The Resus Room

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

This episode covers the topics of ECMO-CPR, ultrasound for testicular torsion, and a quality improvement project on paramedic intubation. Highlights include a trial comparing eCPR and conventional CPR, identifying diagnostic factors for testicular torsion, and significant improvements in first-pass success rate for intubation.

So in this episode we’re going to be covering crush injury.  When you think about it, visions of falling rocks, industrial accidents and high speed RTCs may come to mind, but actually a crush injury can be sustained in a huge variety of ways without such vivid circumstances. Definitions according to the Faculty of Prehospital Care are that; ‘A crush injury is a direct injury resulting from crush.  Crush syndrome is the systemic manifestation of muscle cell damage resulting from pressure or crushing’ So in the episode we’re going to run through all of the bits that we normally cover, from pathophysiology, to presentation and onto treatment. We'll also be looking at the controversy and evidence behind tourniquet use, fluid therapy, electrolyte management and much, much more! Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

This podcast covers three interesting topics. They discuss improving outcomes in refractory VF by changing pad position, limiting adrenaline use, and using beta blockers. They also talk about the use of fentanyl lozenges for pre-hospital pain relief, showing significant decrease in pain levels. Finally, they explore the management of acute behavioral disturbance, emphasizing the use of sedation and de-escalation strategies.

Welcome back to our first Roadside to Resus episode for 2023! We're back with the huge topic that is COPD. In this episode we're going to delve into the depths of the topic, helping us to deliver the best possible care for this frequently encountered presentation. Along with the standard coverage from incidence, to pathophysiology, to presentation and treatment, we'll also be covering those topics that you've specifically asked for; The mechanism behind hypercapnoeic respiratory failure, in those patients given to much oxygen Is there a role for end tidal CO2 interpretation in those spontaneously ventilating in acute exacerbations of COPD How do we tease out those for home care versus those that require hospital admission What is the role of Magnesium in these patients Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James