The Resus Room



Podcasts from the website excellent care in and around the resus room, concentrating on critical appraisal, evidenced based medicine and international guidelines.


  • May 2020; papers of the month

    01/05/2020 Duration: 23min

    Welcome to May's papers of the month podcast. Hope you are all well and keeping safe. This month James joins Simon to discuss some of the great work published following the London Trauma Conference, all available in the hyperlinks on the website. First up we have a look at the incidence of prehospital hypotension and hypoxia in patients with suspected traumatic brain injury and the ways in which we might look to mitigate against these complications. Next we have a think about end-tidal CO2 levels and the correlation between these and arterial CO2 readings and discuss what the findings might mean for our practice. Finally we have a look at the incidence of hyperoxia in patients receiving a prehospital emergency anaesthetic in the context of trauma, and consider the effect this might have on our patients and again practice. We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & James

  • Pelvic Injury; Roadside to Resus

    20/04/2020 Duration: 57min

    Fractures of the pelvis are found reasonably often in major trauma, but they’re a really challenging presentation. They are difficult to assess and accurately diagnose in the prehospital setting, mortality rates are high, particularly in patients with haemodynamic instability and there are often associated injuries. Associated mortality from patients with pelvic fractures who reach hospital is reported to be up to 19%, with mortality rates as high as 37% reported in the presence of haemodynamic instability. In this episode we'll run through pelvic injuries, all the way from anatomy and mechanisms of injury, to assessment and management. As always make sure you have a look at the references and supporting material attached in the show notes, and get in touch with any questions or comments and take care of yourselves. Enjoy! Simon, Rob and James

  • Respiratory Strategies in COVID-19

    10/04/2020 Duration: 17min

    So COVID-19 has produced a multitude of challenges to healthcare providers, the response to these challenges has been phenomenal. One uncertainty is the strategy we should employ for hypoxic respiratory failure and several high quality guidelines have presented conflicting advice for the severely hypoxic patient. The Warwick Clinical Trials Unit has already begun recruiting patients to their RECOVERY-RS trial, which is open for hospitals in the UK to sign up for. This looks at 3 different strategies of respiratory support for patients admitted with suspected or known COVID-19 and hypoxia; namely CPAP, High-flow nasal oxygen and standard care. The trial is funded by the NIHR and supported by the Intensive Care Society. In this episode we get a chance to speak to Bronwen Connolly, one of the investigators of the RECOVERY-RS trial; we discuss the background evidence, the trial design, and when results will be available. As always we’d love to hear any thoughts or comments you have on the website and via twitter,

  • April 2020; papers of the month

    01/04/2020 Duration: 32min

    First we hope you're all well. The world has changed dramatically over the the last few weeks and you are all doing a phenomenal job of providing healthcare under extremely challenging circumstances. We are determined to add a bit of normality to life with a non-COVID-19 papers of the month, full of bad jokes and some EBM. This month we're looking at intubation of acute alcohol intoxication in ED. We take a look at a paper that tries to quantify the risk of patients developing an intracerebral injury when taking antiplatelets and anticoagulants. Finally we have a look at the value of clinical examination and imaging findings in patients with elevated intracranial pressure, how valuable are individual findings? Most importantly take care of yourselves and loved ones and keep fighting the good fight! Simon & Rob

  • Cutting Edge PHEM; Roadside to Resus

    17/03/2020 Duration: 51min

    Excellent practice is led by following the high quality evidence based medicine, and there have been a lot of great papers published in the last 12 months! We were kindly invited to the Faculty of Pre Hospital Care Annual Scientific Conference to give a talk on the top 10 papers over the last year. Sadly, but completely understandably, the conference had to be cancelled due to COVID-19. In this podcast we cover the talk which is based on 2 cases that are common to PHEM;a major trauma and a cardiac arrest, and discuss how we can optimise outcomes for our patients in view of the recent evidence on these areas. As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked below to draw your own conclusions. Enjoy! Simon, Rob & James

  • March 2020; papers of the month

    01/03/2020 Duration: 31min

    We've got a great spread of topics for you this month, stretching all the way from Prehospital Critical Care, to core Emergency Medicine topics. Those of us seeing 'non-specific' complaints will appreciate how difficult they can be to diagnose and manage effectively. We have a look at a paper that helps characterise this group and give some context to their mortality risk. This may well help inform conversations and decision making with this patient group. Recent literature has looked at a more conservative management for traumatic pneumothoraces, but what about those that are spontaneous? The British Thoracic Society has guidelines for how we should deal with them but a recent RCT in the New England Journal of Medicine looks at an even more conservative approach for our patients; can we decrease the number of aspirations and drains that we are performing? Finally we've covered recently a paper on the topic of Prehospital Critical Care on the outcomes for patients in cardiac arrest, in this episode we have a

  • Stabbing; Roadside to Resus

    14/02/2020 Duration: 59min

    Figures for the year ending September 2019 showed a 7% rise in offences involving knives or sharp instruments recorded by the police (to 44,771 offences). This is 46% higher than when comparable recording began (year ending March 2011) and the highest on record.  The news is sadly littered with cases of knife crime and terror and whilst we may have thought of stabbings as confined to small pockets of the country, sadly it now seems that we all have or all will be dealing with such cases. The variability in injury and severity is vast from stabbings, however in extremis they are completely time critical, and striking the balance between performing only those life saving interventions on scene, during transport and in ED and getting to the final destination of theatre as quickly as possible. In this podcast we discuss our thoughts on dealing with these cases; from the moment we get that call, all the way through to getting them into theatre. As always we’d love to hear any thoughts or comments you have on the w

  • February 2020; papers of the month

    01/02/2020 Duration: 36min

    Welcome back! Three very different topics and papers for you this month. First up we have a look at the risk/benefit of sending troponins on patients aged 65 years an older when presenting with non-specific complaints; does this help their work up, or is this a classic case of over-testing? Next up we take a look at the causes of our patients presenting to the ED with a reduced level of consciousness, this paper may help inform your differentials and knowledge on the likelihood of different pathologies. Finally, following on from our recent Roadside to Resus episode on Seizures, we take a look at an RCT which compares 3 second line anti epileptics; will this give us the definitive answer over which we should be using? Once again we would love to hear you comments and feedback, and make sure you check out the articles yourselves and come to your own conclusions. Enjoy Simon & Rob

  • Seizures; Roadside to Resus

    15/01/2020 Duration: 01h04min

    Seizures are defined as a “paroxysmal electrical discharge of the neurones in the brain resulting in a change of function or behaviour”. All of us involved in Emergency Care will encounter patients with seizures which can occur for a number of reasons, with Epilepsy affecting 1 in 100 people in the UK. Being able to identify the cause, terminate ongoing seizures and provide ongoing investigation and care is complicated and of paramount importance, as some of these episodes carry with them a high morbidity and mortality rate. In this episode of Roadside to Resus we run through the following; The scale of the problem Causes of seizures Definition of status epilepticus Different forms of seizures Clinical assessment Investigations Antiepileptic’s Management& guidelines; both Pre and In-hospital RSI for status epilepticus Follow up and guidance As always we’d love to hear any thoughts or comments you have on the website and via twitter, and make sure you take a look at the references and guidelines linked b

  • January 2020; papers of the month

    01/01/2020 Duration: 32min

    Happy New Year!! We hope you've all had a great Christmas and New Year and that you managed to get some well earned time off over the festive period.  2019 saw us publish more insights from lead authors of the latest and most influential studies in Emergency Medicine and Critical Care, and we're really excited to say that we'll be delivering you even more in 2020 with some excellent RCTs, international guidelines and much, much more! This month we've got 3 papers to challenge practice across a wide array of practice. We start off with a paper that evaluates if we can change our d-dimer thresholds in suspected PE's and how many unnecessary work ups and scans that might decrease. Next, following on from our previous Hypothermia podcast, we have a look at a paper which looks at the best rewarming rates in patients with hypothermia, which may change your rewarming strategies.... Finally we have a think about our use of CT scanning in patients who gain a ROSC after cardiac arrest, and consider what benefit full bo

  • Pre-Hospital Critical Care; London Trauma Conference 2019

    12/12/2019 Duration: 17min

    REBOA, ECMO, Thoracotomy? Where should we be focussing our attention in the world of Pre-hospital care? We were lucky enough to be invited to the London Trauma Conference on the Prehospital Day supported by the Norwegian Air Ambulance Foundation. The day focussed on the areas we can make a real impact to the outcomes of our pre-hospital critical care patients. We grabbed a few minutes time of the following speakers to hear their thoughts; Introosseous Access; Jerry Nolan Pre-hospital Blood products; Jostein Hagemo Communication under pressure; Dr Stephen Hearn Pre-hospital Critical Care - what should the near future look like? Dr Stephen Rashford Have a listen and as always we’d love to hear any thoughts or comments you have on the website and via twitter, and take a look at the references below to draw your own conclusions. We'll be back in the new year with monthly episodes of Papers of the Month and Roadside to Resus; have a great Christmas and New Year and we'll speak to you soon! Enjoy! Simon, Rob &

  • December 2019; papers of the month

    01/12/2019 Duration: 35min

    Well the year has flown by and it's already time for December's Papers of the Month Podcast! Head injuries are a huge work load for those of us involved in Emergency Care. Identifying those at risk of deterioration from a traumatic brain injury is a priority, as early intervention and prognostication can make a huge difference to patient outcomes. CT scanning is relatively easy to access and with it investigation creep has lowered our threshold of investigation and use of radiology resources; first up we have a look at a paper that looks at the potential benefits from employing a number of different guidelines in identifying the patients with traumatic brain injury, whilst comparing the risk of over investigation. Next up we have a look at the commonly made diagnosis of urinary tract infection in the older population and a review paper that will help you make the right diagnosis when it's present and not over diagnose when not. Finally we have a think about the potential benefit of a fluid bolus during induct

  • Angioedema

    18/11/2019 Duration: 31min

    Angioedema is something we'll all encounter in the acute setting, whether we recognise it or not... Understanding the different causes and mechanisms is imperative to ensuring the patients get treatment that is not only effective, but in extremis potentially lifesaving. In this episode we talk through the condition; from clinical presentation, causative agents, mechanisms of action, differentials and the evidence base of treatment. Get in touch with any comments on the podcast, ensure to read the papers that are referenced yourself and draw your own conclusions. Enjoy! Simon & Rob  

  • Community Emergency Medicine

    11/11/2019 Duration: 24min

    As care on our emergency and urgent care demand is on an ever upwards course, whilst alongside this the scope of what we can potentially deliver to patients is also increasing. In order to meet this demand and to deliver the best care possible to our patients we will need to look for other solutions. We were lucky enough to be invited to the First Community Emergency at the Royal Society of Medicine in London, hosted by the Physician's Response Unit. This event looked at the current challenges and explored solutions and opportunities for more collaborative working. In this podcast you'll hear from Tony Joy about the concept and practice of Community Emergency Medicine. You'll hear from Gareth Davies on the history of Pre Hospital Emergency Medicine, both challenges and achievements. Finally you'll hear from Bill Leaning, PRU clinical manager & HEMS paramedic about how to go about setting up a service. Please let us know any thoughts or feedback, and we'll be back with another podcast on a clinical topic f

  • November 2019; papers of the month

    01/11/2019 Duration: 28min

    We've got some papers this month that focus on our sickest patients! If you had a patient that you found in cardiac arrest and you believed they had a PE, would you thrombolyse them during the arrest, and how much more likely do you think they would be to survive? Our first paper looks at exactly this question. Second up we consider the potential harms associated with adrenaline administration to those in traumatic arrest. Finally, when RSI'ing a patient and considering your pharmacological cocktail, how likely are you to reach for the fentanyl and how much concern would you have over the risk of this rendering the patient haemodynamically unstable? We take a look at a recent review on the topic and get Dr. Ian Ferguson's insights as the lead author. Make sure to get in touch with any comments on any of the reviews, and importantly make sure you check out the papers and draw your own conclusions. Enjoy! Simon & Rob  

  • Can TXA save lives in head injuries, CRASH-3; Roadside to Resus

    15/10/2019 Duration: 39min

    So an incredibly important paper, CRASH-3 has just been published in the Lancet, which looks at the treatment of head injuries with Tranexamic Acid (TXA). TXA has been shown to save lives in trauma patients at the risk of major haemorrhage, with the notable exclusion of those with head injuries, CRASH-2. TXA has been shown to save lives in those with post parts haemorrhage, WOMAN trial. Time to treatment with TXA has been shown to be hugely influential in it's ability to decrease blood loss and save lives. So has TXA now been shown to save lives in head injuries? In this episode we run through the paper and are lucky enough to have an interview with the lead author, Professor Ian Roberts. Have a listen, read the paper and as always we’d love to hear any thoughts or comments you have on the website and via twitter, and take a look at the references below to draw your own conclusions. Enjoy! Simon, Rob & James References The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects

  • October 2019; papers of the month

    01/10/2019 Duration: 32min

    Welcome to October '19 papers podcast. You can't go far without the topic of TXA as a treatment for anything that bleeds being mentioned! With the publication of CRASH-2 and the WOMAN trial practice has crept such that administration in gastro-intestinal bleeding is seen fairly frequently. However, current guidelines don't recommend the use of TXA in GI bleeding, so this month we have a look at a systematic review which looks to answer whether it's administration is supported by the evidence, before we get a definitive answer from the HALT-IT trial. Next up, following on from our Burns Roadside to Resus podcast, we take a look at a paper that quantifies the potential benefit of thorough first aid in the management of paediatric burns, a really key paper on the topic, with really powerful results. Finally, we all know that Sepsis is a core area of our practice, but at times it may feel like the attention on those that could possibly have severe sepsis displaces the ability to care for other critically ill pati

  • Shock in Trauma; Roadside to Resus

    16/09/2019 Duration: 01h16min

    So as promised, and following on from our previous shock episode, this time we've covered the topic of shock in Trauma. It's a massive topic and one that we all, yet again, can make a huge difference for our patients' outcomes.  There is some crossover as you'd expect from the concepts and assessment that we covered in our Shock episode, so we'd recommend taking a listen to that one first. Make sure you have a comfy seat and plenty of refreshments to keep you going for this one as we cover the following; Definition Aetiology Hypovolaemic shock Neurogenic shock Obstructive shock Cardiogenic shock Physiology; Traumatic coagulopathy Other diagnostics Controlling external haemorrhage Pelvic binders REBOA Avoiding coagulopathy BP targets & permissive hypotension Fluid choices & supporting evidence TEG/ROTEM Calcium TXA Vasopressors Preventing hypothermia Relieving obstruction Interventional radiology Damage control surgery As always we’d love to hear any thoughts or comments you have on the website and v

  • September 2019; papers of the month

    01/09/2019 Duration: 35min

    We start off this month with a much talked about paper in the pre-hospital services, what benefit does Pre Hospital Critical Care bring to cardiac arrest victims? We are lucky enough to have the inside thoughts of the lead author, this a really interesting piece of work and will no doubt lead to further discussions, for more information from the author take a look at his thesis here. Next up we take a look at the utility of troponins in patients that have suffered cardiac arrest, can we use them to evaluate how likely it was that an MI precipitated the arrest? Last up we have a look at a novel approach of ruling out stroke as the cause of acute dizziness. We'd love to hear your thoughts and comments. Enjoy! Simon & Rob  

  • Stroke Management; Roadside to Resus

    15/08/2019 Duration: 55min

    Following on from our previous Roadside to Resus episode on Stroke, in this episode we look at the rapidly evolving area of stroke management.  In the last 2 decades stroke management has progressed beyond recognition and keeping up with the evidence and available therapies is a significant challenge. We cover the following treatments, looking at the risks and benefits of each, with the goal of being able to offer our patients the best possible outcomes; Aspirin Thrombolysis; both prehospitally and in hospital Thrombectomy Decompressive Hemicraniectomy Normoxia Euglycaemia Acute blood pressure management As always we’d love to hear any thoughts or comments you have on the website and via twitter. Enjoy! Simon, Rob & James References Tissue plasminogen activator for acute ischemic stroke. National Institute of Neurological Disorders and Stroke rt-PA.Stroke Study Group. N Engl J Med. 1995  Aspirin in Stroke;NNT Stroke Thrombolysis; Life in The Fast Lane Effects of Prehospital Thrombolysis in Stroke Patie

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