The Resus Room

Latest Episodes:

November 2017; papers of the month Nov 01, 2017

Show notes

Welcome back to November's papers podcast!

This month we've got some great topics to discuss.

We look at another paper on the topic of oxygen therapy, this time a hug article from JAMA on oxygen therapy in the context of acute stroke and the impact on disability.

Next up we look at a fascinating case report of a extradural haematoma that was drained via an I.O. needle prior to surgical evacuation.

Lastly we follow up on our previous podcast on PE; the controversy, which looked at the prevalence of PE in those patients presenting with undifferentiated syncope. This paper puts a great counter to the conclusions arrived at in that Prandoni paper.

Enjoy!

Simon & Rob

References & Further Reading

Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial. Roffe C. JAMA. 2017

Temporising extradural haematoma by craniostomy using an intraosseous needle. Bulstrode H. Injury. 2017

Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. Oqab Z. Am J Emerg Med. 2017

Return in spontaneous circulation; Roadside to Resus Oct 16, 2017

Show notes

Last time in Roadside to Resus we discussed cardiac arrest with a view to obtaining a return in spontaneous circulation, ROSC.

However gaining a ROSC is just one step along the long road to discharging a patient with a good neurological function back into the community. In fact ROSC is really where all of the hard work really starts!

In this podcast we talk more about the evidence base and algorithms that exist to guide and support practice once a ROSC is achieved. We'd strongly encourage you to go and have a look at the references and resources yourself listed below and would love to hear your feedback in the comments section or via twitter.

Enjoy!

Simon, Rob & James

References & Further Reading

Resuscitation to Recovery Document

Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. Niklas Nielsen. N Engl J Med 2013

Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Dumas F. Circ Cardiovasc Interv. 2010

Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Sandroni C. Resuscitation. 2013

Roadside to Resus; Cardiac Arrest

PCI following ROSC; TRR

Pre-Hospital Care; BASICS & FPHC Conference '17 Oct 06, 2017

Show notes

This podcast covers some highlights from the talks at the BASICS and The Faculty of Pre-Hospital Care 2017 Conference.

We were lucky enough to be invited by Caroline Leech to cover the day and managed to grab a couple of minutes with a handful of the superb speakers;

Dr. Tom Evens; Elite sports for high performance clinicians

Dr. Les Gordon; Pre-hospital management of hypothermia

Dr. Helen Milne; Retrieval and transfer medicine

Surgeon Commander Kate Prior; The battlefield

Dr Chris Press; Prehospital management of diving emergencies

Miss Aimee Yarrington; Obstetric Emergencies

Professor Mark Wilson; Pre-hospital Care, where are we going?

Thanks to all involved for making the podcast and for a great day at the conference, and to PHEMCAST for the collaboration!

Simon, Rob & Clare

October 2017; papers of the month Oct 01, 2017

Show notes

Welcome back to October's papers podcast!

This month we have a look at a paper that shines further light on the use of ultrasound in predicting fluid responsiveness in the spontaneously ventilating patient. We look at a paper that sets to challenge the concerns over hyperoxia in presumed myocardial infarction. And lastly we look at how stress impacts in a cardiac arrest situation on the team leader's performance.

Make sure you have a look at the papers yourself and we would love to hear any feedback and alternative thoughts on the ones we cover! Lastly thanks for your support with the podcast

Enjoy!

Simon & Rob

References & Further Reading

Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathingcritically-ill patients. Corl KA. J Crit Care. 2017

Oxygen Therapy in Suspected Acute Myocardial Infarction. Hofmann R. N Engl J Med. 2017

Relationship between non-technical skills and technical performance during cardiopulmonary resuscitation: does stress have an influence? Krage R. Emerg Med J. 2017

iSepsis – Vena Caval Ultrasonography – Just Don't Do It!; EMCrit

The Bottom Line; DETO2X-AMI

JC: Oxygen in ACS. A fuss about nothing? The DETO2X Trial at St.Emlyn's

Cardiac Arrest; Roadside to Resus Sep 21, 2017

Show notes

We have a significant way to go with respect to our cardiac arrest management.

'Cardiopulmoary Resuscitation is attempted in nearly 30,000 people who suffered OHCA in England each year, but survival rates are low and compare unfavourably to a number of other countries'

- Resuscitation to Recovery 2017

25% of patients get a ROSC with 7-8% of patients surviving to hospital discharge, which as mentioned is hugely below some countries.

In this podcast we run through cardiac arrest management and the associated evidence base, right from chest compressions, through to drugs, prognostication and ceasing resuscitation attempts.

Make sure you take a look at the papers and references yourself and we would love to hear you feedback!

Enjoy!

Simon, Rob & James

References & Further Reading

Resuscitation to Recovery Document

"Kids Save Lives": Educating Schoolchildren in Cardiopulmonary Resuscitation Is a Civic DutyThat Needs Support for Implementation. Böttiger BW. J Am Heart Assoc. 2017

Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival.Andersen LW. JAMA. 2017

Double sequential Defibrillation therapy for out-of-hospital cardiac arrests: the London experience. Emmerson AC, et al. Resuscitation. 2017

Dual sequential defibrillation: Does one plus one equal two? Deakin CD. Resuscitation. 2016

Thrombolysis during resuscitation for out-of-hospital cardiac arrest. Böttiger BW. N Engl J Med. 2008

Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Perkins GD. Lancet. 2015

Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. Rubertsson S. JAMA. 2014

Effect of epinephrine on survival after cardiac arrest: a systematic review and meta analysis. Patanwala AE. Minerva Anestesiol. 2014

Impact of cardiopulmonary resuscitation duration on survival from paramedic witnessed out-of-hospital cardiac arrests: An observational study. Nehme Z. 2016 Mar;100:25-31. doi: 10.1016/j.resuscitation.2015.12.011. Epub 2016 Jan 13.

Predicting in-hospital mortality during cardiopulmonary resuscitation. Schultz SC. Resuscitation. 1996

Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Tsou PY. Resuscitation. 2017

End-tidal CO2 as a predictor of survival in out-of-hospital cardiac arrest. Eckstein M. Prehosp Disaster Med. 2011

LITFL; cessation of CPR

Bicarbonate in arrest Sep 11, 2017

Show notes

Bicarbonate use in cardiac arrest.

The topic still provokes debate and multiple publications on the topic still hit the press reels. People talk of the increased rate of ROSC and the improvement in metabolic state, whilst others talk of the increase in mortality and worsening of intracellular acidosis.

A recent paper in Resuscitation looked at a huge cohort of patients receiving bicarbonate in arrest prehospitally. In this episode we take a look at the paper, review the guidelines and give our take on the current situation with regards bicarb in arrest

We hope you enjoy it and would love to hear your feedback!

Simon & Rob

References & Further Reading

Prehospital Sodium Bicarbonate Use Could Worsen Long Term Survival with Favorable Neurological Recovery among Patients with Out-of-Hospital Cardiac Arrest. Kawano T, et al. Resuscitation. 2017

Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature. Velissaris D, et al. J Clin Med Res. 2016

Effect of Sodium Bicarbonate on Advanced Cardiac Life Support. Jungyoup Lee. Circulation 2014

Advanced Life Support; Bicarbonate guidance

September 2017; papers of the month Sep 01, 2017

Show notes

So we're back with some superb topics this month;

Early or late intubation in ICU patients, which is associated with worse outcomes?
What are the predictors of a poor outcome in patients presenting with syncope?
Does a cervical collar result in a demonstrable raise in ICP viewed by ultrasound?

Make sure you take a look at the papers yourself, they certainly provide food for thought and raise important questions in our practice

Let us know any thoughts and feedback you have on the podcast and thanks for your support with the podcast

Enjoy!

Simon & Rob

References & Further Reading

Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit. Bauer PR. J Crit Care. 2017 Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers. Maissan IM. Eur J Emerg Med. 2017

Predicting Short-Term Risk of Arrhythmia among Patients with Syncope: The Canadian Syncope Arrhythmia Risk Score. Thiruganasambandamoorthy V. Acad Emerg Med. 2017

Asthma; Roadside to Resus Part 2 Aug 21, 2017

Show notes

This is the second part of the Roadside to Resus discussion on asthma. Make sure you've listened to part 1 before delving into this one!

Part 2 covers

Ketamine
Ultrasound in asthma
NIV in asthma
Asthma related cardiac arrest
- Imaging
- Management
Discharge

We hope you enjoy the episode and would love to hear your feedback!

Simon, Rob & James

References & Further Reading

BTS Asthma Guidelines 2016

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013

Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016

TheResusRoom; Needle Thoracostomy podcast

TheResusRoom; BTS Asthma Guidelines 2016 podcast

LITFL; Non-invasive ventilation (NIV) and asthma

Intensiveblog; Asthma mechanical Ventilation Pitfalls

BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?

Asthma; Roadside to Resus Part 1 Aug 14, 2017

Show notes

Asthma is a common disease and presents to acute healthcare services extremely frequently.

The majority of presentations are mild exacerbations of a known diagnosis and are relatively simple to assess and treat, many being completely appropriate for out patient treatment.

On the other hand around 200 deaths per year are attributable in the UK to asthma, and therefore in the relatively young group of patients there is a real potential for critical illness with catastrophic consequence if not treated effectively. The majority of these deaths occur prior to the patient making it to hospital making the prehospital phase extremely important and hugely stressful in these cases.

It is also worth noting that of the deaths reported that many were associated with inadequate inhaled corticosteroids or steroid tablets and inadequate follow up, meaning that our encounter with these patients at all stages of their care even if not that severe at the point of assessment is a key opportunity to discuss and educate about treatment plans and reasons to return.

In part 1 of this podcast we will run through

Pathophysiology
How patients present
Guidelines
Treatment
- Salbutamol
- Ipratropium
- Steroids
- Magnesium

Part 2 will be out shortly, we hope you enjoy the episode and would love to hear your feedback!

Simon, Rob & James

References & Further Reading

BTS Asthma Guidelines 2016

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013

Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016

TheResusRoom; Needle Thoracostomy podcast

TheResusRoom; BTS Asthma Guidelines 2016 podcast

LITFL; Non-invasive ventilation (NIV) and asthma

Intensiveblog; Asthma mechanical Ventilation Pitfalls

BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?

August '17; papers of the month Aug 01, 2017

Show notes

We're back with more great papers for you this month, hot off the press!

There's been a lot of talk over the last few years about apnoeic oxygenation and whether it really holds any benefit to patients undergoing RSI, we have a look at a systematic review that may help answer that question.

Next up we have a look at the choice of sedation agent used in the Emergency Department and how this correlates with patient satisfaction.

Finally, following on from our recent podcast on Double Sequential Defibrillation, we have a look at a paper published looking at the results of DSD from the London prehospital service. Will this reveal a patient benefit?

Let us know any thoughts and feedback you have on the podcast and thanks for your support with the podcast.

Enjoy!

Simon & Rob

References & Further Reading

Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. Pavlov I. Am J Emerg Med. 2017

Patient satisfaction with procedural sedation in the emergency department. Johnson OG. Emerg Med Australas. 2017

D ouble sequential defibrillation therapy for out-of-hospitalcardiac arrests: The London experience. Emmerson AC. Resuscitation. 2017