The Resus Room

So we've got a massively important paper that we're going to kick off April's Papers of the Month podcast with, which is the RCT we've been waiting for; whether patients who have a ROSC should go to the cath lab, without a stemi, if the presumed cause is a coronary event? We've covered this topic in the past, for a background take a listen to PCI following ROSC and our December '17 papers of the month podcast. Next up, on the topic of over-testing, we have a look if we should be sending troponins and BNP's on our patients attending with syncope. Lastly, having spoken recently about the importance of ED airway registry's, we take a look at an open access paper from SJTREM that describes the practice, success and complication rates of ED advanced airway management. As always make sure you take a look at the papers yourselves and draw you own conclusions, we'd love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. Lemkes JS. N Engl J Med.2019 Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope? Clark CL. Acad Emerg Med.2019 Airway Management in the Emergency Department(The OcEAN-Study) - a prospective single centre observational cohort study. Bernhard M. Scand J Trauma Resusc Emerg Med.2019 PCI following ROSC podcast December 2017; Papers of the Month Podcast

We were lucky enough to be back at the fantastic TraumaCare Conference last week. There were a whole host of fantastic talks on offer and the Emergency Medicine stream, arranged by our very own Rob Fenwick, included a pro/con debate on whether Emergency Medicine should be managing the trauma airway. During that debate a number of important papers were raised on the evolution and improvement in advanced airway management. In this podcast we'll run through some of the most important points from that talk. Make sure you take a look at the papers yourself and come to your own conclusions. Enjoy! Simon & Rob

We've got a broad array of topics and papers for you this month! First up we look at a paper from the NEJM assessing the potential benefits in providing ventilations to patients undergoing an RSI. Next we look at patients presenting with both syncope and pre-syncope to the emergency department, this paper quantifies the risk that we should be apportioning to these two different presentations. Finally, we look at a paper that suggests the manual pulse check in CPR is dead, and that the time has come for doppler and ultrasound to replace it! As always make sure you take a look at the papers yourselves and draw you own conclusions, we'd love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. Casey JD. N Engl J Med.2019  Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope. Bastani A. Ann Emerg Med.2019 Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Zengin S. Resuscitation.2018  

Explore the challenges of managing hypothermia cases, from understanding the physiology to effective treatment strategies. Dive into heat regulation mechanisms, early recognition, and pre-hospital management. Discover the complexities of keeping patients warm and the importance of team decision-making in severe cases.

Ketamine and trauma are the topics for this months papers. The three papers we cover are really important for all of us involved in the care of critically unwell patients. Hypotensive resuscitation in the context of trauma has been an evolving area of practice in the treatment of our acute trauma victims. A paper published in SJTREM this month meta-analyses the data that exists out there on the topic and looks to give us an idea of the benefits and potential risks associated with such an approach, the paper is available here and is well worth a full read. Morphine has been a mainstay of the treatment of acute severe pain in the Emergency Department for decades, but as the popularity of ketamine grows we take a look at another meta-analysis, this time comparing the efficacy of ketamine versus morphine in this setting and group of patients. And lastly, if you have ever had a patient become severely agitated with ketamine sedation, you'll be keen to avoid that happening again! The last paper we look at is a randomised control trial looking at the potential benefits of using either midazolam or haloperidol to achieve that. We hope you find the podcast useful, as ever please go and take a look at the papers yourself and we'd love to hear any thought or comments you have either rat the bottom of the page, or via twitter @TheResusRoom. Enjoy! Simon & Rob References Risks and benefits of hypotensive resuscitation in patientswith traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med.2018  A Systematic Review and Meta-analysisof Ketamine as an Alternativeto Opioids for Acute Pain in the Emergency Department. Karlow N. Acad Emerg Med.2018 Premedication With Midazolamor Haloperidolt o Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double Blind Clinical Trial. Akhlaghi N. Ann Emerg Med.2019  St Emlyns; JC: Should we premedicate for ketamine sedation?  

The podcast delves into the definition, causes, and management of shock in critically unwell patients. Topics covered include the significance of shock, cardiac physiology, ultrasound evaluation, fluid therapy, inotropes, and vasopressors. The hosts emphasize the importance of recognizing and treating shock early to improve patient outcomes.

Happy New Year!! Hopefully you got a bit of downtime over the festive period and are feeling suitably refreshed and ready to attack 2019! We've got 3 great papers to kick off the year. First up we look at the recent PReVENT trial which looks at ventilator strategies in patients without ARDS with respect to tidal volumes. This paper continues the work from the much cited ARDSNet paper from 2000, and we'd highly recommend you go and have a look at that paper first. Next we look at another paper from JAMA which compares Thrombolysis to Aspirin in minor non-disabling strokes. We say enough about this one in the podcast, but for a bit of background to our thoughts and the evidence surrounding stroke, check out our previous Stroke Thrombolysis podcast. Lastly we have a look at a paper investigating their systems use of push-dose-pressors, which whilst not the most methodologically sound piece of research, certainly brings out some interesting thoughts and points. As always make sure you take a look at the papers yourselves and we'd love to hear and comments or feedback you've got. Enjoy! Simon & Rob References & Further Reading Effectof a LowvsIntermediateTidalVolumeStrategyon Ventilator-FreeDaysin IntensiveCareUnitPatientsWithout ARDS: A Randomized Clinical Trial. JAMA.2018 Writing Group for the PReVENT Investigators Ventilationwith lowertidal volumesas comparedwith traditionaltidal volumesfor acute lung injury and the acute respiratory distress syndrome. Acute Respiratory Distress SyndromeNetwork. N Engl J Med.2000 PReVENT; The Bottom Line EMCrit; Vent and Prevent, an update Effectof AlteplasevsAspirinon FunctionalOutcomefor PatientsWith AcuteIschemicStrokeand MinorNondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. Khatri P. JAMA.2018 TheResusRoom; Stroke Thrombolysis podcast Push dose pressors: Experience in critically ill patients outside of the operating room. Rotando A. Am J Emerg Med.2018

Festive greetings to all! We hope you've had a fantastic 2018 and have some time off over Xmas and New Year to celebrate with friends and family. We thought we'd bring you some of the most influential papers that we've read over the last 12 months, that haven't necessarily fitted in that closely with some of the topics we've covered...we hope you enjoy! Thanks for all of your support with the podcast throughout 2018 and we wish you a very happy 2019. Simon, Rob & James References Pediatric golf cart trauma: Not par for the course. Tracy BM. J Pediatr Surg. 2018 What to eat and drink in the festive season: a pan-European, observational, cross-sectional study. Parker HL, et al. Eur J Gastroenterol Hepatol. 2017. Work of Breathing into Snow in the Presence versus Absence of an Artificial Air Pocket Affects Hypoxia and Hypercapnia of a Victim Covered with Avalanche Snow: A Randomized Double Blind Crossover Study. Karel Roubík. PLoS One. 2015.

Cardiac arrest management is core business of a resuscitationist and practice is constantly evolving in the pursuit of improving patient outcomes.  We were lucky enough to be invited to the London Trauma Conference's Cardiac Arrest Masterclass stream, where Matt Thomas put on a superb array of talks around all things cardiac arrest.  We managed to borrow a bit of time from some of the speakers and caught up with some of the topics covered including; airway management, ECGs pre/post arrest, POCUS, CRM and breaking bad news. We found the day hugely useful and we hope the podcast sums up some of the great points from the day. Enjoy! Simon, Rob & James References London Trauma Conference AIRWAYS-2; podcast SPIKES Protocol LITFL; Killer ECG Patterns Beyondprognostication: ambulancepersonnel's livedexperiencesof cardiacarrestdecision-making. Anderson NE. Emerg Med J.2018 Zero Talent Battle

Well the year maybe coming to a close but the high quality papers keep on coming out! We've got 3 great articles to cover in this episode which have some key points to reflect on in our practice. First up we take a look at the application of Canadian c-spine rules by ED triage nurses and the potential impact this approach could hold. Next up we have a look at the addition of magnesium to current ED rate control of uncompromised patients presenting with rapid AF. Lastly we look at a paper on the conservative management of traumatic pneumothoraces, including those undergoing positive pressure ventilation, which reviews the complication rate of this approach. As always make sure you take a look at the papers yourselves and form your own opinions, we would love to hear you comments and feedback. Enjoy! Simon & Rob References & Further Reading Ian G. Stiell, Catherine M. Clement, Maureen Lowe, Connor Sheehan, Jacqueline Miller, Sherry Armstrong, Brenda Bailey, Kerry Posselwhite, Jannick Langlais, Karin Ruddy, Susan Thorne, Alison Armstrong, Catherine Dain, Jeffrey J. Perry, Christian Vaillancourt, 2018, 'A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses', Annals of Emergency Medicine, vol. 72, no. 4, pp. 333-341 Wahid Bouida, Kaouthar Beltaief, Mohamed Amine Msolli, Noussaiba Azaiez, Houda Ben Soltane, Adel Sekma, Imen Trabelsi, Hamdi Boubaker, Mohamed Habib Grissa, Mehdi Methemem, Riadh Boukef, Zohra Dridi, Asma Belguith, Semir Nouira, 2018, 'Low‐dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double‐blind Study (LOMAGHI Study)', Academic Emergency Medicine Steven P. Walker, Shaney L. Barratt, Julian Thompson, Nick A. Maskell, 2018, 'Conservative Management in Traumatic Pneumothoraces', Chest, vol. 153, no. 4, pp. 946-953 SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse London Trauma Conference; Cardiac Arrest Masterclass