The Resus Room

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!

We have a look at papers covering platelet transfusions for patients on antiplatelets who suffer intracerebral bleeds, the optimal dose for procedural sedation with ketamine in children, a new meta-analysis on the sensitivity of early CT in suspected sub arachnoid haemorrhage and finish up with an amazing case report regarding a hypothermic cardiac arrest Make sure you go and have a look at the papers yourself to see what the evidence means to you. Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial. Kannikeswaran N. Am J Emerg Med. 2016 Apr 2. pii: S0735-6757(16)30011-0. doi: 10.1016/j.ajem.2016.03.064. [Epub ahead of print] Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Baharoglu MI. Lancet. 2016 May 9. pii: S0140-6736(16)30392-0. doi: 10.1016/S0140-6736(16)30392-0. [Epub ahead of print]  Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. Dubosh NM. Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Epub 2016 Jan 21. HEMS advanced trauma team retrieval of a patient with accidental hypothermic cardiac arrest for ECMO therapy. McCormack J. Resuscitation. 2016 May 30  

Sedation is becoming an ever more significant part of our work in the Emergency Department. At the end of May 2016 the Royal College of Emergency Medicine Published the RCEM Sedation Audit of 2015-2016 that covered more than 8,000 ED sedations throughout the UK (involving more than 190 ED's). There are some pearls to take out of this great piece of work in which there would seem to be some significant scope to improve. The document not only benchmarks our practice but helps give us a feel for the risks involved. Have a listen and check out the resources mentioned via the hyperlinks below, most importantly make sure you have a look at the document itself. Relevant Resources RCEM Sedation Audit ACPeducate iTunes feed TEAM course

Carbon Monoxide poisoning is definitely one of those differentials that you consider when the patients books into ED with '?carbon monoxide poisoning'...... but how much do we really think about it in a patient that hasn't been sent down to the ED with this specific thought in mind? Rob Fenwick talks us through the key points of Carbon Monoxide poisoning and some recent evidence on the topic which will probably make us consider the possibility a bit more frequently! This podcast was based around the post Rob wrote for Jonathan Downham's superb Critical Care Practitioner podcast. Go and have a look at the post for a lot more information on the topic.

For June we have a look at papers covering CT head imaging in delayed trauma presentations, risk stratifying TIAs, early administration of fluids in severe sepsis and most importantly the utility of a biro in a surgical airway....... Make sure you go and have a look at the papers yourself to see what the evidence means to you. References Validation of ABCD2 scores ascertained by referring clinicians: a retrospective transient ischaemic attack clinic cohort study. Dutta D. Emerg Med J. 2016 Apr 7. pii: emermed-2015-205519. doi: 10.1136/emermed-2015-205519. [Epub ahead of print] Bystander cricothyrotomy with ballpoint pen: a fresh cadaveric feasibility study. Kisser U. Emerg Med J. 2016 Apr 19. pii: emermed-2015-205659. doi: 10.1136/emermed-2015-205659. [Epub ahead of print] Association of Fluid Resuscitation Initiation Within 30 Minutes of Severe Sepsis and Septic Shock Recognition With Reduced Mortality and Length of Stay. Leisman D. Ann Emerg Med. 2016 Apr 14. pii: S0196-0644(16)00148-7. doi: 10.1016/j.annemergmed.2016.02.044. [Epub ahead of print] CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study. Marincowitz C. Emerg Med J. 2016 Apr 13. pii: emermed-2015-205370. doi: 10.1136/emermed-2015-205370. [Epub ahead of print]

Here's a look at some of the papers that caught our eye this month. We have a look at patient positioning for RSI, the implication of hypothermia on arrival in the ED and the reliability of clinical assessment of syncope in our elderly patients. Make sure you go and have a look at the papers yourself to see what the evidence means to you. Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Khandelwal N. Anesth Analg. 2016 Apr;122(4):1101-7. doi: 10.1213/ANE.0000000000001184. Reliability of clinical assessments in older adults with syncope or near syncope. Nishijima DK. Acad Emerg Med. 2016 Mar 29. doi: 10.1111/acem.12977. [Epub ahead of print] Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial. Klauke N. BMJ Open. 2016 Mar 30;6(3):e009913. doi: 10.1136/bmjopen-2015-009913.