The Resus Room

Latest Episodes:

November 2022; papers of the month Nov 01, 2022

Show notes

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 RCT, with some really clever blinding, that looks at different BP targets for intubated and ventilated patients in ICU who have sustained a cardiac arrest.

Finally we take a look at a paper focussing on healthcare professionals' perceptions of interprofessional teamwork in the emergency critical incidents.

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob

Bradycardia; Roadside to Resus Oct 17, 2022

Show notes

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 those peri-arrest patients where you'll be cracking open your critical care drugs and starting to pace them externally before getting them to definitive care.

In this episode we take an in-depth look at the cause, electrophysiological pathways, assessment and treatments for bradycardias.

Enjoy!

Simon, Rob & James

October 2022; papers of the month Oct 01, 2022

Show notes

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.

Lastly we look at another RCT, this time comparing the benefit of surgical versus conservative management of significant chest wall trauma.

Enjoy!

Simon & Rob

Extrication; Roadside to Resus Sep 15, 2022

Show notes

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 care to these patients is definitely worth looking at and learning about!

Extrication is the process of injured (or potentially injured) patients being removed from vehicles involved in road traffic collisions. The fundamentals behind extrication have been based upon protecting the spine and not worsening an injury of it, but at the potential cost of other time critical injuries and with limited to no sound evidence base.

The EXIT project brings evidence to the practice of extrication and in this podcast we discuss the findings and implications for practice with the lead author Tim Nutbeam, Clare Bosanko (an EM & PHEM consultant) along with the three of us.

We also get the opportunity to hear from Freddie, a patient extricated from a high energy RTC and hear his perspective on Extrication.

Enjoy!

Simon, Rob & James

September 2022; papers of the month Sep 01, 2022

Show notes

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 chest compressions in cardiac arrest, by comparing it to chest and abdominal compression and decompressions.

Finally we take a look at the diagnosis and management of TMJ dislocations and guarantee there will be a new technique in there for all of you!

Simon & Rob

August 2022; papers of the month Aug 01, 2022

Show notes

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 the neck as a result of trauma. But what is the prevalence of c-spine tenderness without trauma and how might that affect our clinical assessment?

Finally we take a look at a paper focussing on the risk of laryngospasm in paediatric sedation; what is the risk, which factors make it more likely to occur, and what can we do to mitigate it's risk?

Enjoy!

Simon & Rob

Lactate; Roadside to Resus Jul 18, 2022

Show notes

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 to delve down into lactate, have a think about what it is, what normal and raised levels are, consider the mechanisms behind it's formation and breakdown and think about the causes of raised lactate. We'll then put this all together and have a think about how we can interpret and lactate levels ensuring we give the best treatment to our patients!

Enjoy!

Simon, Rob & James

July 2022; papers of the month Jul 01, 2022

Show notes

Intraosseous Access; Roadside to Resus Jun 21, 2022

Show notes

So, as we all know, there are loads of presentations that we see in Emergency Medicine that require us to gain rapid access to the circulation. Either to administer medicines around the body or to get fluids into the circulation.

Now there's a number of different ways we can get them into the circulatory system for them then to get to their sites of action, each of which comes with its pros and cons. There's buccal, inhaled, intramuscular, sublingual, intranasal etc etc….

But, in the vast majority of cases we gain this access to the vasculature through intravenous access and a peripheral cannula. That means that iv access is a very common procedure in emergency care. The great news is that the equipment is cheap, there are multiple sites for insertion and it's often feasible regardless of the patients age or presenting complaint. Compared to all the other options for drug administration, iv access and administration of drugs via the IV route, results in 100% bioavailability of all medicines because it avoids the first pass metabolism in the liver, and distribution around the body is rapid because it bypasses the need for absorption into the vasculature.

So that's all good, so why are we doing an episode on intraosseous access then? Well, iv access and we as clinicians, are not infallible. And as we're all too aware, gaining IV access can be challenging. There are other patient factors to like iv drug use, the morbidly obese and paediatric patients when everything is just smaller and more unfamiliar. So all of these factors increase the technical difficulty of iv cannulation. If we add to that some of the environmental issues we might find in the prehospital setting - so poor lighting or difficult patient access, it's not a huge leap to realise that it would be great to have an alternative vascular access option available to a broad range of emergency care providers. And this is where IO access comes in.

So what will we be covering in this episode;

-A recap on the anatomy of bones

-Indications for IO access

-The evidence on IO access and administration

-Insertion site

-Needle selection

-Contraindications

-Case examples

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Enjoy!

Simon, Rob & James

June 2022; papers of the month Jun 01, 2022

Show notes

Welcome back to June '22 papers podcast!

This month we start off with a look at rocuronium dosing in RSI; could a simple change of dosage lead to an increased first pass success for our intubations?

Next up we take a look at the use of TXA in trauma, with specific focus on gender based inequality in its use and a trial with shocking results.

Finally we take a look at a paper focussing on outcomes of cardiac arrest and cut-off points with regards to duration of resuscitation; could this help answer that ever-difficult question of when to stop?

Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom.

Simon & Rob