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...

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...

Welcome back to the podcast! This month we start off thinking about sepsis, specifically fluid management and whether a restrictive approach to fluid resuscitation in combination with earlier vasopressors is advantageous over a liberal approach. Next we have a look at a study evaluating the diagnostic benefit of ultrasound in the prehospital setting. Finally we have a think about the benefit that traumatic brain injury patients may benefit from with regards to beta blocker therapy. Once...

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...

Welcome back to the podcast! ECMO-CPR is a growing conversation in the world of cardiac arrest management. This month we have a look at a paper which adds some great evidence to the overall picture; with an RCT on ECPR in refractory of out of hospital cardiac arrest. How will this compare to the amazing results from the ARREST trial? Next up is a really informative paper looking at the utility of ultrasound in suspected testicular torsion in children, this may make a difference to your...

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...

Welcome back! Three more papers for you this month to inform and improve our care in acute and critical illness. First up and following on from the recent DoseVF paper, we take a look at a study looking at the combined effect of vector change, esmolol and capping adrenaline administration in refractory VF with regards patient out ones. Could this be associated with even better patient outcomes? Secondly we take a look at the utility of fentanyl lozenges in providing effective analgesia to...

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,...

Welcome to 2023 and a very happy New Year! We hope you managed to get some time with your loved ones over the festive period and we're back with the podcast again to kick off the new year. First up, we take a look at a paper assessing whether there is benefit to treatment with thrombolytics or anticoagulants for patients in cardiac arrest due to a presumed MI. Next up we look at the potential harm in administering steroids to patients with COVID-19 nor requiring supplemental oxygen. ...

So following on from our Bradycardia episode, we're going to look in detail at cardiac pacing. Setting up emergency pacing in those compromised bradycardia patients can make a significant difference to patient outcomes, and doing so in a timely and slick fashion can be a real challenge. In this episode we'll be discussing all forms of pacing, strategies for ensuring the greatest likelihood of success and the details of setup and analgesia/sedation strategies for external pacing. Once again...

Welcome back to 200th episode of the podcast! A huge thank to all of you for your support and engagement. Three more papers for you this month to challenge thinking across a board range of Emergency Care. First up we take a look at DOSE VF, an RCT look at the best defibrillation strategy for refractory VF. Next we take a look at another RCT looking at the potential benefit of dexamethasone, in order to reduce pain in patients suffering with renal colic. Last up, we've talked a lot about...

Acute Behavioural Disturbance (ABD), one of the most challenging, dangerous and serious presentations that we will encounter in emergency management of patients. There is no widely accepted definition of ABD. Really it’s an umbrella term for a patient presenting with a triad of features, secondary to a specific underlying cause, made up of; Delirium Severe agitation and aggressive behaviour Autonomic dysfunction In this episode we're going to run through ABD, it's causes, the approach and...

Welcome back to the podcast and to November's Papers Of The Month. First up we're taking a look at a paper that challenges the current American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines that recommend when right ventricular myocardial infarction, that patients are not administered nitrates due to the risks of compromise of cardiac output.  Secondly we look at an RCT, with some really clever blinding, that looks at different BP targets for intubated and...

We’ve covered tachycardias, both narrow and broad before, but we need to complete the set.  So this time we’ll be looking at the slower end of the spectrum, with bradycardias. Bradycardias can be a physiological state in athletes, but they can also be of significant concern. They occur due to a multitude of reasons, some cardiac and some not and they can require no treatment at all right up to those peri-arrest patients where you’ll be cracking open your critical care drugs and starting to...

Welcome back to the podcast! First up this month we're going have a think about fluid therapy, following an RCT focussing on those patients attending ED with moderate severity acute pancreatitis; are we flooding them with fluid & should we ease off? Next we take a look at a paper evaluating the intubation performances between CCPs and physicians in prehospital anaesthesia of trauma patients. Lastly we look at another RCT, this time comparing the benefit of surgical versus conservative...

Despite all the improvements that we have seen in trauma care over the past 20 or more years RTCs are still, sadly, a really common cause of both death and disability, with the number of deaths annually in the UK sitting somewhere between 1500-1900 per annum. Survivors, who have serious injuries and are left with ongoing disabilities, total 22,000 people per year. So anything we can do to improve care to these patients is definitely worth looking at and learning about! Extrication is the...

Welcome back to the podcast! It's brilliant to be back after our summer break and we've got three great papers for you. First up we take a look at a paper looking at the association the a geriatric assessment can make on the mortality of patients aged 65 years and older, admitted with significant injuries to our UK major trauma centres. Next up we take a look at a newly proposed method to simple chest compressions in cardiac arrest, by comparing it to chest and abdominal compression and...

Welcome back! This month we take a look at 3 papers covering the breadth of Emergency Care. First up we look at a paper evaluating outcomes for patients discharged on scene by an EMS service; how many reattend ED, how many require ICU care and what is the associated mortality rate? NEXUS and Canadian c-spine rules both incorporate the presence of c-spine tenderness when deciding whether to image the neck as a result of trauma. But what is the prevalence of c-spine tenderness without trauma...

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,...

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...

Welcome back to June '22 papers podcast! This month we start off with a look at rocuronium dosing in RSI; could a simple change of dosage lead to an increased first pass success for our intubations? Next up we take a look at the use of TXA in trauma, with specific focus on gender based inequality in its use and a trial with shocking results. Finally we take a look at a paper focussing on outcomes of cardiac arrest and cut-off points with regards to duration of resuscitation; could this...

We talk a lot about the different skills involved in the management of the critically unwell patient; CPR, airway management, defibrillation, chest drains, RSI etc, etc…..but there is another aspect which is arguably as important and that is the non-technical skills involved in resuscitation. In this podcast we discuss non-technical skills, followership, leadership and different models of working. What’s really important to remember in this episode is that at the centre of  leadership and...

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...

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...