This podcast discusses the groundbreaking PREOXI trial comparing pre-oxygenation methods in critically unwell patients. They also explore the use of lidocaine patches for rib fractures and the benefits of CT head scans for patients with a first seizure. Additionally, the hosts banter about creating a podcast-inspired sticker album and humorously discuss trading stickers in hospitals during the Euros football matches.
Pre-oxygenation with non-invasive ventilation reduces hypoxia during intubation, potentially changing airway management practices.
Lidocaine patches show promise in mitigating pain and respiratory issues for older adults with rib fractures, providing an alternative to opiates.
Deep dives
The Pre-Oxy Trial and Non-Invasive Ventilation
Exploring the Pre-Oxy trial, the podcast delves into the significance of pre-oxygenation during emergency intubation. The study assesses the effectiveness of non-invasive ventilation versus oxygen face masks for pre-oxygenation in critically ill adults. Results show a lower incidence of hypoxia during intubation with non-invasive ventilation, highlighting the potential practice changes in airway management.
Rib Fractures and Topical Lidocaine Patches
The podcast discusses the Relief Feasibility Trial focusing on topical lidocaine patches for older adults with rib fractures. This study aimed to determine the feasibility of conducting a randomized controlled trial on the efficacy of lidocaine patches. Results suggest potential benefits in reducing pulmonary complications, offering a promising alternative to opiate-based pain management strategies.
CT Scans for First Seizures in the Emergency Department
Addressing the necessity of CT scans for adults presenting with a first seizure in the Emergency Department, the podcast provides insights from a short systematic review. Findings suggest a high yield for CT scans, with a number needed to scan between 10 and 19 to identify intracranial pathologies requiring immediate management, such as hemorrhage, infarction, and tumors.
Advice from the hosts and podcast conclusion
The hosts conclude the episode by emphasizing the importance of considering various strategies in emergency care, reflecting on the papers discussed. They highlight the significance of optimizing patient pathways and the need for evidence-based approaches. The episode also encourages listeners to explore further resources and courses offered on the podcast's website for continuous learning and professional development.
There's a huge paper to talk about this month in the PREOXI trial, a multi centre RCT looking at the pre oxygenation strategy in critically unwell patients undergoing RSI, with patients either getting high flow oxygen through a facemask or NIV. The results are pretty remarkable and may well be practice changing as we'll discuss in the podcast!
Next up we take a look at a feasibility of lidocaine patches for older patients with rib fractures and the potential benefit in terms of pain and respiratory complications.
Lastly we take a look at the benefit of performing a CT head scan in the Emergency Department for patients with a first fit. At times this can feel like a significant utilisation of resources, but what is the yield of positive scans and impact on patient care?
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob
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