The Resus Room

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

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, and make sure you take a look at the protocol yourself. Enjoy! Simon, Rob & James

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

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

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 look on their impact in trauma patients and hear from the lead author Ali Maddock on the implications of the study's findings. Enjoy! Simon & Rob

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 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 and James

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