The Resus Room

Drug ingestion both accidental and intentional accounts for a significant proportion of attendances at UK Emergency Departments and 999 calls. In 2016 there were >2,500 registered deaths in England and Wales related to drug misuse, which had increased by nearly 60% in a decade. So without a doubt we are all going to come across critically unwell patients with drug ingestions. But inappropriate drug use is not confined to illicit substances, with many prescription drugs being misused to ill effect and also overdosed in an attempt to end patients lives. In this podcast we're going to run through the assessment of patients presenting with a possible drug ingestion, cover the potential toxidromes you may encounter and talk about the management of these presentations. Specifically we take a look at serotonin syndrome, sedative toxidrome and both cholinergic and anti-cholinergic syndrome. In next months Roadside to Resus we'll take a look at specific medications of overdose; paracetamol, beta blockers, calcium channel blockers and the intricacies of their management along with other key parts of critical care including the management of cardiac arrest due to toxicity. Make sure to take a look at the references and resources below. Enjoy! Simon, Rob & James

Welcome back!! So we've had a small summer hiatus and are now back with another Papers of The Month and a jam packed line up of episodes for the rest of the year! We start off this month with a paper which looks to evaluate if there is any benefit on mortality with the use of checklists for endotracheal intubation. Next up we take a look at the factors in cardiac arrest that are most important with regards to prognostication; what should your attention and handover be most focussed upon? Finally we take a look at a paper suggesting that blood gases following ROSC can help us prognosticate for our patient and how this might this affect our practice. Finally keep an eye out for our CPD portal and app which is in the final stages of testing and will be out very shortly!! We'll be keeping you up to date on twitter @TheResusRoom with its launch All references can be found on our webpage at TheResusRoom.co.uk Enjoy! Simon & Rob

So this is our last episode before a small summer hiatus, so it better be a good one! Journals are littered with some great articles at the moment, so we've chosen 3 great papers that cover a number of really important EM topics. Over the last few years more emphasis has been put on a more conservative management on pneumothoraces and following that trend we take a look at a paper evaluating the safety of using a small bore chest drain for the delayed management of haemothoraces, compared with large bore. Next up we take a look at the Injury Severity Score and how well it correlates with the need for life saving interventions in trauma. Lastly there is another great paper on the management of acute atrial fibrillation; comparing electrical cardioversion with the potential use of procainamide prior to shocking. Does it result in fewer patients requiring a shock, and when it comes to the shock is AP pad positioning more effective that anterolateral? We'll be taking a small break over the summer and will be back in September for our next Papers Podcast and keep an eye out for the launch of our FREE CPD app and web platform this summer. Enjoy! Simon & Rob

Exploring the use of ultrasound in cardiac arrest for better outcomes, diagnosing reversible causes like cardiac tamponade and pulmonary embolism, and the importance of timely recognition and high-quality CPR. Debating the benefits of ultrasound probes, predictive value in resuscitation efforts, and the challenges of interpreting diverse studies. Emphasizing the holistic approach, serial ultrasounds for prognostication, and efficient team coordination within the ALS algorithm.

There are more great pieces of research to enjoy this month! We start off with a paper following on nicely from our Roadside to Resus episode on Stabbing, which looks at the ability of prehospital providers to predict whether stab injuries penetrate to deep structures, or are purely superficial from clinical assessment. Next up we take a look at a paper using high sensitivity troponin and their limit of detection, to assess whether we could be safely discharging patients earlier from the emergency department. Finally we have a look at the results from the RECOVERY group on dexamethasone use in COVID-19, have we got a treatment that can help improve survival in patients admitted with the virus? We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Tranexamic Acid (TXA) has gained a significant amount of attention over the last few years as multiple studies have shown it's utility in decreasing haemorrhage and associated mortality. It has become part of major trauma guidelines, post part haemorrhage protocols and many have adopted it to the management of traumatic brain injury. The findings have been very similar across a spectrum of haemorrhage disease processes and from this further interest in expanding TXA's application to pretty much anything that bleeds. Time from onset of the bleeding has been shown to be important, with it's effect decreasing from time of onset to its administration. Gastro-intestinal bleeding is a significant cause of morbidity and mortality. Previous meta-analyses have shown favourable outcomes for TXA in GI bleeds and many have already adopted TXA into this area of practice, although guidance from NICE does not yet recommend it. HALT-IT is a multi centre, international, randomised double blind controlled trial of near 12,000 patients that has just been published in the Lancet. The study was a huge piece of work and looks to definitively answer the question of whether we should be giving TXA to patients with life threatening GI bleeds. In this podcast we run through the ins and outs of the paper ad are lucky enough to speak to the lead author Ian Roberts about the findings, some of the intricacies of the trial and what the results mean for practice. Enjoy! Simon, Rob & James

Welcome back to June's Papers Podcast! Traditionally when you're taught about working a patient up for a potential diagnosis you'll find a list of signs, symptoms and tests that you need to perform in order to obtain your diagnosis. What that teaching doesn't tell you is how important each of those aspects is and this month we take a deeper look at this for pneumonia. We look two papers, one focussing on the clinical findings both in signs and symptoms and then a further paper on the importance of biomarker in the diagnosis. We also have a look at a paper which focusses on decreasing time on scene for prehospital patients and the potential benefit of regular time prompts, an idea that may be applicable irrespective of your place and role of work. We'd love to hear any thought or comments you have either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

Transfers of patients happen all the time. It's easy to think about transfers as only those that involve an ambulance and moving patients from one hospital to the next, but in reality it's far more extensive than that. We all move patients all the time, whether that be the unwell patient in the upstairs of their house to the ambulance, the patient in the Emergency Department to the CT scanner or another ward, or the more traditional interhosptal transfer. Transfers of patients are inherently high risk times for the patient and having some background knowledge on transfers and a structured approach helps us ensure the best possible care for our patients. In this episode we run through transfers with the help of an expert on the topic, Scott Grier a Consultant in Intensive Care Medicine and Anaesthesia at Southmead Hospital in Bristol, the South West Critical Care Network Lead for Transfer, and a PreHospital Critical Care Doctor with GWAAC. Enjoy! Simon, Rob and James

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

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