The Resus Room

Simon Laing, Rob Fenwick & James Yates

Emergency Medicine podcasts based on evidence based medicine focussed on practice in and around the resus room.

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286 episodes
Updated Sunday

Episodes286

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May 1, 2018 · 26 min
May 2018; papers of the month
Dare we say it, we think this month's papers podcast is the best yet, we've got 3 superb papers and topics to consider! The literature has been pretty airway heavy this month so we've got 3 papers on and around the topic for you. First up we have a look at a really interesting paper from London HEMS looking at the risks v benefit of prehospital rapid sequence intubation in patients who are awake but hypotensive, is RSI a much needed move or something we should be looking to avoid prehospitally. Airways-2 will soon be published looking at supraglottic airway management compared to intubation as first line airway management in out of hospital cardiac arrest, but JAMA has just published a paper comparing bag-mask ventilation vs endotracheal intubation in the same situation. It'll be interesting to see if this papers results fall inline with Airways-2. Finally we take a look at a systematic review trying to give us the answer to direct or video laryngoscopy in emergency endotracheal intubation outside the OR. Have a listen but most importantly have a look at the papers yourself and let us know your thoughts. Enjoy! Simon & Rob References & Further Reading Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental? Crewdson K. Acta Anaesthesiol Scand. 2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome AfterOut-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. Jabre P. JAMA. 2018 Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis. Arulkumaran N. Br J Anaesth. 2018
Apr 23, 2018 · 22 min
Statistics Demystified
Evidence based medicine (EBM) allows us to deliver the best care to our patients and understanding the concepts involved is crucial. Over the last 18 month we've been building an online course to give people a sound understanding of EBM and we thought we'd give you a free taster of what it's all about. Have a listen to one of our episodes here on statistics and if you want to find out more have a read below about the full course at www.CriticalAppraisalLowdown.co.uk Enjoy! Simon, Rob & James
Apr 18, 2018 · 30 min
Trauma Care 2018
For this episode we've been lucky enough to catch a number of the speakers from the traumacare conference. First up, conference organiser Caroline Leech (EM + PHEM consultant) gave us a few minutes of her time to talk about the latest major trauma key performance indicators from NICE. Nicola Curry (Consultant Haematologist) spoke about transfusion in trauma and the use of massive haemorrhage protocols. Importantly, she covers the evidence behind the current strategies and where future research opportunities exist. Stuart Reid (EM + PHEM consultant) covered the ways of optimising timely transfer of major trauma patients. This had an inter-hospital focus, but there were certainly some elements which can be applied to a primary patient transfer. David Raven (EM consultant) provided an update to the ongoing work with the HECTOR project. We've previously heard about their amazing course but this time he was able to let us know about the "silver trauma safety net" which is being used by the ambulance service in the West Midlands. This aims to provide appropriate recognition and triage of trauma in the elderly population. Finally, Elspeth Hulse (anaesthetic SpR) gave us a timely reminder about the identification and management of organophosphate poisoning - really useful from both and EM and PHEM perspective. Thanks again to Caroline for the invite to the conference and keep and eye out for a special podcast in the next few weeks where Simon Carley will be running through his top 10 trauma papers of 2017/18 (we were going to try and condense it, but there was way too much good stuff!) Enjoy! Simon, Rob & James References & Further Reading Trauma Care St Emlyns HECTOR
Apr 8, 2018 · 24 min
A case to make you think...
In this episode Rob takes us through a case he saw recently that brought about some invaluable learning. We're not going to give you anymore clues than that! Enjoy! Simon & Rob References & Further Reading (anonymised to keep the anticipation!) Article 1 Article 2 Article 3 Article 4
Apr 1, 2018 · 31 min
April 2018; papers of the month
Welcome back to April's papers of the month. We've got 3 papers this month that look to challenge our work up strategies for the critically unwell. First up we look at a paper on the Ottawa subarachnoid haemorrhage rule, specifically considering if we can decrease scanning in patients with a suspected SAH and what application of the rule might mean for our practice. Next up we look at a paper that might shine some real doubt on the use of IO access in our patients in cardiac arrest. Lastly we look at a validation paper for the PERC rule for those patients with a suspected pulmonary embolus and this paper brings about some interesting points on external validity Once again we'd really encourage you to have a look at the papers yourself and we've love to hear any thoughts or feedback you have. Enjoy! Simon & Rob References Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. Perry JJ. CMAJ. 2017 Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Kawano T. Ann Emerg Med. 2018 Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. Freund Y. JAMA. 2018 CORE EM; IO in Cardiac Arrest
Mar 20, 2018 · 48 min
RSI; Roadside to Resus
Gaining control of the airway in a critically unwell patient is a key skill of the critical care team and littered with potential for difficulty and complications. NAP4 highlighted the real dangers faced with their review of complications of airway management in the UK, lessons have been learnt and practice has progressed. As always there is room to improve on current practice and a recent paper published in Anaesthesia describes a comprehensive strategy to optimise oxygenation, airway management, and tracheal intubation in critically ill patients in all hospital locations. In this podcast we cover; Why this matters to all involved in critically unwell patients, not just those delivering RSI Recap of RSI, the procedure and its indictions Headlines from NAP4 Strategies highlighted to optimise airway management and oxygenation How this impacts our prehospital and inhospital practive We'd love to hear your thoughts so please leave your comments below or contact us via twitter @TheResusRoom Enjoy! Simon, Rob & James References & Further Reading NAP4 Guidelines for the management of tracheal intubation in critically ill adults. A Higgs B. British Journal of Anaesthesia. 2017 Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study.De Jong A. Am J Respir Crit Care Med. 2013 Introduction to the Vortex; vimeo
Mar 12, 2018 · 22 min
The Crystalloid Debate
How often do you prescribe or give i.v. fluids to your patients? How much thought goes into what's contained in that fluid? What effect will you fluid choice have on your patient? Two trials on crystalloid administration in the acutely unwell patient have occupied a lot of conversation in the research world over the last few weeks, both published in the NEJM and in this podcast we take a look at them. In the podcast we cover the following; Whats the big deal with crystalloids Previous trials on fluid administration NEJM papers on crystalloids Myburgh's editorial Make sure you take a look at the papers yourself and come up with your own conclusions. There are a whole host of superb FOAM resources out there on the topic that are well worth a look and referenced below. We'd love to hear any thoughts and comments below. Enjoy! Simon & Rob References & Further Reading Fluid Na K Cl Ca Mg Lact Acet Glucon Dext Osmol mOsm/L 0.9% N Saline 154 0 154 0 0 0 0 0 0 308 Lactated Ringers 131 5 11 2.7 0 29 0 0 0 273 Hartmanns 129 5 109 4 0 29 0 0 0 278 Plasma Lyte 140 5 98 0 3 0 27 23 0 280 Constituents measured in mEq/L Reference; University Texas Balanced Crystalloids versus Saline in Critically Ill Adults. Semler MW. N Engl J Med. 2018 Balanced Crystalloids versus Saline in Noncritically Ill Adults. Self WH. N Engl J Med. 2018 Patient-Centered Outcomes and Resuscitation Fluids. Myburgh J. N Engl J Med. 2018 REBEL.EM; Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over? PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation JC: Balanced fluids vs Saline on the ICU. The SMART trial. St Emlyn's JC: So long Salt and Saline? St Emlyn's The Bottom Line; SALT-EM The Bottom Line; SMART
Mar 1, 2018 · 27 min
March 2018; papers of the month
Welcome to March's papers of the month. We know we're biased but we've got 3 more superb papers for you this month! First up we review a paper looking at oxygen levels in patient's with a return of spontaneous circulation following cardiac arrest, is hyperoxia bad news for this patient cohort as well as the other areas we've recently covered? Secondly we have a look at a paper reviewing the association between time to i.v. furosemide and outcomes in patients presenting with acute heart failure, you may want to have a listen to our previous podcast on the topic first here. Lastly, when you see a pregnant patient with a suspected thromboembolic event, can you use a negative d-dimer result to rule out the possibility? We review a recent paper looking at biomarker and specifically d-dimers ability to do this. We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here. Enjoy! Simon & Rob References & Further Reading Association Between Early Hyperoxia Exposure AfterResuscitation from Cardiac Arrest and Neurological Disability: A Prospective Multi-Center Protocol-Directed Cohort Study. Roberts BW. Circulation. 2018 The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspectedvenous thromboembolism during pregnancy and puerperium. Hunt BJ. Br J Haematol. 2018 Time to Furosemide Treatment and Mortality in PatientsHospitalized With Acute Heart Failure. Matsue Y . J Am Coll Cardiol. 2017 MDCALC; Framingham Heart Failure Diagnostic Criteria REBEL.EM; Door to Furosemide in AHF Modified Rankin Scale
Feb 22, 2018 · 1 hr 9 min
Sepsis; Roadside to Resus
So the three of us are back together and going to take on Sepsis! It's vital to have a sound understanding of sepsis. It has a huge morbidity and mortality but importantly there is so much that we can do both prehospital and in hospital to improve patient outcomes. In the podcast we cover the following; Definitions Scale of problem Different bodies; NICE/Sepsis Trust/3rd international consensus definition including qSOFA Handover and pre alerts Treatment; Sepsis 6 The evidence base behind treatment Contentious areas Prehospital abx Fever control Steroids ETCO2 We hope the podcast helps refresh your knowledge on the topic and brings about some clarity on some contentious points. As always don't just take our word for it, go and have a look at the primary literature referenced below. Enjoy! Simon, Rob & James References & Further Reading Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Kumar. Critical Care Medicine. 2006 Prognostic value of timing of antibiotic administration in patientswith septic shock treated with early quantitative resuscitation. Ryoo SM. Am J Med Sci. 2015 The association between time to antibiotics and relevant clinicaloutcomes in emergency department patients with various stages of sepsis: a prospective multi-center study. de Groot B. Crit Care. 2015 Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Puskarich MA. Crit Care Med. 2011 Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E. N Engl J Med. 2001 Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Nguyen HB. Crit Care Med. 2004 The prognostic value of blood lactate levels relative to that of vitalsigns in the pre-hospital setting: a pilot study. Jansen TC Crit Care. 2008 Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Jones AE. JAMA. 2010 Lower versus higher hemoglobin threshold for transfusion in septic shock. Holst LB. N Engl J Med. 2014 A randomized trial of protocol-based care for early septic shock. ProCESS Investigators. N Engl J Med. 2014 Trial of early, goal-directed resuscitation for septic shock. Mouncey PR. N Engl J Med. 2015 Goal-directed resuscitation for patients with early septic shock. ARISE Investigators. N Engl J Med. 2014 Acetaminophen for Fever in Critically Ill Patients with SuspectedInfection. Young P. N Engl J Med. 2015 NICE; Sepsis: recognition, diagnosis and early management The Sepsis Trust The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Singer M. JAMA. 2016 NHS E; Improving outcomes for patients with sepsis. A cross-system action plan Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Alam N. Lancet Respir Med. 2018 Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 2018 PHEMCAST; End Tidal Carbon Dioxide Current clinical controversies in the management of sepsis. Cohen J. J R Coll Physicians Edinb. 2016 St Emlyns; qSOFA RCEM; Severe Sepsis and Septic Shock Clinical Audit 2016/2017 National report RCEM & UK Sepsis Trust; Toolkit: Emergency Department management of Sepsis in adults and young people over 12 years- 2016
Feb 12, 2018 · 13 min
Devastating Brain Injuries
On a not infrequent basis we will come across patients in hospital who have a CT head scan that appears to show an unsurvivable event. Having sourced opinion from our neurosurgical and neurology colleagues we may well be given the advice to withdraw care for the patient. It has become increasingly recognised that prognosticating in such patients at an early stage is extremely difficult with numerous cases surviving what was initially thought to be an unsurvivable event, with a good neurological outcome. This joint document from the Intensive Care Society, Royal College of Emergency Medicine, Neuro Anaesthesia and Critical Care Society of Great Britain & Ireland and the Welsh Intensive Care Society gives new guidance for such perceived devastating brain injuries and will challenge many peoples thinking on the topic with additional questions being asked on resource utilisation. In this podcast Caroline Leech, EM and PHEM Consultant in Coventry, discusses the guidelines and the implications they hold for our practice. As always make sure you read the document yourself, we would love to hear your thoughts. Enjoy! Simon & Caroline References Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement A case for stopping the early withdrawal of life sustainingtherapies in patients with devastating brain injuries. Manara AR. J Intensive Care Soc. 2016
Feb 1, 2018 · 26 min
February 2018; papers of the month
Welcome back, we've got 3 absolute beauties of papers for you this month! You'll have struggled not to have heard about the ADRENAL trial, a trial of iv steroids in the sickest of patients with septic shock. We also have a look at a trial that many have been quoting as sound evidence for the utility of pH during the prognostication of patients in cardiac arrest. Finally we have a look at a paper that may shed some concern on the use of Double Sequential Defibrillation that we covered recently on the podcast... We'd love to hear from you with any thoughts or feedback you have on the podcast. And we've now launched of Critical Appraisal Lowdown course, so if you want to gain some more skills in critical appraisal make sure you go and check out our online course here. Enjoy! Simon & Rob References & Further Reading TheBottomLine; ADRENAL St Emlyns; ADRENAL Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Venkatesh B. N Engl J Med. 2018 External Defibrillator Damage Associated With Attempted Synchronized Dual-Dose Cardioversion. Gerstein NS. Ann Emerg Med. 2018 Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study. Shin J. Crit Care. 2017
Jan 22, 2018 · 12 min
Tranexamic Acid; time to treatment
In this episode we cover a paper that you have to know about! The use of tranexamic acid(or TXA) has become widespread in the case of major trauma and post partum haemorrhage. This time we discuss a recent paper that asks us if giving it within 3 hours is enough, or whether we need to be even more specific regarding its urgency of administration in order to save lives from bleeding. There is a superb podcast over at our buddies site PHEMCAST which covers an interview with one of the authors and we'd highly recommend listening to that! Enjoy! Simon & Rob References Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Gayet-Ageron A. Lancet. 2017
Jan 12, 2018 · 29 min
Prehospital Care; FPHC conference
Prehospital Care is evolving rapidly and is one of the most exciting and dynamic specialties to be involved with at the moment. As a reflection of it's progress the Faculty of Pre Hospital Care held its first scientific conference this week. We were lucky enough to be invited by Caroline Leech, EM & PHEM Consultant and the person responsible for organising this superb event, to interview some of the superb speakers at the event. Here are the speakers we were lucky enough to catch up with and the topics they discuss Matt Thomas – Hyperoxia: when oxygen is harmful Jo Manson – The hyperacute inflammatory response to trauma Rob Moss – FPHC Consensus Statement - Spinal Malcolm Russell – FPHC Consensus Statemnent – External Haemorrhage Tim Nutbeam – Pre-hospital research: what do we not know? David Menzies – Impact brain apnoea & motorsport Stacey Webster – Calcium in pre-hospital blood transfusion: the missing link Rod Mackenzie Injury prevention, control & recovery A huge thanks to all involved in the conference for having us at the conference and we hope to see you all next year! Simon, Rob & James References and links FPHC Consensus statement guidelines Ionised calcium levels in major trauma patients who received blood in the Emergency Department. Webster S. Emerg Med J. 2016 TOP-ART
Jan 1, 2018 · 26 min
January 2018; papers of the month
Happy New Year!! Welcome back to the podcast and what we hope will be a superb year. We've got three excellent papers that are extremely relevant to our practice and will have an impact on practice. First up it's a paper looking at the benefit of iv versus oral paracetamol in the Emergency Department, something we do really frequently but what does the evidence say? Next we have a look at the difference that topical TXA could make to epistaxis in terms of bleeding cessation. Lastly we look at a systematic review looking at adenosine versus calcium channel blockers for SVT. Very soon we'll be releasing our Critical Appraisal Lowdown course, so keep an eye out for that. And finally a huge thanks to our sponsors ADPRAC for all of the support with TheResusRoom. Enjoy! Simon & Rob
Dec 11, 2017 · 39 min
Handover; Roadside to Resus
Handover matters. Handover of patient care occurs at multiple points in the patient's journey and is a crucial point for transference of information and inter professional working. Whether it's the big trauma in Resus with the prehospital services presenting to the big crowd, right the way through to the patient coming to minors who looks like they will be going home shorty, each of these transactions of information needs to be done correctly. Handover can be stressful though and different parties will have different priorities that they are trying to juggle. In this podcast we explore handover, some of the barriers and issues that exist. We have a look at the evidence that exists on it's importance, impact and associated techniques. We also look at tools that exist that can be used to facilitate effective handover. As ever make sure you look at the articles mentioned in the podcast yourself and we would love to hear your thoughts. Enjoy! Simon, Rob & James References & Further Reading Information loss in emergency medical services handover of trauma patients. Carter AJ. Prehosp Emerg Care. 2009 Maintaining eye contact: how to communicate at handover. Dean E. Emerg Nurse. 2012 The handover process and triage of ambulance-borne patients: the experiences of emergency nurses. Bruce K. Nurs Crit Care. 2005 Handover from paramedics: observations and emergency department clinician perceptions. Yong G. Emerg Med Australas. 2008 Review article: Improving the hospital clinical handover between paramedics and emergencydepartment staff in the deteriorating patient. Dawson S. Emerg Med Australas. 2013
Dec 1, 2017 · 27 min
December 2017; papers of the month
You've got a critically unwell patient who needs an RSI. You've got lots of things to think about but specifically do you ramp them up or keep them supine, additionally do you use a checklist or are those things a complete waste of time? This month we have a look at 2 papers which should shed some light on the subject. We also look at a systematic review and meta-analysis which hopefully helps us answer a question we've been looking at on the podcast for quite some time: in the the context of a cardiac arrest that has gained a ROSC, if the ECG is not diagnostic of a STEMI but the history is suggestive of a cardiac event, should the patient go straight to the cathlab for PCI? As always don't just take our word for it but go and have a look at the papers yourself and we would love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults. Semler MW. Chest. 2017 A Multicenter Randomized Trial of a Checklist for Endotracheal Intubation of Critically Ill Adults. Janz DR. Chest. 2017 Early coronary angiography in patients resuscitated from out of hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis. Khan MS. Resuscitation. 2017 JC: Should non ST elevation ROSC patients go to cath lab? St.Emlyn's CHECK-UP Checklist; The Bottom Line
Nov 20, 2017 · 44 min
Traumatic Arrest; Roadside to Resus
Traumatic Cardiac Arrest; for many of us an infrequent presentation and it that lies the problem. In our previous cardiac arrest podcast we talked about the approach to the arresting patient, however in trauma the approach change significantly. We require a different set of skills and priorities and having the whole team on board whilst sharing the same mental model is key. Have a listen to the podcast and let us know your thoughts. The references are below but if you only read one thing take a look at the ERC Guidelines on traumatic cardiac arrest which we refer to. Enjoy! Simon, Rob & James References & Further Reading Resuscitation to Recovery Document Roadside to Resus; Cardiac Arrest ERC Guidelines; Traumatic Arrest Traumatic cardiac arrest: who are the survivors? Lockey D. Ann Emerg Med. 2006 Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest. Wah W. Am J Emerg Med. 2017 Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. Beck B. Resuscitation 2017. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. Seamon MJ. J Trauma Acute Care Surg. 2015 EAST guidelines 2015; ED Thoracotomy FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation. Inaba K. Ann Surg. 2015
Nov 10, 2017 · 26 min
Massive PE Thrombolysis
If you talk to people about the topic of thrombolysis in PE they'll tell you about the controversy of the submassive category, but there's a universal acceptance that thrombolysing massive PE's is well evidenced and straight forward. In this episode we delve back into the literature and not only explore massive PE thrombolysis, but also the gold standard to which it is judged upon, heparin. Have a listen to the podcast and as always we would love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism British Thoracic Society guidelines for the management of suspected acute pulmonary embolism; 2003 Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report; 2016 Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. A Scientific Statement From the American Heart Association. 2011 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing; NICE. 2012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1438862/pdf/jrsocmed00257-0051.pdfValue of anticoagulants in the treatment of pulmonary embolism: a discussion paper. Paul Egermayer. Journal of the Royal Society of Medicine 1981. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. BARRITT DW. Lancet. 1960 Treatment of pulmonary embolism in total hip replacement. Johnson R. Clin Orthop Relat Res. 1977 PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. Dalla-Volta S. J Am Coll Cardiol. 1992 Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Goldhaber SZ. Lancet. 1993 Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism. A Meta-Analysis of the Randomized Controlled Trials. Susan Wan. 2004 Massive PE and cardiogenic shock. To thrombolyse or not to thrombolyse, that is the question. Francoise Ticehurst. BestBets. 2004
Nov 1, 2017 · 24 min
November 2017; papers of the month
Welcome back to November's papers podcast! This month we've got some great topics to discuss. We look at another paper on the topic of oxygen therapy, this time a hug article from JAMA on oxygen therapy in the context of acute stroke and the impact on disability. Next up we look at a fascinating case report of a extradural haematoma that was drained via an I.O. needle prior to surgical evacuation. Lastly we follow up on our previous podcast on PE; the controversy, which looked at the prevalence of PE in those patients presenting with undifferentiated syncope. This paper puts a great counter to the conclusions arrived at in that Prandoni paper. Enjoy! Simon & Rob References & Further Reading Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial. Roffe C. JAMA. 2017 Temporising extradural haematoma by craniostomy using an intraosseous needle. Bulstrode H. Injury. 2017 Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. Oqab Z. Am J Emerg Med. 2017
Oct 16, 2017 · 54 min
Return in spontaneous circulation; Roadside to Resus
Last time in Roadside to Resus we discussed cardiac arrest with a view to obtaining a return in spontaneous circulation, ROSC. However gaining a ROSC is just one step along the long road to discharging a patient with a good neurological function back into the community. In fact ROSC is really where all of the hard work really starts! In this podcast we talk more about the evidence base and algorithms that exist to guide and support practice once a ROSC is achieved. We'd strongly encourage you to go and have a look at the references and resources yourself listed below and would love to hear your feedback in the comments section or via twitter. Enjoy! Simon, Rob & James References & Further Reading Resuscitation to Recovery Document Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. Niklas Nielsen. N Engl J Med 2013 Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Dumas F. Circ Cardiovasc Interv. 2010 Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Sandroni C. Resuscitation. 2013 Roadside to Resus; Cardiac Arrest PCI following ROSC; TRR