The Resus Room

So in our last Roadside to Resus episode we covered narrow complex tachycardias. In that we delved pretty deep into the normal cardiac conductance along with the clinical assessment and their management. This episode is going to build on some of that…so if you haven’t already given it a listen, we’d recommend you pause here, take a listen….and then come back on board!!  But for those of you that have already listened, here we go with the bigger brother and even more exciting broad complex tachycardia episode!! Again we’ll be covering everything from the underlying electrophysiological abnormality, all the way through to the assessment and treatment of patients with these life threatening presentations. 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 we’ve got three papers covering a wide variety of topics and practice in emergency care. First up we’ll be looking at whether pre-charging the defibrillator prior to rhythm analysis in cardiac arrest can decrease our hands-off time. Next we take a look at a paper that can help inform our assessment and investigation of trauma patients; looking at the risk of concomitant injuries with regards to specific levels of spinal trauma. Finally have a think about how different methods of extrication affect spinal movements from road traffic collisions; will it make a difference to your extrication method and speed? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

So in this episode we run through narrow complex tachycardias, not I hear you say a perfect visual topic for an audio platform like a podcast, but hold your horses… No matter what your level, or your depth of understanding of narrow complex tachycardias, we really hope this will offer some extra knowledge and contemplation for both those of you, like us, that have been treating patient with NCT for decades, right through to those of you that are completely new to the topic. We run through all the normal stuff like definitions, clinical context and electrical pathways. Then we have a think about those terms and concepts like node dependance, AVRT, AVNRT, WPW etc, and then we come back to the fundamentals of delivering excellent care and how we can use a structure of interpretation to decide how best to treat our patient both pre and in-hospital.  We’ve tried to really nail down and describe some of the concepts in a way that should make this topic a lot easier to understand and most importantly help us all deliver excellent care. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James

Happy New Year! Well we’ve got three really excellent papers to start off your new year with! First up we take a look at the complication rates seen when performing a prehospital thoracostomy; how frequent are complications and what could this information hold in improving our ongoing practice? Next up we take a look at an RCT on the use of Calcium in the context of cardiac arrest. Can it’s inotropic and vasopressor effects translate into better outcomes for our patients? Lastly we take a look at another excellent RCT comparing the use of a bougie to a stylet in adult emergency intubations; which will lead to a great first pass success and will the results lead to a change in or practice and teaching? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Critically unwell patients often present with inadequate oxygenation and ventilation, in this episode we’re going to explore some of the physiology of critical illness, look at how we can improve oxygenation and ventilation, take a look mechanical ventilation and have a think about how we can deliver this to a really high level. We’ll be covering the following; Type 1 & 2 respiratory failure Breathing assessment Optimising patients own ventilation Mechanical ventilation Modes of ventilation Setting up a ventilator; tidal volume, RR, FiO2, I:E ratios, dead space End tidal CO2 Optimising oxygenation & ventilation Hand ventilation Ventilation in cardiac arrest 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 December’s paper of the month podcast! In the first paper this month we take a look at a paper that assesses the utility of CT scans for patients presenting with fever of an unknown origin; could this help us identify the source more frequently and if so how often? Next, we often focus on the specific of medical management in cardiac arrest, but what impact does witnessing a cardiac arrest have on bystanders and could this affect the way we interact and behave on scene? Lastly we consider those patients that require a prehospital anaesthetic following return of spontaneous circulation from a medical cardiac arrest. Does the choice of induction agent between midazolam and ketamine affect the likelihood of hypotension and other complications? Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Being involved in Emergency Care, by it’s very nature, sadly means that we will have to break bad news to patients and families both in the prehospital & in-hospital setting. Breaking bad news well has benefits to both the recipient of that news and also to the provider delivering it. Teaching and education on the topic can be difficult to access and not always prioritised. In this episode we run through some of the evidence around breaking bad news, techniques and structures to follow and talk about the practicalities of adopting these, along with our own varied personal thoughts and styles. We hope listening to the podcast gives you an opportunity to reflect on how we could all work and improve on breaking bad news and also helps to make the process a little bit easier. 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 the papers of the month podcast! First up we take a look at a paper assessing the importance of symptoms and sings in suspected Cauda Equina cases and consider which factors we should be giving weight to, including whether a PR is appropriate. Next up we take a look at a paper looking at electrical injuries presenting to the Emergency Department, the risk of significant injury and the appropriate investigations to perform on both high and low energy voltage injuries. Lastly we take a look a paper looking at the use of vasopressin and steroids in in-hospital cardiac arrest and see what effect in has in the latest RCT. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

The hosts discuss the use of hyper-angulated VL blades for intubation and the potential drawbacks. They debate the establishment of intubation standards for paramedics and emphasize the importance of competency and training. The chapter also explores the recent changes in the curriculum for intubation and discusses the different roles of advanced practitioners in performing the procedure.

Intubation is a key part of advanced airway management. Although some of you out there may not intubate, we’ll be covering aspects where the identification of the need for intubation and how contributing as a team to the process can make a real difference to patient outcomes. Intubation is subject of a considerable amount of evidence and debate. Increasing use of supraglottic airways both in theatre and in cardiac arrest creates a situation in which there are limited opportunities to train and learn the skill. This brings into question who should these limited opportunities to train go to, what defines competence, which patients now would benefit from intubation. In this episode we’re going to cover these topics and more, including talking through how to fine your intubation technique as much as possible. We’re coming at this episode with our collective neonatal, ED and PHEM practice which all involve advanced airway management and it’s fair to say that we’re all passionate about delivering intubation and advanced airway management to the highest level possible.  We hope this episode gives a further opportunity to consider the topic in great depth and reflect upon how we can all contribute to improving practice. Once again we’d love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon, Rob & James