The Resus Room

Latest Episodes:

Ventilation; Roadside to Resus Dec 15, 2021

Show notes

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

December 2021; papers of the month Dec 01, 2021

Show notes

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

Breaking Bad News; Roadside to Resus Nov 15, 2021

Show notes

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

November 2021; papers of the month Nov 01, 2021

Show notes

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

Intubation; The Discussion Oct 25, 2021

Show notes

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; Roadside to Resus Oct 14, 2021

Show notes

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

October 2021; papers of the month Oct 01, 2021

Show notes

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

Acute Coronary Syndrome; Roadside to Resus Sep 15, 2021

Show notes

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

September 2021; papers of the month Sep 01, 2021

Show notes

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

August 2021; papers of the month Aug 01, 2021

Show notes

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