The Resus Room

This month we cover a paper looking at the role of early craniectomy for raised intracranial pressure, the outcomes associated with advanced airway managements in prehospital cardiac arrest and lastly at the utility on ETCO2 and consider if it's application decreases adverse respiratory events. This month our great sponsors ADPRAC our giving away a £30 iTunes voucher to spend on education/entertainment to support your work life balance! All you need to do is click the link on our home page through to the ADPRAC website and answer the question relating to the podcast, good luck! References and Links Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. Hutchinson PJ, N Engl J Med. 2016 Sep Capnography for procedural sedation in the ED: a systematic review. Dewdney C, Emerg Med J. 2016 The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis. Jeong S. Am J Emerg Med. 2016 Jul TheBottomLine - RESCUEicp ICS State of the Art Conference 2016: Find out more here

This week the British Thoracic Society have released an updated version of their guidelines on asthma. The document covers all aspects from diagnosis, treatment and follow up, in this podcast we briefly run through some of the aspects covered in the acute management section. Make sure you have a look at the full document that can be found here https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/ Speak to you soon!

In 2014 NICE updated their guidelines on Head Injury: assessment and early management. This included specific guidance for those patients on warfarin Guidance regarding the ongoing observation of these patients is not contained within the guideline but as with much of Emergency Medicine variation between departments and regions vary in the threshold to admit patients with a normal CT head due to concerns of these patients developing a delayed bleed. A recent systematic review and meta analysis on the topic has just been published and we thought it would be worth a look. Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis. Chauny JM. J Emerg Med. Jul 26 2016 The paper gives an interesting take on the risk we are dealing with following a normal scan in presentation to the ED and whilst the papers contained may not be the strongest level of evidence the meta-analysis is probably the best we have to go on at present. Enjoy and we'd love to hear any of your thoughts!

Here's a look at some of the papers that caught our eye this month. We cover a paper looking at the the potential benefits of ketofol over propofol for conscious sedation, the role of aggressive blood pressure reduction in haemorrhage stroke and finally a really interesting paper of PE thrombolysis in cardiac arrest. This month our great sponsors ADPRAC our giving away a £50 iTunes voucher to spend on education/entertainment for you to spend on supporting your work life balance! All you need to do is email through the answer to the following question; With regards to this September 2016 Papers podcast and The PEA-PETT study, which of the following is correct; A. The RCT shows a statistically significant benefit in PE thrombolysis intra arrest B. The paper focussed on peri-arrest thrombolysis C. The paper was a case series of PE's thrombolysed during arrest Send your answer via email to contacttheresusroom@gmail.com with your name, answer and iTunes email address, entries close on 15th September and we'll announce the winner in October's podcast. Enjoy! References Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial. Ferguson I, et al. Ann Emerg Med. 2016. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. Qureshi AI, et al. N Engl J Med. 2016 Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the "PEAPETT" study). Sharifi M. Am J Emerg Med. 2016 Jun 30.

Where does the role of a chest X-ray lie in major trauma? With the ever increasing use of CT and ultrasound in the resus room what role does the old school CXR hold? How many injuries will it pick up? How many will it miss? And when is the extra delay justified? This podcast looks at a recent paper on the topic and some related national guidelines. Enjoy! References Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study. Langdorf MI. Ann Emerg Med. 2015 Dec NICE 2016: Major trauma; assessment and initial management The Royal College of Radiologists 2011; Standards of practice and guidance for trauma radiology in severely injured patients

Burns are a common presentation to the ED and can result in a significant degree or morbidity and mortality. In this podcast we talk through the approach and treatment of burns along with some controversies in the literature regarding assessment of burn depth and fluid management. Enjoy! References The Parkland formula under fire: is the criticism justified? Blumetti J, et al. J Burn Care Res. 2008 Jan-Feb. Mersey Burns for calculating fluid resuscitation volume when managing burns: NICE advice [MIB58] Published date: March 2016 SCANRCIT: Pain can't be used to differentiate between partial and full thickness burns

Here's a look at some of the papers that caught our eye this month. In this podcast we cover a paper looking at the significance of findings with the history, physical exam and imaging in subarachnoid haemorrhage to inform your work up. We look at another paper focussing on total body versus selective CT scanning in trauma and lastly a paper looking at the validation of the DECAF score to predict mortality in COPD exacerbations. We've also got the e book 'ABC of Emergency Radiology' to give away on iTunes thanks to our new sponsors ADPRAC. All you need to do is answer the following question; With regards to this August 2016 Papers podcast and REACT-2, which of the following is correct; A. The use of selective CT scanning in major trauma leads to a dramatic decrease in radiation B. The use of selective CT scanning in major trauma leads to a decrease in time to diagnosis C. The use of selective CT scanning in major trauma leads to a decrease in cost per in patient episode D. The safety of selective CT scanning vs whole body CT scanning was equivocal Send your answer via email to contacttheresusroom@gmail.com with your name, answer and iTunes email address, entries close on the 15th August and we'll announce the winner in September's podcast. Enjoy!

This podcast explores the challenges of determining which post-cardiac arrest patients should undergo PCI. They discuss the limitations of using standard tools like ECG and biomarkers, and highlight the importance of finding new evidence. The podcast also touches on the varying outcomes of PCI dependent on angiography findings and emphasizes the need for collaboration between hospitals. The hosts express surprise at the lack of conclusive evidence on post-cardiac arrest PCI, and invite listeners to contribute papers and evidence on the topic.

I haven't always read papers and with the time pressures of training and life it's impossible for us to be on top of all of the literature. But over the last few years I've come across some papers that I wish others had told me about. For some of you this will all be a recap but for others hopefully it will spark an interest and get you to have a look at the papers yourself. We all know that it is extremely rare that one paper alone will or should change our practice but hopefully it's the interest and further questions into a topic that can come out of these papers. Enjoy! 5 References Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm. Scheuermeyer FX. Ann Emerg Med. 2015 May Thrombolysis during resuscitation for out-of-hospital cardiac arrest. Böttiger BW. N Engl J Med. 2008 Dec 18 Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Appelboam A. Lancet. 2015 Oct Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Martindale JL. Acad Emerg Med. 2016 Mar Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Blyth L. Acad Emerg Med. 2012 Oct

So the long awaited new NICE Guidelines on Sepsis have just been released. I'm no sepsis expert, I'm not on a panel involved with the guidelines but I am someone who is going to be trying to use these guidelines everyday at work with multiple patients and I'm not the only one....we all are! In this podcast we run through some of the main points brought up in the new guidelines. Talk about some potential difficulties and join toward some useful resources such as the brilliant flow charts developed by the Sepsis Trust. Let us know your thought and feedback either via the site www.TheResusRoom.co.uk or on twitter @TheResusRoom. Enjoy!