The Resus Room

So when people talk about patients having a high lactate we think about them being sick, it can at times be easy to slip into thinking that this equals sepsis or maybe ischaemia. And whilst the presence of a high lactate in the context of infection and ischaemia is important to note, there is a lot more to interpreting a raised lactate than may first be apparent... So in this episode we’re going to delve down into lactate, have a think about what it is, what normal and raised levels are, consider the mechanisms behind it’s formation and breakdown and think about the causes of raised lactate. We'll then put this all together and have a think about how we can interpret and lactate levels ensuring we give the best treatment to our patients! Enjoy! Simon, Rob & James

So, as we all know, there are loads of presentations that we see in Emergency Medicine that require us to gain rapid access to the circulation. Either to administer medicines around the body or to get fluids into the circulation. Now there’s a number of different ways we can get them into the circulatory system for them then to get to their sites of action, each of which comes with its pros and cons. There’s buccal, inhaled, intramuscular, sublingual, intranasal etc etc…. But, in the vast majority of cases we gain this access to the vasculature through intravenous access and a peripheral cannula. That means that iv access is a very common procedure in emergency care. The great news is that the equipment is cheap, there are multiple sites for insertion and it’s often feasible regardless of the patients age or presenting complaint. Compared to all the other options for drug administration, iv access and administration of drugs via the IV route, results in 100% bioavailability of all medicines because it avoids the first pass metabolism in the liver, and distribution around the body is rapid because it bypasses the need for absorption into the vasculature. So that’s all good, so why are we doing an episode on intraosseous access then? Well, iv access and we as clinicians, are not infallible. And as we’re all too aware, gaining IV access can be challenging. There are other patient factors to like iv drug use, the morbidly obese and paediatric patients when everything is just smaller and more unfamiliar. So all of these factors increase the technical difficulty of iv cannulation. If we add to that some of the environmental issues we might find in the prehospital setting - so poor lighting or difficult patient access, it’s not a huge leap to realise that it would be great to have an alternative vascular access option available to a broad range of emergency care providers. And this is where IO access comes in. So what will we be covering in this episode; -A recap on the anatomy of bones -Indications for IO access -The evidence on IO access and administration -Insertion site -Needle selection -Contraindications -Case examples Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

This month's podcast discusses the impact of rocuronium dosing on intubation success. They also delve into the gender bias in the administration of tranexamic acid (TXA) for trauma patients. Additionally, they explore the optimal duration of CPR for favorable neurological outcomes after cardiac arrest.

In this podcast, the hosts discuss the importance of non-technical skills in resuscitation and critically unwell patients. They delve into topics such as situational awareness, leadership, followership, and effective resuscitation techniques. The podcast also explores the concepts of nurse-led code, devolved leadership approach, graded assertiveness, and empowering new leaders. Overall, it's an informative and insightful discussion on the vital skills needed in healthcare.

Welcome back to May's papers of the month! First up this month we'll be looking at an RCT focussed on prehospital intra-arrest management and comparing an early move in arrest towards ECMO-CPR and invasive treatment, versus remaining on scene continuing ALS until achieving a ROSC. Does E-CPR hold the promise we are hoping for? Next up we take a look at another RCT on pad placement for electrical Cardioversion-BMI of AF, are antero-posterior pads superior to the standard antero-lateral position? Finally we look at the potential for remote supervision of pre-hospital ultrasound, has technology moved the bar in what can be achieved? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

We have been wanting to do an episode on aortic dissections for quite a while now but you will see that what we’ve actually gone and done is created an episode on acute aortic syndromes…so we’ve done a great job of staying on point straight from the off! In fairness, we’ve done this because it turns out that there are actually a few different potentially life threatening acute aortic conditions which we need to know about and getting them all into one episode seemed achievable, so let’s see how we get on with that! Hopefully in this podcast we will try and improve your knowledge of these conditions and we’ll also discuss a couple of cases to bring out some key points. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to April ‘22 papers of the month podcast! We start off this month with a paper looking at the effect of a structured airway course on first pass success in novice and HEMS clinicians. Next up we take a look at the much discussed RePHILL trial; do packed red blood cells and lyoplas lead to better outcomes in patients with traumatic hypovolaemic shock? Finally we take a look at the topic of over-diagnosis and a paper that has made us think and reflect really hard on our practice of Emergency Medicine! Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Debrief is an extremely important topic both in the prehospital and in-hospital environment. It offers the opportunity to clarify, reflect and improve on future practice. But partaking in and running a debrief can be challenging. So in this episode we'll be exploring debrief in a lot more detail. We'll be covering both hot and cold debriefs, frameworks for debriefing and tips on what works well, as well as what sometimes doesn't. To celebrate International Women's Day 2022 we have handed over the mics to three incredible colleague; Gemma Richmond has worked for the Yorkshire Ambulance Service for 20 years. She joined as an Emergency medical technician and spent 10 years working on a DCA. She then took a full time position with the Yorkshire Hazardous Area Response Team and during that time qualified as a paramedic and remained there for 8 years. She is now currently seconded to work on the Yorkshire Air Ambulance as a HEMS paramedic After leaving full time military service Clare Fitchett qualified as a Paramedic with South Central Ambulance Service in 2013. She joined Thames Valley Air Ambulance in 2018 and has been working as a trainee and then qualified Critical Care Paramedic since. Finally Vicki Brown, who has been in the ambulance service for 20 years. She became a HEMS paramedic in 2006, joined Great Western Air Ambulance in 2012 and is currently working as an Advanced Practitioner Critical Care. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Welcome back to March '22 Papers Podcast! This month we have a think about causes and coping strategies for Emergency Clinicians involved in stressful cases; what can trigger us and more importantly what can we do to mitigate these circumstances? In our other two papers we have a think about ECMO-CPR and Resuscitative Thoracotomy, both relatively low frequency but high skill interventions. The papers look at outcomes and case selection and can give us more information about service setups and challenges, and also offer us an opportunity to mentally mode how we can best prepare and decision make in these cases. Simon & Rob