The Resus Room

Welcome back, this is our last podcast before our short summer break! We start off having a look at the physiological effects of prolonged resuscitation with a supraglottic device compared with endotracheal intubation, which raises some really interesting questions about our ongoing ventilation strategy in resuscitations. Next up we look at an RCT comparing RSI to DSI in critically injured patients and the effect on peri-intubation hypoxia. Finally we take a look at the practice of lateral canthotomy for retrobulbar haemorrhage/orbital compartment syndrome. How effective is the procedure and how competent are EM clinicians compared to Opthalmogists? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September! Simon & Rob

So in this episode we’re going to run though the primary survey in trauma. This clinical assessment helps us identify and treat life threatening injuries and to rapidly intervene and correct them, so getting it right really matter1.  How this is done is hugely dependant upon the setting (either pre or in-hospital) as it is affected by the access to the patient, the number of people there to contribute to care and the challenges that the scene or hospital environment might hold. We run through a model of primary survey that looks to gain as much information as possible in a rapid and effective pattern and discuss the slightly different approaches we all take, along with  rationale behind them. Finally we cover the communication of the primary survey to the team, strategies that we can undertake to achieve this and how this can affect the momentum and onwards care of the patient.  We found this a really useful topic to consider in some depth and we hope it's of use to you too! Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

There have been some huge trials released over the last month and we've got three brilliant papers to discuss! First up we take a look at an RCT on video versus direct laryngoscopy for patients requiring emergency intubation with the DEVICE trial. The VL versus DL debate has been ongoing for quite some time now, so is this a final nail in the coffin for DL? Next up we take a look at an RCT of prehospital TXA use in patients at risk of bleeding from major trauma in the PATCH trial. The results seen in the trial look at a glance to oppose those seen in CRASH-2, so is this the end of TXA in this cohort of patients? Finally we have a great paper giving us further information on whether we should we be initiating immediate antihypertensive treatment for patients admitted to hospital with asymptomatic hypertension. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

This is the first of two episodes looking at pneumothoraces. In this episode we're going to start out by taking a look at traumatic pneumothoraces. Traumatic pneumothoraces are present in about a fifth of multiple trauma patients, so it's not infrequent to come across them and they can obviously occur in those with isolated chest injury too. Thoracic trauma occurs in around two thirds of multi-trauma cases and is classified as the primary cause of death in a quarter of trauma patients. The clinical assessment carries with it a fair amount of dogma, including looking for tensions with tracheal deviation, so we'll be running through what the signs we should look for actually mean. Then we'll move on to a detailed discussion about investigation strategies before finally looking at the guidelines and evidence on the topic, including which we have to intervene with, which we probably shouldn't and those in which there is much uncertainty... Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James ps; if you’re interested in getting your site involved with the CoMITED Trial then email comited-trial@bristol.ac.uk 

Welcome back to the podcast and to the first episode in collaboration with our new sponsors Zoll, a huge thanks to them in their support of free open access medical education! First off this month we return to the topic of rib fractures; with an apparent shift in practice to the surgical fixation of multiple rib fractures, we take a look at an early vs late approach and consider the impact these results may have on trauma systems. Next up it's a prehospital RCT assessing the use of a prehospital strategy including a single troponin to rule out acute coronary syndrome. Will this prove safe when compared to an in hospital strategy and what impact does it have on prehospital resources? Finally we look at ventilation rates in cardiac arrest management. For as long as we can remember the guidance has been to ventilate at ten breaths per minute, but will a strategy involving a faster ventilatory rate yield better results? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

The last time we took a good look at head injuries was back in 2018 in our Roadside to Resus episodes and for all of the foundational stuff on incidence, assessment, management and loads more  make sure you go and check that episode out.  But this episode is one of our new UPDATES episodes, because we’re pretty old now… and whilst we’ve been having a go at this for a while evidence and guidelines will have progressed, which clearly have implications on how we manage certain cases and that’s where these come in! So they’ll focus mainly on the last 5 years of practice. The new NICE head injury guidance has just been released and it’s the first major overhaul since 2014.  Now we know it’s a UK guideline, but there’s some really key practice updates and evidence in there that’s relevant irrespective of where you find yourself listening this!  So in this episode we're going to be having a look at the most recent TXA evidence, with in terms of indications, timing and dosing. We'll be having a look at the risk of intracerebral injury with regards to anticoagulants and antiplatelet agents and a few other bits and pieces that can help us inform and improve our care. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

This month we start off with a paper looking at the first pass success rate of intubation in cardiac arrest when performing continual CPR versus pausing. We then come on to two really interesting diagnostic papers and our prehospital accuracy for identifying certain injuries; we take a look at the accuracy of HEMS clinicians in assessing the stability of a pelvic ring and subsequent application of a pelvic binder. And then we look at the accuracy of prehospital clincians in assessing for all life and limb threatening injuries. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Being in a situation of being unable to intubate and unable to oxygenate is an absolute time critical emergency.  Focus needs to be paid to the techniques and strategy to deal with this situation. But we also need to consider steps to ensure it occurs at a low frequency and our decision making and recognition of the situation happens quickly and simply. In the episode we’re going to be talking about a number of other aspects that are relevant for all emergency providers, irrespective of whether you intubate or not, along with how those aspects translate into everyday practice.  We'll be covering bits around patient positioning, optimising simple ventilation via a BVM & supraglottics, all the way through to needle cricothyroidotomy and surgical airways. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

This podcast explores topics such as sepsis fluid management, diagnostic benefit of ultrasound in the prehospital setting, and the potential benefits of beta blockers in traumatic brain injury patients.

So NOF's aren't the most glamorous of topics to cover on a podcast, but the difference we can make to patients but refining our care is huge.  Neck of femur fractures have a high and increasing incidence. They occur predominantly in frail patients who have the greatest risk of complications, both from the injury and medical interventions.  In this episode we'll be running through their presentation, discuss both the clinical and radiological diagnostics. We'll also be looking in depth about both pharmacological and non-pharmacological methods of pain relief and have a think about where fascia-iliaca compartment blocks sit with regards to pre and in- hospital practice.  Finally we'll move on to the definitive surgical approach and in-hospital care. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James