The Resus Room

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.

In this engaging discussion, Matt Thomas, a consultant in intensive care medicine and pre-hospital care, shares insights from the Cardiac Arrest Masterclass at the London Trauma Conference. He dives into critical topics such as airway management techniques and the importance of ECG interpretation in cardiac arrest scenarios. Matt emphasizes the role of ultrasound in guiding treatment decisions and the challenges professionals face in breaking bad news. With a focus on communication and innovative strategies, listeners gain valuable knowledge on improving patient outcomes in cardiac arrest management.

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

We were delighted to be back to cover the joint Faculty of Prehospital Care and BASICS conference, day 2, held at the Royal College of Surgeons of Edinburgh. Again we were absolutely spoilt for choice when it came to content for the podcasts but we managed to catch up with: • Dr Anne Weaver – a consultant in Emergency Medicine and Prehospital Care working for the Royal London Hospital and London HEMS. She talked to us about chemical burns and a novel treatment for managing these injuries. • Dr Virginia Beckett – an Obstetrics and Gynaecology consultant who is a member of the mMOET working group and has recently published on the topic of cardiac arrest in pregnancy. She was talking on the topic of resuscitative hysterotomy. • Sam Cooper – a Critical Care Paramedic from Derbyshire, Leicestershire and Rutland Air Ambulance who discussed a case of prehospital amputation and the learning points that arose from it. • Dr Rob Lloyd – an Emergency Medicine trainee, blogger and fellow podcaster who has an interest in performance psychology. He talked about Mental Toughness, framed by his experiences working in a hospital deep in a South African township. Once again, our thanks to Caroline Leech for being instrumental in the organisation of today and inviting us up. We're already looking forward to next year…. Enjoy! Simon, Rob & James References PonderMed Diphoterine A video showing a similar demonstration to the one at the conference showing why Diphoterine works and the limitations of water Pre-hospital Obstetric Emergency Training; POET VA Beckett, M Knight, P Sharpe, 2017, 'The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 124, no. 9, pp. 1374-1381 Realtime simulation of peri-mortem c-section; Bradford Teaching Hospital K. M. Porter, 2010, 'Prehospital amputation', Emergency Medicine Journal, vol. 27, no. 12, pp. 940-942 Caroline Leech, Keith Porter, 2016, 'Man or machine? An experimental study of prehospital emergency amputation', Emergency Medicine Journal, vol. 33, no. 9, pp. 641-644

We were delighted to be invited to cover the joint Faculty of Prehospital Care and BASICS conference held at the Royal College of Surgeons of Edinburgh. This two-day prehospital extravaganza covered a broad range of topics and the content was delivered by some excellent speakers. As such, we were absolutely spoilt for choice when it came to content for the podcasts but we managed to catch up with: Dr Abi Hoyle – a paediatric emergency medicine consultant with a background in military and retrieval services. She gave us some key tips when dealing with paediatric patients. Ian Dunbar – a technical and medical rescue consultant with years of experience in the UK Fire and Rescue Service and ongoing involvement with British Touring Car Championship and the FIA. He did some myth busting around extrication from vehicles. Professor Mike Tipton – a leading figure in extreme physiology who is the Associate Head of Research at the Extreme Environments Laboratory in Portsmouth, is trustee/director of Surf Life Saving GB, sits on the medical committee for the RNLI and was awarded an MBE for services to physiological research in extreme environments. Mike spoke on the topic of drowning. Massive thanks to Dr Caroline Leech who put together this brilliant programme and extended the invitation to us. We hope you enjoy the podcast and extract some learning to inform your practice. Enjoy! Simon, Rob & James References Resus Council UK; Prehospital Resuscitation Michael J. Shattock, Michael J. Tipton, 2012, ''Autonomic conflict': a different way to die during cold water immersion?',The Journal of Physiology, vol. 590, no. 14, pp. 3219-3230 Faculty of Pre-Hospital Care and Basics Conference

We've heard a lot about advanced airway management recently, with some really significant publications over the last few months and in the last few weeks in JAMA we've had another! Cricoid pressure during emergency anaesthesia and for those at high risk of aspiration has been common place for more than half a century. But it's a topic that has caused quite some debate. On one hand it has the potential to reduce aspiration, a very real and potentially very serious complication of RSI. But on the other it has the potential to hinder the view on laryngoscopy and decrease first pass success. The founding evidence for cricoid pressure has always been a little soft. In this podcast we look at the background of cricoid pressure and then run through this key paper, discussing the implications it holds for both pre and in-hospital advanced airway management. As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you. Enjoy! Simon, Rob & James References Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anaesthesia: The IRIS Randomized Clinical Trial. Birenbaum A. JAMA Surg 2018 Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA Lancet.1961 Safer Prehospital Anaesthesia 2017;AAGBI JC: Cricoid Pressure and RSI, do we still need it?St Emlyn's Cricoid: To press, or not to press?(Hinds and May)

Welcome back to November's Papers Podcast! We've got 3 great papers for you again this month. First up we take a look at a paper that looks to quantify the amount of experience needed to be a proficient intubator, in this case in arrest. Next we have a look at a paper which shows a significant difference in mortality in cardiac arrest dependant on the intravascular access route used. Finally we have a look a really interesting paper in the dispatch method of a HEMS service which we be of real interest to all those involved in paramedicine and prehospital critical care. Make sure you take a look at the papers themselves and form your own opinions. We'd love to hear any thoughts and feedback you have. Enjoy! Simon & Rob References & Further Reading How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation? Kim SY. Resuscitation.2018 A novel method of non-clinical dispatch is associated with a higher rate of criticalHelicopter Emergency Medical Service intervention. Munro S .Scand J Trauma Resusc Emerg Med.2018 Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Kawano T. Ann Emerg Med.2018