The Resus Room

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

Exploring burn severity and essential care, assessing burn type and depth, managing airway compromise, emergency intubation, fluid resuscitation, and referral guidance for burn patients. Importance of prompt intervention for better outcomes in burn cases.

Welcome back to October's Papers Podcast, this month we move airway from advanced airway management and bring you a broad array of papers. First up we have a look at the relative success of a variety of pharmacological strategies for managing the acutely agitated patient in ED. Next up we have look at the well know CURB-65 score and it's ability to predict the need for critical care interventions. Lastly, we may all feel at times that performing a CT head on those well patients solely because they take anticoagulants may be a little on the excessive side, we review a paper that looks at the yield of positive scans in this cohort. As ever don't just take our word for it, go and have a look at the papers yourself, we would love to hear any comments or feedback you have. Enjoy! Simon & Rob References & Further Reading  IntramuscularMidazolam, Olanzapine, Ziprasidone, or Haloperidolfor TreatingAcuteAgitationin the Emergency Department. Klein LR. Ann Emerg Med. 2018 Performanceof the CURB-65Scorein PredictingCritical CareInterventionsin PatientsAdmitted With Community-AcquiredPneumonia.Ilg A. Ann Emerg Med.2018 Incidenceof intracranial bleedingin anticoagulatedpatientswith minor head injury: a systematic review and meta-analysis of prospective studies. Minhas H. Br J Haematol.2018

So we're back with September's papers of the month a little later than usual but we wanted to give you a little time to digest AIRWAYS-2... before we give you some more prehospital research on advanced airway management in cardiac arrest! The American version of AIRWAYS-2, PART, has just been released in JAMA, looking at the laryngeal tube versus endotracheal intubation as a primary strategy for advanced airway management. The paper is fascinating accompaniment to AIRWAYS-2. Next we have a look at a paper assessing Emergency Medicine clinicians' ability to predict hospital admission at the time of triage, should we be making early calls on the destination of our patients? Finally we have a look at the potential role of esmolol in cases of refractory VF and a paper that reports twice the survival rates in those that receive it! As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom. Enjoy! Simon & Rob References & Further Reading Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. Henry E. Wang, MD. 2018 Emergency medicinephysicians' abilityto predicthospital admissionat the timeof triage. Vlodaver ZK. Am J Emerg Med.2018 Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patientswith refractory ventricular fibrillation. Driver BE. Resuscitation.2014 King Laryngeal Tube  

So we're back from our summer hiatus with a real treat. The long awaited AIRWAYS-2 paper has just been released and we've been lucky enough to speak with the lead author, Professor Jonathan Benger, about the paper and discuss what the findings mean for cardiac arrest management. AIRWAYS-2 looks at the initial advanced airway management strategy for paramedics attending out of hospital cardiac arrests, essentially whether or not the aim should be to place a supraglottic airway device or an endotracheal tube when advancing from simple airway techniques. The study was a huge undertaking with many speculating over how the results would change practice, including discussion of how it may affect paramedic's practice of intubation, all of which we cover in the podcast. Before you listen to the podcast make sure you have a look at the paper yourself, have a listen to PHEMCAST's previous episode which covers the study design and have a look at the infographics on the website which summarise the primary outcome and secondary analysis and which we refer to in the interview with Professor Benger. In the podcast we refer to Jabre's paper which can be found below and we also covered in May's papers podcast. Have a listen to the interview and let us know any thoughts or feedback you have, we're sure this one will create a lot of discussion! Simon, Rob & James References & Further Reading Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. The AIRWAYS-2 Randomized Clinical Trial. Benger J. JAMA. 2018 PHEMCAST; the LMA Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomised Clinical Trial. Jabre P. JAMA. 2018 TEAM Course

Welcome to August's papers of the month. So this is our last offering for the summer until whilst we take a short break until September, so we had to finish off we 3 great papers! First up we look at the drug of the moment (or decade...) in tranexamic acid and the effect that it has on outcomes in primary intracerebral haemorrhage. Next, what role does point of care ultrasound (POCUS) hold in the patient presenting with undifferentiated shock? We look at a randomised control trial of POCUS in this patient cohort that assesses the ability to translate POCUS into a mortality benefit. Finally we look at a delphi study published in the EMJ which explores expert opinion upon multiple aspects of paediatric traumatic arrests. The results are fascinating and may inform some of the CRM used in the next case you see. As always we strongly suggest you have a look at the papers yourself and come to your own conclusions. Make sure you check out the hyperlinked blogs below that we mention in the podcast that contain some fantastic critiques. We'd also love to hear any comments either at the foot of this page or on twitter to @TheResusRoom. Enjoy!   Simon & Rob References & Further Reading Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Sprigg N. Lancet. 2018 Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With UndifferentiatedHypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Atkinson PR. Ann Emerg Med. 2018 Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Rickard AC. Emerg Med J. 2018 St Emlyns JC; Tich Tich Boom? First10EM; TXA in ICH (TICH-2) 

Drugs in cardiac arrest are controversial. Prehospital research is notoriously difficult to perform. PARAMEDIC2 has just published in the New England Journal of Medicine and is a multi centre randomised placebo controlled trial looking at adrenaline (or epinephrine depending on which side of the pond you reside) in out of hospital cardiac arrest, no mean undertaking and a landmark paper. The paper has gained a huge amount of traction online with multiple blogs discussing the primary outcome which showed a higher survival rate in those receiving adrenaline when compared to placebo. This has been accompanied with a firm debate over the secondary outcomes, which include the rate of survival with a favourable neurological outcome (mRS 0-3), which showed no statistically significant difference between the two treatment arms, but in pure numbers gave a higher proportion of favourable outcomes in the adrenaline group. The trade off for this increased survival is the significant number of survivors with a poor neurological outcome. The question on everyone's lips then being; should we continue to administer adrenaline in cardiac arrest given the findings from this study? In the podcast we run over the main findings of the paper and are lucky enough to speak to the lead author Professor Gavin Perkins about the paper and some of the questions we and you have had following publication of the paper. A huge thanks to Gavin for taking the time to do this. Have a listen, enjoy, and let us know any thoughts or feedback you have Simon, Rob & James References & Further Reading PARAMEDIC2; Warwick University Clinical Trials Unit A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Perkins GD. N Engl J Med. 2018 PARAMEDIC2 Protocol Testing Epinephrine for Out-of-Hospital Cardiac Arrest. Callaway CW. N Engl J Med. 2018 First10EMParamedic 2: Epinephrine harms/helps in out of hospital cardiac arrest REBEL Cast Ep56 PARAMEDIC-2: Time to Abandon Epinephrine in OHCA?