The Resus Room

Latest Episodes:

July 2016; papers of the month Jul 01, 2016

Show notes

We have a look at papers covering platelet transfusions for patients on antiplatelets who suffer intracerebral bleeds, the optimal dose for procedural sedation with ketamine in children, a new meta-analysis on the sensitivity of early CT in suspected sub arachnoid haemorrhage and finish up with an amazing case report regarding a hypothermic cardiac arrest

Make sure you go and have a look at the papers yourself to see what the evidence means to you.

Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial. Kannikeswaran N. Am J Emerg Med. 2016 Apr 2. pii: S0735-6757(16)30011-0. doi: 10.1016/j.ajem.2016.03.064. [Epub ahead of print]

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Baharoglu MI. Lancet. 2016 May 9. pii: S0140-6736(16)30392-0. doi: 10.1016/S0140-6736(16)30392-0. [Epub ahead of print]

Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Dubosh NM. Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Epub 2016 Jan 21.

HEMS advanced trauma team retrieval of a patient with accidental hypothermic cardiac arrest for ECMO therapy. McCormack J. Resuscitation. 2016 May 30

How safe is ED sedation? Jun 17, 2016

Show notes

Sedation is becoming an ever more significant part of our work in the Emergency Department. At the end of May 2016 the Royal College of Emergency Medicine Published the RCEM Sedation Audit of 2015-2016 that covered more than 8,000 ED sedations throughout the UK (involving more than 190 ED's).

There are some pearls to take out of this great piece of work in which there would seem to be some significant scope to improve. The document not only benchmarks our practice but helps give us a feel for the risks involved.

Have a listen and check out the resources mentioned via the hyperlinks below, most importantly make sure you have a look at the document itself.

Relevant Resources

RCEM Sedation Audit

ACPeducate iTunes feed

TEAM course

Carbon Monoxide Jun 12, 2016

Show notes

Carbon Monoxide poisoning is definitely one of those differentials that you consider when the patients books into ED with '?carbon monoxide poisoning'...... but how much do we really think about it in a patient that hasn't been sent down to the ED with this specific thought in mind?

Rob Fenwick talks us through the key points of Carbon Monoxide poisoning and some recent evidence on the topic which will probably make us consider the possibility a bit more frequently! This podcast was based around the post Rob wrote for Jonathan Downham's superb Critical Care Practitioner podcast. Go and have a look at the post for a lot more information on the topic.

June 2016; papers of the month Jun 01, 2016

Show notes

For June we have a look at papers covering CT head imaging in delayed trauma presentations, risk stratifying TIAs, early administration of fluids in severe sepsis and most importantly the utility of a biro in a surgical airway.......

Make sure you go and have a look at the papers yourself to see what the evidence means to you.

References

Validation of ABCD2 scores ascertained by referring clinicians: a retrospective transient ischaemic attack clinic cohort study. Dutta D. Emerg Med J. 2016 Apr 7. pii: emermed-2015-205519. doi: 10.1136/emermed-2015-205519. [Epub ahead of print]

Bystander cricothyrotomy with ballpoint pen: a fresh cadaveric feasibility study. Kisser U. Emerg Med J. 2016 Apr 19. pii: emermed-2015-205659. doi: 10.1136/emermed-2015-205659. [Epub ahead of print]

Association of Fluid Resuscitation Initiation Within 30 Minutes of Severe Sepsis and Septic Shock Recognition With Reduced Mortality and Length of Stay. Leisman D. Ann Emerg Med. 2016 Apr 14. pii: S0196-0644(16)00148-7. doi: 10.1016/j.annemergmed.2016.02.044. [Epub ahead of print]

CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study. Marincowitz C. Emerg Med J. 2016 Apr 13. pii: emermed-2015-205370. doi: 10.1136/emermed-2015-205370. [Epub ahead of print]

May 2016; papers of the month May 15, 2016

Show notes

Here's a look at some of the papers that caught our eye this month. We have a look at patient positioning for RSI, the implication of hypothermia on arrival in the ED and the reliability of clinical assessment of syncope in our elderly patients.

Make sure you go and have a look at the papers yourself to see what the evidence means to you.

Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Khandelwal N. Anesth Analg. 2016 Apr;122(4):1101-7. doi: 10.1213/ANE.0000000000001184.

Reliability of clinical assessments in older adults with syncope or near syncope. Nishijima DK. Acad Emerg Med. 2016 Mar 29. doi: 10.1111/acem.12977. [Epub ahead of print]

Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial. Klauke N. BMJ Open. 2016 Mar 30;6(3):e009913. doi: 10.1136/bmjopen-2015-009913.

Heart failure, sedation, intubation, anaphylaxis & cardiac arrest; EBM updates in Resuscitation May 04, 2016

Show notes

So this is a talk I gave at the EMCEF 22 conference. This covers a few of the papers we've discussed in the last 6 months on the podcast but a bit of spaced repetition is never a bad thing!

We'll be running through topics on heart failure, sedation, intubation, anaphylaxis and duration of cardiac arrest. The papers are well worth a look and whilst not all high quality evidence they do bring to the front some really interesting questions about are practice and prompt us to challenge our habits. Enjoy!

References

Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Martindale JL. Acad Emerg Med. 2016 Mar;23(3):223-42. doi: 10.1111/acem.12878. Epub 2016 Feb 13.Martinda

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Bellolio MF. Acad Emerg Med. 2016 Feb;23(2):119-34. doi: 10.1111/acem.12875. Epub 2016 Jan 22.

Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial. Komasawa N. Am J Emerg Med. 2016 Jan;34(1):54-6. doi: 10.1016/j.ajem.2015.09.016. Epub 2015 Sep 21.

Defining the learning curve for endotracheal intubation using direct laryngoscopy: A systematic review. Buis ML. Resuscitation. 2016 Feb;99:63-71. doi: 10.1016/j.resuscitation.2015.11.005. Epub 2015 Dec 19.

Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Grunau BE. Ann Emerg Med. 2014 Jun;63(6):736-44.e2. doi: 10.1016/j.annemergmed.2013.10.017. Epub 2013 Nov 13.

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

REBOA; setting up a service with Sam Sadek & Zaf Qasim Apr 24, 2016

Show notes

In this episode we were lucky enough to catch up with Sam Sadek, EM Consultant at The Royal London hospital and HEMS doctor and also Zaf Qasim EM Consultant in Delaware in the United States. Both have been heavily involved in the setup and delivery of REBOA service in their respective posts.

In this podcast they share their experience and expertise on the topic of setting up a REBOA service. A huge thanks to both of them as this is a superb podcast for anybody considering getting involved in REBOA.

Recent podcasts on REBOA on ERCAST and EMCrit are essential listening and serve as great preludes to our discussion so make sure you check them out.

Please pop any comments or questions at the bottom of the page and we will come back with a Q&A podcast on the topic really soon!

References

Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties. Morrison JJ. . Shock. 2014 May;41(5):388-93. doi: 10.1097/SHK.0000000000000136.

Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: A propensity score analysis. Inoue J. J Trauma Acute Care Surg. 2016 Apr;80(4):559-67. doi: 10.1097/TA.0000000000000968.

The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock. Morrison JJ. J Surg Res. 2014 Oct;191(2):423-31. doi: 10.1016/j.jss.2014.04.012. Epub 2014 Apr 13.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Barnard EB. Emerg Med J. 2015 Dec;32(12):926-32. doi: 10.1136/emermed-2015-205217.

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Rossaint R. Crit Care. 2016 Apr 12;20(1):100. doi: 10.1186/s13054-016-1265-x.

Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. Moore LJ. J Trauma Acute Care Surg. 2015 Oct;79(4):523-30; discussion 530-2. doi: 10.1097/TA.0000000000000809.

The AAST Prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). DuBose JJ. J Trauma Acute Care Surg. 2016 Apr 5. [Epub ahead of print]

Brohi, Nutbeam, Appleyard, Jones, Parsons & Newton; TraumaCare2016, Major Trauma in the ED Apr 20, 2016

Show notes

So we were lucky enough to be asked to cover the Trauma Care Conference and specifically today's day focussing on Major Trauma in the Emergency Department. We managed to to get a few minutes of time from some of the superb speakers and get their take home messages from their talks. Enjoy!

Relevant Resources

Hypothermia Apr 06, 2016

Show notes

Rob Fenwick talks to us about this common condition and amongst others throws up a few surprises about the risks of rewarming. Enjoy

April 2016; papers of the month Mar 30, 2016

Show notes

Here's a look at some of the papers that caught our eye this month. We cover the best way to diagnose heart failure, the risks associated with hyperopia and the utility of ETCO2. Take the time to have a look at the papers yourself and leave any feed back or comments at the bottom of the page, enjoy!

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