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    Health & Fitness

    The Resus Room

    Emergency Medicine podcasts based on evidence based medicine focussed on practice in and around the resus room.

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    Copyright: © TheResusRoom

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    Latest Episodes:
    Pre Alert; Roadside to Resus Jul 19, 2021
    Show notes

    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


    July 2021; papers of the month Jul 01, 2021
    Show notes

    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


    Subarachnoid Haemorrhage; Roadside to Resus Jun 16, 2021
    Show notes

    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


    June 2021; papers of the month Jun 01, 2021
    Show notes

    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


    Resuscitation Guidelines 2021; Roadside to Resus May 05, 2021
    Show notes

    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


    May 2021; papers of the month May 01, 2021
    Show notes

    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


    Newborn Life Support; Roadside to Resus Apr 15, 2021
    Show notes

    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


    April 2021; papers of the month Apr 01, 2021
    Show notes

    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


    Maternal Emergencies; Roadside to Resus Mar 15, 2021
    Show notes

    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


    March 2021; papers of the month Mar 01, 2021
    Show notes

    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


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