A: Optimal airway position for infants Note how a rolled towel is placed under the baby’s shoulders to allow space for the occiput and avoid flexion of the neck and airway. ‘B’ assessment Video links to examples of children with signs of respiratory distress: Stridor Grunting Increased work of breathing ‘D’ assessment Example video showing … Continue reading Episode 35: The collapsed infant

So, where is the Cauda Equina? From Core EM How does a herniated disc cause CES? This fab infographic summarising the key points about the CES guidance was produced by @DrLindaDykes and @saspist. Here is the full guideline from The Society of British Neurological Surgeons and The British Association of Spinal Surgeons. NICE guidance on Low back … Continue reading Episode 34: Back pain

Many thanks to Suzanne O’Sullivan for her time in putting this podcast together. Her excellent books “It’s all in your head” and “Brainstorm” are well worth a read.   It is certainly one of the PHEMcast recordings which is going to change my own practice the most.   We can all find these patient’s challenging … Continue reading Episode 33: Psychosomatic Illness

      Huge thanks to the team at World Extreme Medicine and WEM Cast for sharing the interview with Richard Harris.       Dosing These are a guide only, each patient will need a bespoke approach depending on their pre-existing condition, degree of cardiovascular compromise, conscious level and drugs already administered. Clearly you … Continue reading Episode 32: Ketamine

  The Danish mnemonic to help remember the elements of a cerebellar neurological examination: There are lots of Youtube videos to demonstrate these signs, here are a few which I thought were particularly helpful: Disdiadochokinesis Ataxia Nystagmus Intention tremor If you would like to read more, there is a blog post Martin and I wrote … Continue reading Episode 31: Stroke & Dizziness

Quite a few of our previous podcasts include content which is relevant to this Head Injury one. Why not go back and have a listen to: Episode 3: Hyperoxia Episode 20: End Tidal Carbon Dioxide Episode 28: LOST (Low Output State in Trauma) Munroe-Kellie Doctrine The Munroe-Kellie Doctrine is illustrated by the following pictures: Or, … Continue reading Episode 30: Head injury

  Another invitation to the Trauma Care Conference this year inspired us to combine two of the excellent speakers into this podcast considering major incidents. Thanks to both our speakers for sharing their talks from the conference.   Trauma Care offer more than the annual conference; there are monthly webinars and regional meetings too, click … Continue reading Episode 29: Major Incidents

  Cardiac arrest is the end point, it is the symptom, not the diagnosis. The pathophysiological process varies, and this is particularly relevant in trauma vs medical. In medical cardiac arrest, the pathological processes tend to affect the heart’s ability to pump: eg primary cardiac event, chemical/electrolyte abnormality, but full circulation. In trauma the process is … Continue reading Episode 28: LOST

We recommend reading Atul Gawande’s book ‘The Checklist Manifesto’. It’s a well written, fascinating story about the introduction of the WHO Safer Surgery checklist and the impact it had. This link will take you straight to Amazon if you want to buy a copy (other internet retailers exist!!) To understand the how human factors failed … Continue reading Episode 27: Checklists

  The paper which we discuss in the interview is available open access here How does tranexamic acid work? Critical appraisal aids To understand more about hierachy of evidence and how a systematic review fits into this please have a look at these resources available from the Cochrane group. http://consumers.cochrane.org/levels-evidence http://training.cochrane.org/path/grade-approach-evaluating-quality-evidence-pathway The CASP checklist can … Continue reading Episode 26: Tranexamic Acid

Where can you undertake decompression of a pneumothorax? Be particularly careful when using the 2nd intercostal space mid-clavicular line that you are sufficiently lateral. For example, here are the locations identified as ‘2nd ICS mid clavicular line’ amongst 25 EM physicians in a 2005 EMJ paper. The Three Kings: George Clooney’s recommended approach to decompression … Continue reading Episode 25: Tension pneumothorax 2

Firstly, go and read Simon and Tim Harris’ great 2005 paper on the subject which we reference repeatedly in the podcast. It is available free open access here. A pneumothorax exists when air accumulates in the potential space between the visceral and parietal pleura: A tension pneumothorax exists when the air in the pleural cavity … Continue reading Episode 24: Tension pneumothorax 1

The various devices which Tony discusses are: This video shows the rapidity of infusion entering the circulation from a humeral IO. This is the paper mentioned by Tony, which shows the stepwise improvement in mortality amongst combat casualties from military conflict 2003-2012, including the ‘unicorn’ graph: Anatomy of bones and the humerus related to intraosseus access … Continue reading Episode 23: Intraosseus access

Guest contributor: Lauren Weekes What is ETCO2? % or partial pressure of carbon dioxide measured somewhere near the mouth at the end of a normal exhalation (hence end tidal, end of tidal volume breath) To get a measurement the following systems need to be functioning: Metabolically active tissue to produce CO2 Circulation & cardiac output … Continue reading Episode 20: End Tidal Carbon Dioxide

  The West Midlands surgical skills course offers cadaveric training for PHEM and EM practitioners on rare life saving procedures. Click here to go straight to their page. Anatomy The Guidelines Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk et al. Difficult Airway Society: Intubation guidelines working group. British Journal … Continue reading Episode 19: Surgical Airway

Many apologies for the delay in the release of this podcast! A second apology is due for the sound quality – it was recorded at a ‘live’ HEMS base – this has led to lots of background noise I am afraid. We have done our best to edit this out / reduce its effect but … Continue reading Episode 18: The Ventilator Part 2

This episode has been compiled over a year – many thanks to our four contributors, who have shared their stories and knowledge. They were interviewed at TraumaCare 2016, TraumaCare 2017 and the BASICS/FPHC Conference 2016. If you ever need to talk about the impact of stresses and work experiences on you, please find a friend, … Continue reading Episode 17: Broken? Impact on the rescuer

  There is the potential for significant controversy in this month’s episode – and we would really appreciate the feedback of the prehospital community on this one. We have held the ‘no clear fluids’ mantra close to our hearts for most of our prehospital careers. We ‘know’ that giving sea water to our patients, and … Continue reading Episode 16: “Blood”

Paediatric Trauma TARN report: Severe Injury in Children Simulation ATACC:The Anaesthesia Trauma and Critical Care course Thanks to Mark Forrest (@ObiDoc) for sharing these videos: References Spurr J, Gatward J, Joshi N, Carley SD. Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. EMJ. 2016. Bredmose PP, … Continue reading Episode 15: Paediatric Trauma & How to Do Sim

  Details of the surgical skills course mentioned in the podcast can be found here: https://wmstc.co.uk/portfolio/phem-ess/ The Sydney HEMS Traumatic Cardiac arrest operating procedure can be viewed on their website, and there are a number of useful references within the document: Policies and Procedures An excellent ‘how to do it’ paper, published in 2005, by … Continue reading Episode 14: Thoracotomy

Ventilation – a dark art. Difficult to be a master, easy to be average (or terrible)! This is “part 1”, which includes some of the basic (and not very basic) concepts behind ventilation. We recorded over 60 minutes of excellent content with George – we will post more below as soon as it is edited. … Continue reading Episode 13: The Ventilator

YouTube videos: From the police officer’s perspective: https://www.youtube.com/watch?v=toaA_TNwcxg From the mother’s perspective: https://www.youtube.com/watch?v=0KJZXOKStao The paper about watching resuscitation is this one: http://www.nejm.org/doi/full/10.1056/NEJMoa1203366#t=article This is a section taken from the London Ambulance Service clinical bulletin, from 2011, which includes the SPIKES mnemonic: The alternative mnemonic mentioned in the podcast is GRIEV_ING, which has been...

  The paper we mentioned by Jonathan Benger and Jules Blackham can be accessed here: https://sjtrem.biomedcentral.com/articles/10.1186/1757-7241-17-44 Stable versus unstable spinal injury The location of an injury and involvement of different structures defines the stability of a spinal injury. Anterior column: anterior longitudinal ligament and the anterior half of the vertebral body/disc. Middle column: posterior half of the vertebral … Continue reading Episode 11: Gentle Patient Handling