PHEMCAST

PHEMCAST

By Tim Nutbeam and Clare BosankoMedicine
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PHEMCAST episodes

  • Episode 8: Chemical Suicide

    The recent resurgence in this method of suicide has put emergency responders at a significant increase of serious injury and death.

    This podcast discussed the current most frequent methods of attempted and successful inhalational suicide  – keep safe.

     

    https://phemcast.co.uk/wp-content/uploads/2016/04/chem-final.mp3

     

    There are a multitude of professional and advisory websites out there.

    We are keen not to raise awareness of specific combinations of chemicals / products.

    35 min
  • Episode 7: Sepsis

    https://phemcast.co.uk/wp-content/uploads/2016/04/ph-sepsis-10042016-08-56.mp3

    We hope you enjoyed our sepsis podcast. It is obviously a huge topic and there is lots of information to cover; a couple of other recently released podcasts are available which are produced with the Emergency Medicine community in mind, but will no doubt expand your knowledge.

     

    St Emlyns Induction podcast on Sepsis. March 2016. A great summary of what to do when a patient with suspected sepsis first arrives in the ED.

    And from our buddies at HEFT EM CAST:

    http://www.heftemcast.co.uk/sepsis-in-the-ed/

    A bit more detail covering some of the research in an easy to understand way. It particularly discussed the original Rivers trial which we mention in the podcast.

    It’s worth remembering that sepsis is a spectrum of disease when assessing patients.

    It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required…

    The Rivers’ paper can be accessed here: http://www.nejm.org/doi/full/10.1056/nejmoa010307

    It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT). This is what the study did:

    As you will see the trial was relatively small – with only 263 patients being recruited into the trial. What was impressive, and changed practice, forming the basis of the Surviving Sepsis Campaign, was the significant reduction in mortality. Patients in the standard care group had a mortality of 46% compared with the treatment group 30%, which was statistically significant (p=0.009).

    Further large randomized controlled studies to try and demonstrate the same mortality benefit from Rivers-style EGDT have not shown the same results (Process, Arise, PROMISe). Patients in these trials were randomly assigned to one of two groups. The ‘intervention’ group received the new treatment, in this case EGDT, which was being tested. The ‘standard care’ group were looked after according to how the clinician would usually treat a patient with severe sepsis. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. The mortality in both groups in all 3 trials was similar, there was not the significant reduction in mortality seen in the Rivers study. This was probably because, as we say in the podcast, ‘standard’ care for sepsis has improved considerably in the intervening years. The control group received many similar treatments as the ‘intervention’ group (just not full protocolised EGDT) highlighting that with good sepsis care (fluid resuscitation, close monitoring, early appropriate antibiotic administration), mortality can be reduced.

    Red flag sepsis is a way of identifying those patients with sepsis who are high risk  and who warrant immediate treatment:

    Have a look at the UK Sepsis Trust website: http://sepsistrust.org. There are toolkits available to download, including one specifically written for the prehospital environment with the College of Paramedics, which summarises the recognition and management of sepsis.

     Link to the Sepsis-3 guideline. 

    Reviewed (again for the Emergency Medicine community) here.

    When Tim talks about test characteristics he is referring to the ability of a test to correctly identify the presence or absence of an illness. Some may think that if a test is positive it always means the patient has the illness, or indeed if it is negative it rules out the possibility of that illness but this is not the case with many of the tests we use.

    Think about ECG as an example, So, where the box is green, the test has given us the correct result for the patient. But, where the box is red the test has given us the incorrect result: you will all be able to think about patients in whom the ECG was normal, but the patient turned out to have had an MI, or when the ECG showed an MI but the patient turned out not to have had one. These tables are used when assessing the usefulness of a test (or it’s sensitivity and specificity), and, when researching how useful tests are we need the majority of patients to fall into the green boxes.

    We will put together a podcast on test characteristics over the next couple of months, which will explain this in more detail. An amazing podcast on the subject can be found at SMART EM: SMART Testing: Back to Basics

    As always, any feedback, comments etc. – please let us know on the blog below!

    1. Herlitz J, ng AB, m BW-S, Axelsson C, Bremer A, Hagiwara M, et al. Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care. Scand J Trauma Resusc Emerg Med. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine; 2012 Jun 27;20(1):1–1.
    2. Studnek JR, Artho MR, Garner CL, Jones AE. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. 2012 Jan;30(1):51–6.
    3. Puskarich MA, Marchick MR, Kline JA, Steuerwald MT, Jones AE. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Crit Care. 2009;13(5):R167.
    4. Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC. Severe Sepsis in Pre-Hospital Emergency Care. Am J Respir Crit Care Med. 2012 Dec 15;186(12):1264–71.
    5. Band RA, Gaieski DF, Hylton JH, Shofer FS, Goyal M, Meisel ZF. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. Academic Emergency Medicine. 2011 Aug 30;18(9):934–40.
    6. Seymour CW, Cooke CR, Heckbert SR, Spertus JA, Callaway CW, Martin-Gill C, et al. Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. 2014 Oct 28;:1–9.
    7. Trust US. You Gov Poll – Public Awareness of Sepsis. UK Sepsis Trust; 2014 Nov pp. 1–1.
    8. MD GEH, MD RET, MD RS, MD JDL, BS AMB, BS AJS, et al. ACCEPTED MANUSCRIPT. Am J Emerg Med. Elsevier B.V; 2015 Aug 26;:1–31.
    9. Amado Alejandro Baez MD MSc MFFF, MD LC. ACCEPTED MANUSCRIPT. Am J Emerg Med. Elsevier B.V; 2015 Oct 17;:1–16.
    10. Guerra WF, Mayfield TR, Meyers MS, Clouatre AE, Riccio JC. Early detection and treatment of patients with severe sepsis by prehospital personnel. J Emerg Med. 2013 Jun;44(6):1116–25.
    11. Gaieski DF, Mikkelsen ME, Band RA, Pines JM, Massone R, Furia FF, et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department*. Crit Care Med. 2010 Apr;38(4):1045–53.
    12. Yealy DM, Huang DT, Delaney A, Knight M, Randolph AG, Daniels R, et al. Recognizing and managing sepsis: what needs to be done? ??? ??? 2015 Apr 24;:1–10.
    13. Báez AA, Hanudel P, Perez MT, Giráldez EM, Wilcox SR. Prehospital Sepsis Project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers. Prehosp Disaster Med. 2013 Apr;28(2):104–6.
    14. Harnden A. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. BMJ. 2006 Jun 3;332(7553):1295–8.
    15. Femling J, Weiss S, Hauswald E. EMS Patients and Walk-In Patients Presenting With Severe Sepsis: Differences in Management and Outcome. South Med J. 2014.
    16. Gray A, Ward K, Lees F, Dewar C, Dickie S, McGuffie C, et al. The epidemiology of adults with severe sepsis and septic shock in Scottish emergency departments. Emergency Medicine Journal. 2013 Apr 12;30(5):397–401.
    17. Seymour CW, Cooke CR, Mikkelsen ME, Hylton J, Rea TD, Goss CH, et al. Out-of-hospital fluid in severe sepsis: effect on early resuscitation in the emergency department. Prehosp Emerg Care. 2010 Apr;14(2):145–52.
    18. Hahné SJM, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, et al. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ. 2006 Jun 3;332(7553):1299–303.
    19. Wang HE, Weaver MD, Shapiro NI, Yealy DM. Opportunities for Emergency Medical Services care of sepsis. Resuscitation. 2010 Feb;81(2):193–7

      20.  

      How to cite this podcast:

      Nutbeam T, Bosanko C. Sepsis. PHEMCAST. 2016 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

      37 min
    20. Episode 6: Oxygenation

      To provide a bit of balance following our earlier hyperoxia podcast, this episode we are discussing circumstances when we want to deliver extra oxygen to patients and ways to do this effectively, including an interview with Sydney HEMS Consultant Yash Wilmalasena on apnoeic oxygenation. Hope you find it useful!

      https://phemcast.co.uk/wp-content/uploads/2016/03/oxygenation-16032016-15-25.mp3

       

      Some of the stuff we talked about:

      Optimal patient positioning when managing the airway and assisting ventilation has traditionally been taught as ‘sniffing the morning air’, shown here.

      But now, learning from bariatric practice we are realising that ramping is better for airway optimisation. In this position the patient’s tragus is lined up with their sternal notch to make the airway as straight as possible.

      Taken from: http://www.emsworld.com/article/11264318/airway-management-and-ventilation-best-practices

      A water’s circuit looks like this:

      This is an image of the oxygenation dissociation curve mentioned in the podcast. Taken from Weingart & Levitan 2012.

      Here are some other great resources which demonstrate some of the principles we have discussed:

      Our Birmingham Emergency Medicine colleagues review the evidence so far for apnoeic oxygenation:

      http://www.heftemcast.co.uk/apnoeic-oxygenation/

      There are some short videos from Scott Weingart demonstrating some of the techniques discussed available here:

      http://emcrit.org/preoxygenation

      A well written blog post summarising the key features of a BVM from the Life in the Fast Lane team:

      http://lifeinthefastlane.com/ccc/bag-mask/

      This is a great (and entertaining!) video cast from Emergency Medicine colleagues in the States discussing and demonstrating techniques for optimal bag-valve-mask ventilation.

      References

      Wilmalasena Y, Burns B, Reid C, Ware S., Habig K. Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service. Annals of Emergency Medicine. 2015; 65(4): 371-376.

      Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine. 2012; 59(3): 165-175.

      Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed Sequence Intubation: A Prospective Observational Study. Annals of Emergency Medicine. 2014; 65(4): 349-355.

      Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the Emergency Department. The Journal of Emergency Medicine. 2010;

      Grant S, Khan F, Keijzers G, Shirran M, Marneros L. Ventilator-assisted preoxygenation: protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emergency Medicine Australasia. 2016: 28(1); 67-72.

      Von Goedecke A, Wenzel V, Hormann C, Voelckel WG, Wagner-Berger HG, Zecha-Stallinger A, Luger TJ, Keller C. Effects of face mask ventilation in apneic patients with a resuscitation ventilator in comparision with a bag-valve-mask. Journal of Emergency Medicine. 2006: 30(1); 63-67.

      Semier MW, Janz DR, Lentz RJ, Matthews DT, Norman BC, Assad TR, Keriwala RD, Ferrell BA, Noto MJ, McKown AC, Kocurek EG, Warren MA, Huerta LE, Rice TW. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. American Journal of Respiratory Critical Care Medicine. 2016; 193(3): 273-280. (FELLOW Trial)

      How to cite this podcast:

      Nutbeam T, Bosanko C. Oxygenation. PHEMCAST. 2016 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

      39 min
    21. Episode 5: Amputation

       

      https://phemcast.co.uk/wp-content/uploads/2016/02/amputation.mp3

       

      Welcome to PHEMCAST episode 5: Amputation

      One of the things we never want to have to do, but need to be prepared for. Have a listen, consider your kit, your top-cover arrangements, and when and how you may need to get this done.

      This podcast covers, which patients to consider, how to do it and discussion around consent, capacity and top-cover arrangements.

      This podcast features interviews with Professor Sir Keith Porter and Caroline Leech, which we hope you will enjoy.

       

      Which patients / scenarios:

      1. An immediate and real risk to the patient’s life due to a scene safety emergency.
      2. A deteriorating patient physically trapped by a limb when they will almost certainly die during the time taken to secure extrication
      3. A completely mutilated non-survivable limb retaining minimal attachment, which is delaying extrication and evacuation from the scene in a non-immediate life-threatening situation.
      4. The patient is dead and their limbs are blocking access to potentially live casualties.

        5.  

        Which kit:

        • CAT x 2
        • Scalpel
        • Gigli saw (and spare)
        • Arterial forceps x 4
        • Tuff Cut scissors
        • Appropriate dressing (e.g. Israeli combat bandage)

          •  

          Preparation:

          • Sedation or anaesthesia
          • Brief team
          • Plan next phase

            •  

            Stages of amputation process:

            • Apply an effective proximal tourniquet.
            • Amputate as distally as possible.
            • Perform a guillotine amputation.
            • Apply haemostats to large blood vessels.
            • Leave the tourniquet in situ.

              • (consider IV antibiotics if can be delivered as concurrent activity)

               

              Please contribute to the blog below – specifically around top cover arrangements, decision making and individual competency around this procedure.

               

              References:

              Porter KM. Prehospital amputation. Emerg Med J. 2010 Dec 1;27(12):940–2.

              Reid C, Clancy M. Life, limb and sight-saving procedures–the challenge of competence in the face of rarity. Emerg Med J. 2013 Feb 1;30(2):89–90. .

              Porter K. Ketamine in prehospital care. Emerg Med J. 2004 May 1;21(3):351–

              Brodie S, Hodgetts TJ, Ollerton J, McLeod J, Lambert P, Mahoney P. Tourniquet use in combat trauma: UK military experience. J R Army Med Corps. 2007 Dec 1;153(4):310–3.

              Akporehwe NA, Wilkinson PR, Quibell R, Akporehwe KA. Ketamine: a misunderstood analgesic? BMJ. 2006 Jun 24;332(7556):1466.

              McNicholas MJ, Robinson SJ, Polyzois I, Dunbar I, Payne AP, Forrest M. ‘Time critical’ rapid amputation using fire service hydraulic cutting equipment. Injury. 2011; 42: 1333-1335.

              39 min
            • Episode 4: Chemical incidents

              https://phemcast.co.uk/wp-content/uploads/2016/01/chemical-incidents.mp3

              We hope you enjoyed this PHEMCast. Please feedback your comments via the blog, twitter or email us on [email protected].

              The NARU video we mention in the podcast can be accessed here:

              http://naru.org.uk/videos/ior-nhs/

              And the paper we discuss is:

              • Chilcott RP. Managing mass casualties and decontamination. Environmental International. 2014; 72: 37-45.

                • This is the Step 1,2,3 tool described:

                For more information on the toxidromes associated with various chemicals, biological agents and radiation sources have a look at this document (admittedly it’s a few years old but the content is still good, especially the flow chart which is pasted below):

                http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340709/Chemical_biological_radiological_and_nuclear_incidents_management.pdf

                What is an anti-muscarinic chemical?

                • Anti-muscarinic = blocking the muscarinic receptors, ie blocking the effect of acetylcholine, hence also called anti-cholinergic. Impacts on parasympathetic stimulation. Antimuscarinic effects include dilated pupils (leading to blurred vision), reduced secretion of saliva (hence dry mouth), sweat and digestive juices. Relaxation of smooth muscle causing urinary retention, ileus. Also tachycardia, confusion progressing to delirum/coma.
                • Nerve agents inhibit anticholinesterase therefore there is an excess of acetylcholine resulting in opposite features: diarrhoea, urination, miosis, increased bronchial secretions, bronchoconstriction, vomiting, lacrimation, salivation.

                  •  

                  Always ahead of the curve… St Emlyns have recently published a blog post on this very topic! It’s great, so have a read:

                  http://stemlynsblog.org/cbrn-an-introduction/

                   

                  Further Reading

                  1. Monteith RG. Pearce LDR. Self-care Decontamination within a Chemical Exposure Mass-casualty Incident. Prehospital and Disaster Medicine. 2015; 30: 288-296.
                  2. http://chemm.nlm.nih.gov/mmghome.htm
                  3. Centers for Disease Control and Prevention. Chemical Suicides in Automobiles – Six States, 2006-2010. JAMA. 2001; 306(16): 1751-1753.
                  4. http://www.msdmanuals.com/en-gb/professional/injuries;-poisoning/poisoning/general-principles-of-poisoning#v1118045
                  5. https://www.england.nhs.uk/wp-content/uploads/2015/04/eprr-chemical-incidents.pdf
                  6. JRCALC http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/chemical_biological_radiological_and_nuclear_incidents_2006.pdf

                    7.  

                    How to cite this podcast:

                    Nutbeam T, Bosanko C. Chemical Incidents. PHEMCAST. 2016 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

                     

                     

                    43 min
                  7. Episode 3: Hyperoxia

                     

                    https://phemcast.co.uk/wp-content/uploads/2015/12/episode-3-hyperoxia.mp3

                    Hello and welcome to our next episode – we hope you enjoy it. This episode concentrates on hyperoxia – the delivery of lots (often too much) oxygen and the harms it may cause our patients. We both had colds – many apologies for the blocked noses and many sniffs!

                    We hope you find it useful.

                    To follow: Dr Matt Thomas from the Great Western Air Ambulance discussing his groups work around reducing hyperoxia post-rosc.

                    Further reading:

                    1.  https://www.brit-thoracic.org.uk/guidelines-and-quality-standards/
                    2. Cornet AD, Kooter AJ, Peters MJL, Smulders YM. The potential harm of oxygen therapy in medical emergencies. Crit Care. 2013 Apr 11;17(2):313.
                    3. Rincon F, Kang J, Maltenfort M, Vibbert M, Urtecho J, Athar MK, et al. Association Between Hyperoxia and Mortality After Stroke. Crit Care Med. 2014 Feb;42(2):387–96.
                    4. Stub D, Smith K, Bernard S, Bray J, Stephenson M, Cameron P, et al. A randomized controlled trial of oxygen therapy inacute myocardial infarction Air Verses Oxygen InmyocarDial infarction study (AVOID Study). American Heart Journal. Mosby, Inc; 2012 Mar 1;163(3):339–345.e1. 3.    Asfar P, Singer M, Radermacher P. Understanding the benefits and harms of oxygen therapy. Intensive Care Med. 2015 Jan 30.
                    5. Calzia E, Asfar P, Hauser B, Matejovic M, Ballestra C, Radermacher P, et al. Hyperoxia may be beneficial. Crit Care Med. 2010 Oct;38:S559–68.
                    6. Asfar P, Calzia E, Huber-Lang M, Ignatius A, Radermacher P. Hyperoxia during septic shock–Dr. Jekyll or Mr. Hyde? Shock. 2011 Nov 21;37(1):122–3.
                    7. Cornet AD, Kooter AJ, Peters MJL, Smulders YM. The potential harm of oxygen therapy in medical emergencies. Crit Care. 2013 Apr 11;17(2):313.
                    8. Ligtenberg JJM, Stolmeijer R, Broekema JJ, Maaten ter JC, Zijlstra JG. A little less saturation? Crit Care. 2013 Jun 12;17(3):439.

                      9.  

                      How to cite this podcast:

                      Nutbeam T, Bosanko C. Hyperoxia. PHEMCAST. 2015 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

                      24 min
                    9. Episode 2: The Pelvic Binder

                      Sorry for the slight delay releasing our “October” podcast – but here it is (note how it is cunningly labelled Episode 2)! This month we are reviewing the evidence for the pelvic binder and discussing scenarios in which it should (and should not) be used.

                      https://phemcast.co.uk/wp-content/uploads/2015/09/pelvis-final-1.mp3

                      As always, please get in touch with questions and comments, either via the blog, twitter or email [email protected]

                      This is where the greater trochanters are:

                      This is where a binder should sit on the pelvis – it commonly ends up higher, either in application or ‘rides up’ during transfer – keep an eye on it!

                      These are the different types of fracture pattern that can occur in a pelvic fracture: of course patients can suffer from multiple force vectors so may end up with any combination of these fracture types.

                      Please click on this link below for our video on using a scoop to insert the pelvic binder…

                      As always… Get in touch!

                      References

                      1. Scott I, Porter K, Laird C, Greaves I, Bloch M. The prehospital management of pelvic fractures: initial consensus statement. EMJ. 2013; 30(12): 1070-1072.
                      2. Lee C, Porter K. The prehospital management of pelvic fractures. EMJ. 2007; 24: 130-133.
                      3. Prasarn ML, Conrad B, Small J, Horodyski M, Rechtine GR. Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability. Injury. 2013; 44: 1756-1759.
                      4. Trebilcock H. Reducing overtriage and undertriage rates if pelvic fractures and unnecessary pelvic binder applications in major trauma patients. EMJ. 2015; 32(6): e17.
                      5. DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: A cadaveric study. Injury. 2008; 39: 903-906.
                      6. Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. The Journal of Bone & Joint Surgery. 2002; 84A (2): 43-47.
                      7. Tan ECTH, van Stigt SFL, van Vugt AB. Effect of a new pelvic stabilizer (T-POD) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury. 2010; 41(12): 1239-1243.
                      8. Knops SP, Van Lieshout EMM, Spanjersberg WR, Patka P, Schipper IB. Randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers. Injury. 2011; 42(10): 1020-1026.
                      9. Mason LW, Boyce DE, Pallister I. Catastrophic myonecrosis following circumferential pelvic binding after massive crush injury: A case report. Injury Extra. 2009: 84-86.
                      10. Stewart M. BestBet: Pelvic circumferential compression devices for haemorrhage control: panacea or myth. EMJ. 2013; 30: 425-426.
                      11. Croce MA, Magnotti LJ, Savage SA, Wood GW, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. Journal of American College of Surgeons. 2007; 204: 935-942.
                      12. Knops SP, Schep NWL, Spoor CW, van Riel MPJM, Spanjersberg WR, Kleinrensink GJ, van Lieshout EMM, Patka P, Schipper IB. Comparison of three different pelvic circumferential compression devices: A biomechanical cadaver study. Journal of Bone & Joint Surgery. 2011; 93: 230-240.
                      13. Knops SP, van Riel MPJM, Goossens RHM, Lieshout EMM, Patka P, Schipper IB. Measurements of the exerted pressure by pelvic circumferential compression devices. The Open Orthopaedics Journal. 2010; 4: 101-106.

                        14. How to cite this podcast:

                        Nutbeam T, Bosanko C. The Pelvic Binder. PHEMCAST. 2015 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

                        29 min
                      14. Podcast: September 2015: The LMA

                        Here it is – our very first podcast, and guess what – it is on supraglottic airways!

                        https://phemcast.co.uk/wp-content/uploads/2015/08/version-2-lma.mp3

                        This first episode reviews the history of the laryngeal mask airway and we discuss the relative benefits and risks of supraglottic airway devices. We’ve interviewed Dr Rob Moss, author of the Faculty of Prehospital Care (FPHC) Consensus Guidelines on pharmacologically assisted laryngeal mask (PALM) insertion. Click here for the link to the guideline.
                        We also met Professor Jonathan Benger and discuss the role of supraglottic devices in patients in cardiac arrest. Please have a look at the airways 2 trial website here.

                        References and resources:

                        1. Benger JR, Voss S, Coates D, Greenwood R, Nolan J, Rawstorne S, et al. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of prehospital cardiac arrest (REVIVE-Airways): a feasibility study research protocol. BMJ Open. 2013 Jan 31;3(2):e002467–7.
                        2. Berlac P, Hyldmo PK, Kongstad P, Kurola J, Nakstad AR, Sandberg M. Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand. 2008 Jul 9;52(7):897–907.
                        3. Bosch J, de Nooij J, de Visser M, Cannegieter SC, Terpstra NJ, Heringhaus C, et al. Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation. Emergency Medicine Journal. 2014 Aug 14;31(9):750–3.
                        4. Cook T, Howes B. Supraglottic airway devices: recent advances. Continuing Education in Anaesthesia, Critical Care & Pain. 2011 Mar 15;11(2):56–61.
                        5. Deakin CD, Clarke T, Nolan J, Zideman DA, Gwinnutt C, Moore F, et al. A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008. Emergency Medicine Journal. 2010 Mar 19;27(3):226–33.
                        6. Deakin CD, Peters R, Tomlinson P, Cassidy M. Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emergency Medicine Journal. 2004 Dec 20;22(1):64–7.
                        7. Gruber C, Nabecker S, Wohlfarth P, Ruetzler A, Roth D, Kimberger O, et al. Evaluation of airway management associated hands-off time during cardiopulmonary resuscitation: a randomised manikin follow-up study. Scand J Trauma Resusc Emerg Med. 2013;21:10.
                        8. Hasegawa K, Hiraide A, Chang Y, Brown DFM. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA. 2013 Jan 16;309(3):257–66.
                        9. Kajino K, Iwami T, Kitamura T, Daya M, Ong ME. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care. 2011.
                        10. Mason AM. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series. Case Reports in Medicine. 2009;2009(3):1–7.
                        11. Middleton PM, Simpson PM, Thomas RE, Bendall JC. Higher insertion success with the i-gel® supraglottic airway in out-of-hospital cardiac arrest: A randomised controlled trial. Resuscitation. 2014 Jul;85(7):893–7.
                        12. Moss R, Porter K, Greaves I, consensus group Faculty of Pre-Hospital Care. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emergency Medicine Journal. 2013 Dec;30(12):1073–5.
                        13. Ostermayer DG, Gausche-Hill M. Supraglottic Airways: The History and Current State of Prehospital Airway Adjuncts. Prehosp Emerg Care. 2014 Jan;18(1):106–15.
                        14. Ramachandran SK, Kumar AM. Supraglottic Airway Devices. Respiratory Care. 2014 Jun 2;59(6):920–32.
                        15. Schmid M, Mang H, Ey K, Schüttler J. Prehospital airway management on rescue helicopters in the United Kingdom. Anaesthesia. 2009 Jun;64(6):625–31.
                        16. Tanabe S, Ogawa T, Akahane M, Koike S, Horiguchi H, Yasunaga H, et al. Comparison of Neurological Outcome between Tracheal Intubation and Supraglottic Airway Device Insertion of Out-of-hospital Cardiac Arrest Patients: A Nationwide, Population-based, Observational Study. J Emerg Med. 2013 Feb;44(2):389–97.
                        17. Wang HE, Szydlo D, Stouffer JA, Lin S, Carlson JN, Vaillancourt C, et al. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation. 2012 Sep;83(9):1061–6.

                          18. How to cite this podcast:

                          Nutbeam T, Bosanko C. The LMA. PHEMCAST. 2015 [cite Date Accessed]. Available from: http://www.phemcast.co.uk

                          1 hr 10 min

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                        A UK Prehospital Emergency Medicine Podcast.