We've got a great spread of topics for you this month, stretching all the way from Prehospital Critical Care, to core Emergency Medicine topics. Those of us seeing 'non-specific' complaints will appreciate how difficult they can be to diagnose and manage effectively. We have a look at a paper that helps characterise this group and give some context to their mortality risk. This may well help inform conversations and decision making with this patient group. Recent literature has looked at a more conservative management for traumatic pneumothoraces, but what about those that are spontaneous? The British Thoracic Society has guidelines for how we should deal with them but a recent RCT in the New England Journal of Medicine looks at an even more conservative approach for our patients; can we decrease the number of aspirations and drains that we are performing? Finally we've covered recently a paper on the topic of Prehospital Critical Care on the outcomes for patients in cardiac arrest, in this episode we have a look on their impact in trauma patients and hear from the lead author Ali Maddock on the implications of the study's findings. Enjoy! Simon & Rob

March 2020; papers of the month

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Lower back pain is a really common cause for patients to present to primary care, urgent care and emergency care. Thankfully many of these cases are self limiting, but somewhere in the region of 1:300 patients with back pain in the ED will have Cauda Equina Syndrome. Cauda Equina Syndrome is something that is challenging for all clinicians because many patients with simple lower back pain may have many similar symptoms,  but if we miss it, or if there is a delay to surgery that can lead to potentially avoidable long-term disability for our patients and on top of that its a major cause of healthcare litigation. And we’re not talking about a delay in weeks being a problem here, we’re talking about hours to days, with big  potential complications like impaired bowel/bladder/sexual dysfunction or lower limb paralysis - so you can see why litigation is a big part of some missed cases. In this episode we run through the the signs, symptoms, investigations and treatment with a strong reference back to the underlying anatomy and disruption. We also cover the recently published national Cauda Equina Pathway, which is a great resource but poses some real challenges in it’s implementation! Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Cauda Equina Syndrome; Roadside to Resus

Welcome back to the podcast! Three more papers covering topics that are relevant to all of our practice. The importance of removing wet clothes from patients is often discussed, both to prevent hypothermia and increase patient comfort. But how important is it to get wet clothes off and is it something we can defer to a different point? We start off taking a look at an RCT on this very question. Next up another RCT, this time looking at the efficacy of morphine, ibuprofen and paracetamol for patients with closed limb injuries. Which one, or combination, would you think would be most efficacious… Lastly, following on from our most recent Roadside to Resus episode, we take a look at a paper on the association between end tidal CO2 levels and mortality in prehospital patients with suspected traumatic brain injury. This paper highlights really well the need understand the fundamentals that contribute to ETCO2 when applying to clinical practice.  Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

April 2024; papers of the month

End Tidal CO2, or ETCO2 for short, is something that’s talked about pretty often in Emergency and Critical Care and that’s because it’s used a lot in the assessment and treatment of patients! It’s got a big part to play in airway management, resuscitation, sedation and is also increasingly used in other situations. Some of these applications have some pretty strong evidence to back them up but others are definitely worth a deeper thought, because without a sound understanding of ETCO2 we can fall foul of some traps… ETCO2 is a non-invasive measurement of the partial pressure of CO2 in expired gas at the end of exhalation. Ideally we’d like to know what’s really going on arterially with the partial pressure of arterial CO2 but we can use the end tidal because that’s an easy reading to get from exhaled breath, when it will most closely resemble the alveolar CO2 concentration. Its value is reflective of ventilation but also really importantly is affected by the circulation, the circuit and how it’s applied. In the podcast we run through all of these aspects, its application to clinical care and also some of its pitfalls.  Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

End Tidal CO2; Roadside to Resus

Welcome back to the podcast, a new month, three more papers and discussion around the topics. We kick off with a paper comparing mechanical ventilation in CPR compared to the more traditional hand ventilation; what difference does the machine make to ventilation in arrest and should we be changing to this strategy as a standard? We've talked about aneurysmal subarachnoid haemorrhage a fair amount on the podcast and the second paper looks at the effectiveness of lumbar CSF drain compared to standard care with some pretty staggering results! Lastly we take a look at a paper exploring decision making in prehospital trauma, specifically with regard to blood transfusion. This is a great paper to focus on the complexities of decision making, understand decision making strategies, recognise areas of weakness and consider how aspects of these can be used educationally and to improve emergency care for our patients. Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

March 2024; papers of the month

As we all know, rapid and effective resuscitation makes a huge difference to the chance of survival from a cardiac arrest. If you’re going to pick a rhythm to have as the patient or as the Resuscitationist, then it’s going to be a shockable rhythm, so VF or pulseless VT as they hold the greatest chance of survival. You'll find an initial shockable rhythm in around 20% of cases & defibrillation alone may lead to a ROSC. So it’s absolutely imperative to get the immediate management spot on! Whilst current practice is good, there are some aspects of care that we can improve on and make a real difference to outcomes in these patients, with those first on scene or at the bedside in a phenomenally important position to deliver life saving care. In this episode we’ll be talking predominantly about refractory VF but the strategy will transfer to how we can also deal with refractory VT cardiac arrests.  We'll be running through all of the following;  VF incidence Mechanisms behind VF Refractory and recurrent VF Defibrillation strategies Pharmacological strategies PCI in arrest ECMO  Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

March 2020; papers of the month

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