. Next, is a patient with a refractory VF arrest more likely to have a positive finding on coronary angiography than one with non-refractory VF? And finally, in patients with blunt chest wall injury, does the presence of a flail chest indicate a worse morbidity and mortality compared to rib fractures alone? And what do the findings mean for our clinical examination focus? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. We're giving you all a summer break from us and we'll be back again with our Papers of the Month and Roadside to Resus episodes in September. Enjoy! Simon and Rob

So welcome back to another Roadside to Resus episode! Pre alerts are a key part of the interface between pre hospital and in hospital care of the critically unwell patient, when made and received in an effective manner they can really benefit the patient and the system. But too often we hear of friction associated with pre alerts and recent discussions on social media has really highlighted this. In this episode we explore the pre alert, the guidance that exists already on the topic, the challenges of both making and receiving those pre alerts and our four major questions; why we pre alert, what we should pre alert, how to pre alert and when to pre alert. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Another month and 3 more papers! First up we have a look at a paper that has grabbed a lot of recent headlines in the form of TTM2. So we now seem to have the answer to whether comatose patients following out of hospital cardiac arrest benefit from therapeutic hypothermia over maintenance of normothermia. Next up we take a look at a paper which adds some real value to our assessments of maxillofacial injuries and can help inform our assessment of the likelihood of fracture and need for imaging. Lastly we take a look at the whether iv vs io access in cardiac arrest might make a difference to outcomes when it comes to the use of adrenaline. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon and Rob

So this time we're going to be talking about subarachnoid haemorrhage. So this is going to be a short and punchy look at a really important and interesting topic in subarachnoid haemorrhage. We run through the approach to headache and then focus on the specific features and findings that we should be looking for with regards subarachnoid haemorrhage. We then consider who we should be investigating further, what value a CT head brings and the sticky subject of who should be going on to have a lumbar puncture. Finally we consider the the management once the diagnosis of SAH is reached and how we can ensure the best outcomes for our patients. At the time of recording NICE has published its draft version of Subarachnoid Haemorrhage Caused by a Ruptured Aneurysm; diagnosis and management, which will be a great resource once finalised. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

This month we've got three papers that have challenged our practice both from an in-hospital and pre-hospital perspective. Firstly we consider a paper that looks at admission saturations for patients with exacerbations of COPD and compare this to the BTS guidance on oxygen therapy, regarding altering oxygen saturations for those proven not to be hypercapnoeic. Should we be aiming for 88-92% or 94-98%? Next we look at a paper from the team at KSS looking at dispatch to older trauma victims and consider whether current triggers for HEMS dispatch are set at the appropriate level to catch those in this cohort that may benefit from critical care interventions. Lastly we look at a paper evaluating the QRS width in PEA cardiac arrests and consider firstly whether a broad QRS complex is predictive of hyperkalaemia and secondly whether we would treat patients based off this finding? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon and Rob

So the Resuscitation Council UK have today published new guidelines on resuscitation based on the European Resuscitation Council 2021 Guidelines and recommendations from the International Liaison Committee on Resuscitation. We were lucky enough to catch up with two key members of both ERC and RCUK, Gavin Perkins and Jasmeet Soar, gaining their valuable insights into the new guidelines. As well as this Simon, Rob and James pick out some other key points from the guidelines and discuss how these may translate into systems and practice. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to May's Papers of the Month Podcast! Three more papers for you on three varied topics. We start off with the use of end tidal carbon dioxide in the content of prehospital head injuries.Taking a look at a paper delving a bit deeper into the utility of end tidal CO2 when compared with arterial CO2 measurements on arrival in ED, in patients having received a prehospital anaesthetic; how accurate is end tidal and what level should we be aiming for? Next we consider the importance of frailty in the outcomes of our older trauma patients and the ability of three different screening tools in identification of this cohort of high risk patients presenting to our hospitals. Finally we take a look at a treatment which some prehospital services have already employed and others are considering; the use of CPAP for patients presenting with acute respiratory distress. Does the evidence support its use? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So last month we considered Maternal Emergencies and the approach and interventions we can make in order to minimise complications during pregnancy and during childbirth. As promised this month we're looking at the next step along the process and focussing on Newborn Life Support. Dealing with newborns has the potential to be really stressful but hopefully by concentrating on the fundamentals and guidelines we'll all be able to approach the situation with greater confidence. Let us know any thought and comments you have on the podcast. Enjoy! Simon, Rob & James

Well if last month was based on cardiac arrest, this month takes a deeper look at airways! First up we take a look at a paper that benchmarks the use of video laryngoscopy, specifically with the C-MAC and gives some really useful information from a Swiss HEMS service on first-pass success, the relevance of operator experience on success and factors that alter intubation success. Next up we're looking at blood in the airway with epistaxis...okay it's a tenuous link, but it pretty much works! The NOPAC study looks at the use of TXA in atraumatic epistaxis and compare it to placebo use, will TXA come up trumps in this setting? Finally we take a look at the use of scalpel cricothyroidotomy within the London HEMS service over a 20 year period, with a number of things we can learn from this experience. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So this is the first of a pregnancy related double-header, with the focus being firmly set on the mother this month and next month we'll focus in on NLS. This month though we're going to be discussing maternal emergencies. Now many conditions that could fall into this category but, as much as we love a good yarn, we really can't be here all day, so we've decided to focus on are the conditions that we are more likely to come across in either prehospital or EM practice. Those conditions in which we can make a really big difference to either the mum or the baby. We're talking antepartum haemorrhage, postpartum haemorrhage, cord prolapse, breech presentation and shoulder dystocia, all after we've set the scene on assisting with an uncomplicated delivery. So what would be really good is if we could find someone to bring in some prehospital maternal experience too. Ideally, someone qualified as a midwidfe and paramedic…and we're incredibly lucky to have just that in Aimee Yarrington, who has joined us for the podcast! As a background; PPH is the third leading cause of maternal death in the UK and the most common cause of obstetric-related intensive care admissions. APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Cord prolapse ranges from 0.1% to 0.6%. Breech presentation occurs in 3–4% of term deliveries. Shoulder dystocia has a reported incidence of around 0.70%. And the incidence of primary PPH continues to rise progressively in the UK, reaching as high as 13.8% in 2012–2013. So there's a good reason for us to be experts on these topics. Let us know any thought and comments you have on the podcast. Enjoy! Simon, James & Aimee

So this month we've got a cardiac-arrest-fest for you! With 3 papers centered on the management of cardiac arrest, with some key points that will help inform and improve our practice. First up we have a think about where patients with a presumed cardiac cause of their arrest should be transported to. Trauma networks in the UK have changed destinations for patients, but is there a patient benefit transporting this patients to a cardiac arrest centre and if so how much? Next we look at the potential benefit to nurse-led cardiac arrests with a study that might change some thoughts on how we best run and collaborate our cardiac arrests. Finally we take a look at an open access paper from SJTREM, looking at the use of serum markers to help us prognosticate in hypothermic cardiac arrest and in these really challenging cases there is some great stuff to take from the paper. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Welcome back to the podcast and our next Roadside to Resus episode, this time we're taking a look at Diabetic Ketoacidosis, DKA. In this episode we'll be getting our heads around the pathophysiology that underpins DKA, consider the clinical picture and severity of patients that present and look at both the in-hospital and pre-hospital management of these patients including topics such at fluid choice, insulin boluses and nasal ETCO2 for diagnosis of DKA. Let us know any thought and comments you have. Enjoy! Simon, Rob & James

So three very different papers for you this month... We start off having a look at a paper on the HINTS examination. This exam came to prominence a few years ago as a way to distinguish between central and peripheral causes of vertigo with a pretty amazing sensitivity and specificity. Since then many EM clinicians have brought it onto their practice and this paper seeks to assess how good the test is at the bedside in real life practice. Next up we take a look at a paper assessing the injury patterns in trapped patients and consider the prevalence of injuries both with regard to spinal and other injury patterns and then consider the impact that this holds with respect to extrication. Finally we have a look at a paper focussing on the inhospitable management of hypertension; the treatment strategies and the outcomes comparing those being treated during their inpatient stay versus this left untreated with some surprising outcomes... Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So in this episode we're going to have a deeper think about advanced airway management and specifically supraglottic use in the prehospital and ED environment. Many prehospital service have seen the removal of intubation from their scope of practice, and that's understandably been received with mixed thoughts. But this isn't the end of 'expert advanced airway care for all; in fact far, far from it… we've all heard people talking about 'whacking in an i-gel', but really utilising a supraglottic device to its maximal potential can make a huge difference to our critically unwell patients. We'll be running through an overview of supraglottic devices, the evidence surrounding their use, patient selection, patient positioning and size selection, placing a supraglottic device, troubleshooting and finally ongoing ventilation with a supraglottic device. We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Happy New Year! Well 2020 certainly wasn't what we were all expecting, so here's hoping for a phenomenally better 2021. We've got some really exciting episodes for you this year including Supraglottic Airways, Neonatal Resuscitation, Diabetic Emergencies, New Resuscitation guidelines and much much more! We're kicking off the podcast year with three really interesting papers! First up we consider the importance of first pass success of both supraglottic airways and endotracheal intubation in the context of cardiac arrest; a lot of attention has been shone recently on question of which approach we should consider after bag valve mask ventilation, but how important is the first pass of either of the approaches to the outcomes of our patients? Next up we have a look at a paper that challenges the use of TXA in our patients with a severe traumatic brain injury after the publication of CRASH 3. Finally we have another look at the mantra of 'GCS 8-intubate' with a systematic review which draws together all of the evidence across the age ranges and both traumatic and non-traumatic presentations. Make sure you take a look at our new CPD apps on both Android and iOS to log your time listening to this episode. Enjoy! Simon & Rob

So for decades people have talked about Contrast Induced Nephropathy…or Contrast Induced Acute Kidney Injury, depending on the decade and location of discussion. The theory being that diuresis, increased urine viscosity and changes in vasoconstriction and vasodilation leads to a worsening of renal function following iv contrast administration. It seems to come from the 1950's where some patients were seen to develop acute kidney injuries following iv contrast. Now times have changed and treatments and contrasts evolved but the discussion around contrast induced nephropathy continues. At times these discussion can mean that some patients wait for scans in the Emergency Department whilst waiting for blood tests to come back first. But is this the right thing to do? In this episode we take a look at the origins of contrast induced nephropathy, consider some recent publications on the topic and see how this translates to practice and applications of the most recent guidelines. Reading around the topic has been hugely informative for us and we hope will be of benefit to you too! Enjoy Simon & Rob

Welcome back to December's Papers of The Month Podcast! Three more papers for you which will challenge and inform you practice. First up we have a look at a systematic review and meta-analysis which considers the fluid choice in resuscitating those patients with suspected traumatic brain injury in the prehospital setting; should we be reaching for the hypertonic solutions, or is an isotonic fluid such as normal saline adequate? Next we take a look at a paper that has received a lot of online discussion which looks at the two approaches of antibiotics or surgery for an appendicitis. This is a randomised control trial that looks to answer a question that the literature has dipped into over the last few years, but this RCT goes that bit further and will help give patients a good idea of the pro's and con's of each approach. Finally we take a look at the UK national approach to oxygenation strategies in those patients receiving a prehospital emergency anaesthetic. How many clinicians provide PEEP, how commonly implemented is apnoeic oxygenation and do we all ventilate through apnoea? Gaining an understanding as to where our practice sits compared to others gives us the opportunity to consider the potential benefits and downsides of various strategies and may help unify practice to more streamlined working and better outcomes for our patients. We also get the opportunity to hear thoughts on the subject from one of the authors Dr. Amar Amshru, Emergency Medicine and and Pre Hospital Doctor in London and with Kent Surrey and Sussex Air Ambulance. Enjoy! Simon & Rob

Welcome back to the podcast! In this episode of Roadside to Resus we're going to take a look Anaphylaxis, which has been highlighted on a national level of concern as NICE state 'many people do not receive optimal management following their acute anaphylactic reaction'. Much of the problem lies within a lack of understanding of what actually constitutes an anaphylactic reaction and the knock on effect this has to the treatment provided. In this episode we'll explore the definition of anaphylaxis and the significant differences that can be seen in the presentation. We have a a think about the pathophysiology and reasons behind the variance in presentations and how this affects the importance of treatments available and their relative importance. Anaphylaxis is known to have a a number of patients who have a biphasic reaction, it predicates the need to convey patients to hospital and a period of observation; however the frequency and severity of these biphasic reactions can help to inform this further and for that reason we take a look at the literature on it. We've covered angioedema before in a separate episode, but we briefly cover the similarities and differences and how this affects management. Lastly we cover the follow up and management that these patients require. We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Welcome to November's papers of the month podcast! This month we kick things off looking at TXA in trauma and consider in complex scenes and resource limited environments if TXA could be administered effectively in an IM rather than IV route? We also get an authors inside view from Professor Ian Roberts. Next up; does the anatomical location of a head injury affect the risk of an intracerebral bleed and could this affect those patients that can go without a scan? And finally we have a look at the importance of a chest X-ray in COVID-19 and consider how accurate the X-ray is at both picking up and ruling out the infection. Enjoy! Simon & Rob

So in our Toxidrome Roadside to Resus episode we covered the initial management of a poisoned patient, some of the constellation of features to look out for and the specific management. But what about specific agents and circumstances that require particular knowledge and management both in the prehospital environment and in ED? Well in this episode we'll cover these by running through; Paracetamol poisoning and treatment Calcium channel blocker overdose Beta blocker overdose High dose insulin euglycaemic therapy Activated charcoal Intralipid therapy Cardiac arrest due to toxicology We'd love to hear any comments or feedback you have and make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Welcome back to the Papers of the Month podcast, once again we've got 3 more papers to inform, discuss and hopefully improve our practice. First up we have a look at a paper which looks to quantify the prognostic utility of lactate in our sick Resus patients; we often look at the initial lactates and draw conclusions for what they mean, but this paper helps us understand the results a bit further. For our patients that sustain a head injury, the NICE guidelines advocate that all patients on direct oral anticoagulants should have a CT head scan, irrespective of clinical findings or other high risk features of the patients history. Quantifying the risk that these patients have for an intracranial bleed is really important, as to date it isn't fully understood. Our second paper looks at this directly and can help inform practice, guidelines and discussions with patients. Finally; we often think about how we can improve resuscitation of our patients in cardiac arrest, look for the latest treatment and evidence, but it can be easy to overlook how our actions can significantly affect their loved ones who may be present at this time. We take a look at a fascinating study looking at the impact of inviting patients in to witness the resuscitation in its entirety and the effect that this has in regards too PTSD. In our opinion this paper holds a huge amount to think about and is a game changer! Finally keep an eye out for our CPD portal and app which is in the final stages of testing and will be out very shortly!! We'll be keeping you up to date on twitter @TheResusRoom with its launch Enjoy! Simon & Rob

Drug ingestion both accidental and intentional accounts for a significant proportion of attendances at UK Emergency Departments and 999 calls. In 2016 there were >2,500 registered deaths in England and Wales related to drug misuse, which had increased by nearly 60% in a decade. So without a doubt we are all going to come across critically unwell patients with drug ingestions. But inappropriate drug use is not confined to illicit substances, with many prescription drugs being misused to ill effect and also overdosed in an attempt to end patients lives. In this podcast we're going to run through the assessment of patients presenting with a possible drug ingestion, cover the potential toxidromes you may encounter and talk about the management of these presentations. Specifically we take a look at serotonin syndrome, sedative toxidrome and both cholinergic and anti-cholinergic syndrome. In next months Roadside to Resus we'll take a look at specific medications of overdose; paracetamol, beta blockers, calcium channel blockers and the intricacies of their management along with other key parts of critical care including the management of cardiac arrest due to toxicity. Make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Welcome back!! So we've had a small summer hiatus and are now back with another Papers of The Month and a jam packed line up of episodes for the rest of the year! We start off this month with a paper which looks to evaluate if there is any benefit on mortality with the use of checklists for endotracheal intubation. Next up we take a look at the factors in cardiac arrest that are most important with regards to prognostication; what should your attention and handover be most focussed upon? Finally we take a look at a paper suggesting that blood gases following ROSC can help us prognosticate for our patient and how this might this affect our practice. Finally keep an eye out for our CPD portal and app which is in the final stages of testing and will be out very shortly!! We'll be keeping you up to date on twitter @TheResusRoom with its launch All references can be found on our webpage at TheResusRoom.co.uk Enjoy! Simon & Rob

So this is our last episode before a small summer hiatus, so it better be a good one! Journals are littered with some great articles at the moment, so we've chosen 3 great papers that cover a number of really important EM topics. Over the last few years more emphasis has been put on a more conservative management on pneumothoraces and following that trend we take a look at a paper evaluating the safety of using a small bore chest drain for the delayed management of haemothoraces, compared with large bore. Next up we take a look at the Injury Severity Score and how well it correlates with the need for life saving interventions in trauma. Lastly there is another great paper on the management of acute atrial fibrillation; comparing electrical cardioversion with the potential use of procainamide prior to shocking. Does it result in fewer patients requiring a shock, and when it comes to the shock is AP pad positioning more effective that anterolateral? We'll be taking a small break over the summer and will be back in September for our next Papers Podcast and keep an eye out for the launch of our FREE CPD app and web platform this summer. Enjoy! Simon & Rob

The more you delve into cardiac arrest, the more it seems that delivering the essentials well is the key to great outcomes; timely recognition, high quality chest compressions, with early and appropriate defibrillation. But is ultrasound in cardiac arrest a layer that we should all be adding in as a standard. It holds the potential to not only prognose outcomes from cardiac arrest, both medical and traumatic, but also to add a level of diagnosis of potentially reversible causes. In this podcast we chat through the evidence surrounding ultrasound in cardiac arrest and consider the practicalities of application during delivery of patient care. Make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

There are more great pieces of research to enjoy this month! We start off with a paper following on nicely from our Roadside to Resus episode on Stabbing, which looks at the ability of prehospital providers to predict whether stab injuries penetrate to deep structures, or are purely superficial from clinical assessment. Next up we take a look at a paper using high sensitivity troponin and their limit of detection, to assess whether we could be safely discharging patients earlier from the emergency department. Finally we have a look at the results from the RECOVERY group on dexamethasone use in COVID-19, have we got a treatment that can help improve survival in patients admitted with the virus? We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Tranexamic Acid (TXA) has gained a significant amount of attention over the last few years as multiple studies have shown it's utility in decreasing haemorrhage and associated mortality. It has become part of major trauma guidelines, post part haemorrhage protocols and many have adopted it to the management of traumatic brain injury. The findings have been very similar across a spectrum of haemorrhage disease processes and from this further interest in expanding TXA's application to pretty much anything that bleeds. Time from onset of the bleeding has been shown to be important, with it's effect decreasing from time of onset to its administration. Gastro-intestinal bleeding is a significant cause of morbidity and mortality. Previous meta-analyses have shown favourable outcomes for TXA in GI bleeds and many have already adopted TXA into this area of practice, although guidance from NICE does not yet recommend it. HALT-IT is a multi centre, international, randomised double blind controlled trial of near 12,000 patients that has just been published in the Lancet. The study was a huge piece of work and looks to definitively answer the question of whether we should be giving TXA to patients with life threatening GI bleeds. In this podcast we run through the ins and outs of the paper ad are lucky enough to speak to the lead author Ian Roberts about the findings, some of the intricacies of the trial and what the results mean for practice. Enjoy! Simon, Rob & James

Welcome back to June's Papers Podcast! Traditionally when you're taught about working a patient up for a potential diagnosis you'll find a list of signs, symptoms and tests that you need to perform in order to obtain your diagnosis. What that teaching doesn't tell you is how important each of those aspects is and this month we take a deeper look at this for pneumonia. We look two papers, one focussing on the clinical findings both in signs and symptoms and then a further paper on the importance of biomarker in the diagnosis. We also have a look at a paper which focusses on decreasing time on scene for prehospital patients and the potential benefit of regular time prompts, an idea that may be applicable irrespective of your place and role of work. We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Transfers of patients happen all the time. It's easy to think about transfers as only those that involve an ambulance and moving patients from one hospital to the next, but in reality it's far more extensive than that. We all move patients all the time, whether that be the unwell patient in the upstairs of their house to the ambulance, the patient in the Emergency Department to the CT scanner or another ward, or the more traditional interhosptal transfer. Transfers of patients are inherently high risk times for the patient and having some background knowledge on transfers and a structured approach helps us ensure the best possible care for our patients. In this episode we run through transfers with the help of an expert on the topic, Scott Grier a Consultant in Intensive Care Medicine and Anaesthesia at Southmead Hospital in Bristol, the South West Critical Care Network Lead for Transfer, and a PreHospital Critical Care Doctor with GWAAC. Enjoy! Simon, Rob and James

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 we might look to mitigate against these complications. Next we have a think about end-tidal CO2 levels and the correlation between these and arterial CO2 readings and discuss what the findings might mean for our practice. Finally we have a look at the incidence of hyperoxia in patients receiving a prehospital emergency anaesthetic in the context of trauma, and consider the effect this might have on our patients and again practice. We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & James

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 reported to be up to 19%, with mortality rates as high as 37% reported in the presence of haemodynamic instability. In this episode we'll run through pelvic injuries, all the way from anatomy and mechanisms of injury, to assessment and management. As always make sure you have a look at the references and supporting material attached in the show notes, and get in touch with any questions or comments and take care of yourselves. Enjoy! Simon, Rob and James

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 RECOVERY-RS trial, which is open for hospitals in the UK to sign up for. This looks at 3 different strategies of respiratory support for patients admitted with suspected or known COVID-19 and hypoxia; namely CPAP, High-flow nasal oxygen and standard care. The trial is funded by the NIHR and supported by the Intensive Care Society. In this episode we get a chance to speak to Bronwen Connolly, one of the investigators of the RECOVERY-RS trial; we discuss the background evidence, the trial design, and when results will be available. As always we'd love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the protocol yourself. Enjoy! Simon, Rob & James

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. We take a look at a paper that tries to quantify the risk of patients developing an intracerebral injury when taking antiplatelets and anticoagulants. Finally we have a look at the value of clinical examination and imaging findings in patients with elevated intracranial pressure, how valuable are individual findings? Most importantly take care of yourselves and loved ones and keep fighting the good fight! Simon & Rob

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 podcast we cover the talk which is based on 2 cases that are common to PHEM;a major trauma and a cardiac arrest, and discuss how we can optimise outcomes for our patients in view of the recent evidence on these areas. As always we'd love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions. Enjoy! Simon, Rob & James

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 inform conversations and decision making with this patient group. Recent literature has looked at a more conservative management for traumatic pneumothoraces, but what about those that are spontaneous? The British Thoracic Society has guidelines for how we should deal with them but a recent RCT in the New England Journal of Medicine looks at an even more conservative approach for our patients; can we decrease the number of aspirations and drains that we are performing? Finally we've covered recently a paper on the topic of Prehospital Critical Care on the outcomes for patients in cardiac arrest, in this episode we have a look on their impact in trauma patients and hear from the lead author Ali Maddock on the implications of the study's findings. Enjoy! Simon & Rob

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 of the country, sadly it now seems that we all have or all will be dealing with such cases. The variability in injury and severity is vast from stabbings, however in extremis they are completely time critical, and striking the balance between performing only those life saving interventions on scene, during transport and in ED and getting to the final destination of theatre as quickly as possible. In this podcast we discuss our thoughts on dealing with these cases; from the moment we get that call, all the way through to getting them into theatre. As always we'd love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions. Enjoy! Simon, Rob and James

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 consciousness, this paper may help inform your differentials and knowledge on the likelihood of different pathologies. Finally, following on from our recent Roadside to Resus episode on Seizures, we take a look at an RCT which compares 3 second line anti epileptics; will this give us the definitive answer over which we should be using? Once again we would love to hear you comments and feedback, and make sure you check out the articles yourselves and come to your own conclusions. Enjoy Simon & Rob

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 and care is complicated and of paramount importance, as some of these episodes carry with them a high morbidity and mortality rate. In this episode of Roadside to Resus we run through the following; The scale of the problem Causes of seizures Definition of status epilepticus Different forms of seizures Clinical assessment Investigations Antiepileptic's Management& guidelines; both Pre and In-hospital RSI for status epilepticus Follow up and guidance As always we'd love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions. Enjoy! Simon, Rob & James