Welcome back! In this episode, we’re diving deep into something we all think we know, the Glasgow Coma Scale.

The GCS has been a fundamental part of assessing patients with altered consciousness for over 50 years. You’ll find it in trauma scores, neurology exams and practically every prehospital and ED handover. But here's the thing, is it as reliable and useful as we think?

In this episode, we’ll explore the origins of the scale, what it was designed for and how it’s been used (and maybe misused...) since. We take a look at how reproducible it really is, particularly when different clinicians score the same patient. Spoiler alert: it’s not always as consistent as you might hope!

We’ll also unpack the individual components; eyes, voice, motor and ask if they all carry equal weight, or are some more prognostically useful than others? Because a GCS of 4 isn’t always the same GCS of 4, depending on how you get there…

We’ll be looking at real-world implications, how we make decisions around airway management, imaging, and referral, all based on that one number.

So whether you’re in prehospital care, the ED, or intensive care - stick with us as we try to answer the question: is the GCS still doing what we need it to, or is it time to move on?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to the podcast!

We've got three papers this month covering the breadth of Emergency Care presentations and locations; from prehospital arrests, ketamine for analgesia in trauma and those complex elderly patients presenting with abdominal pain.

First up we look at the use of prehospital thrombolysis for out of hospital cardiac arrest, something some critical care services are using for suspected PEs and MIs. But what are the outcomes for these patients and how accurate are the clinical suspicions that lead to the thrombolysis?

Next up we look at an excellent prehospital RCT, PACKMaN, on the use of ketamine vs morphine for patients with pain following trauma. Is ketamine safe? Is it superior? And what is the side effect profile of each of these approaches? We're also lucky enough to have the lead author, Mike Smyth, come on to give his thoughts on the paper and what it might mean for clinical practice

Finally we have a think about abdominal pain in the elderly population. Without a cause for the pain being found this can feel like a very high risk group of patients to discharge. Our final paper helps quantify that risk further, inform our decision making and identify factors that are associate with an increased morbidity and mortality.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Opioid toxicity is a major and growing challenge across the UK and beyond, with nearly 10 deaths every day from opioid overdose and over a million adults using Class A drugs annually, the impact on emergency services is enormous.

In this episode, we’re diving deep into the recognition and management of acute opioid toxicity in the emergency setting, including the reversal using naloxone.

We’ll run through;

• The scale of the problem, including the rise of novel synthetic opioids like fentanyl and nitazenes.
• A breakdown of opioid pharmacology, including receptor types, potencies, and onset of action.
• How to identify classic and mixed presentations of opioid overdose.
• Best practice on naloxone dosing, routes of administration, and when to start infusions.
• The risk of acute withdrawal and how to manage it with care.
• How to approach mixed overdoses, cardiac arrests involving opioids, and nebulised naloxone.
• And finally, the importance of holistic care, safeguarding, and onward referral to support recovery.

Whether you’re in ED, prehospital care, or just want to sharpen your tox knowledge, this episode’s packed with take-home learning. Oh, and yes... Gangs of London gets a shout-out too.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to April's Papers of the Month!

First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at the use of three bedside scoring systems; HINTS, TriAGe+ and ABCD2 scores in ED for patients presenting with possible posterior circulatory strokes. How accurate are they and can we reliably incorporate into our practice?

Next up is traumatic cardiac arrest. This has obviously got a very high mortality rate. One of the interventions that might improve mortality (for some mechanisms and patients) is a resuscitative thoracotomy, however this is a really significant intervention and we want to ensure we are targeting it at the patients that may benefit. A great paper has just been published from London Air Ambulance which might just help us to identify those patients who would benefit with more certainty, along with those where futility has already been reached.

Finally we take a look at acute kidney injury (AKI) and its association contrasted scans. Contrast induced nephropathy (CIN) has historically been a concern, particularly for patients with chronic kidney disease, with contrast causing direct injury and limited blood flow. But recent studies have questioned the actual risk of CIN & there’s been a more recent RCEM statement on the topic, but we thought this might be a nice opportunity to refresh and look at a recent paper on the topic.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Welcome back to The Resus Room! This time, we’re diving into the fascinating and often overlooked world of electrical injuries. From household mishaps and workplace accidents to tasers and even lightning strikes, electrical injuries can range from minor shocks to life-threatening cardiac arrests.

As always, we’ll be taking you through the full spectrum of care, from first contact at the roadside to critical management in resus. And let’s be honest, there’s a real lack of clear guidance out there when it comes to managing these cases. So, we’ve done the legwork, scoured the literature, and we’re here to make sense of it all.

In this episode, we’ll cover:

• Pathophysiology; how electricity interacts with the body and why not all shocks are created equal.
• Classification; what makes a low-voltage injury different from a high-voltage one, and why that matters.
• Prehospital & ED Management; who needs an ECG, who needs admission, and what to do with those tricky "seemingly fine" patients.
• Special cases; tasers, lightning strikes, and the unique challenges they pose.

One of the big questions we’ll be tackling: Does everyone who gets an electric shock need to go to hospital? We’ve all seen them, the patient that has a shock at work, but they feel fine. So, do they need a work-up, or can they safely go home?

So, grab a coffee (or maybe a non-conductive beverage of choice), and let’s get stuck in to Electrical Injuries!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to March 2025's papers podcast!

We start off this month with a fascinating paper looking at the experiences of relatives who were witness to unsuccessful resuscitation. We often talk on the podcast about the impact of medical or technical interventions, but this paper offer us an opportunity to consider the huge impact of our non-technical elements of practice and reflect on how we can best support relatives whilst still performing resuscitation to the best of our abilities.

Next up we look at a paper deriving and validating a new adult trauma triage score The sBATT that predicts early mortality and need for intervention.

Lastly we have a think about the use of adrenaline in out of hospital traumatic cardiac arrests; what association does it have on outcomes?

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

Cardiac Arrest in pregnancy affects around 1: 12-30,000 women in the developed world.

As you’d expect the risk of death for mother and child is extremely high, but some causes of arrest are reversible and we can make a real impact with our care and treatment of these cases

Now it goes without saying that these are some of the most emotive, complex and technically challenging Resuscitations that you could think to be involved in; by definition young female arrest with unborn babies involved.

Thankfully this is not going to be a case that many of us see, but with the stakes so high and potential to impact on the outcome of two patients, it’s an area that’s worth real consideration, preparation and mental rehearsal in case we are one of the few that may need to deal with it!

In this episode we’re going to run through all the same stuff that you’d expect; pathophysiology of pregnancy, aetiology and the way in which we should approach these arrests. But then we’re lucky enough to be joined by Caroline Leech, an EM and Prehospital doctor who’s an expert in the area having just published a key paper that’s prompted loads of discussion in crew room and online on the topic of maternal arrest and Resuscitative Hysterotomy which will really challenges our perception on survival for both mum and the unborn baby if a RH is indicated.

So we’ll be running through that paper with some really valuable insights from Caroline and wrap up with some questions to her exploring experience from cases, along with potential strategies for how approach and manage these cases for those working both in prehospital and in-hospital settings.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to February 2025's papers podcast!

This month we're exploring papers on seizure management, oxygen strategies in trauma, along with transfusion strategies in patients with traumatic brain injuries.

First up we look at at a paper exploring the potential benefit of adding ketamine into the strategy for treating patients with status epilepticus. Does it help to more reliably terminate seizures and what can we take from the paper?

Trauma courses frequently mention the use of high flow oxygen in the management of trauma patients. But recent evidence in non-trauma patients has questioned whether we should be more targeted with oxygen therapy to optimise outcomes in other conditions. We take a look at an RCT looking to answer the question of which out of liberal or targeted oxygen therapy in trauma is the best approach.

Finally we look at another RCT, this time focussing on traumatic brain injury and the transfusion strategy we should take to those who are anaemic. This is a really interesting paper, with great methodology and a lot to talk about from the conclusion!

Welcome back to the first Roadside to Resus episode for 2025!!

In this episode, we’re diving into a seasonally appropriate, and really paediatric common presentation for anyone involved in emergency care….Bronchiolitis. 

Now although it’s one of the most common respiratory illnesses affecting kids, bronchiolitis can easily cause confusion and concern around the severity of illness, whether to convey/admit/discharge, and also which treatments are indicated and which aren’t, including the perennially hot topic of bronchodilators.

In this episode we’re going to and delve into all of those aspects & explore the evidence and guidelines that are out there for bronchiolitis, including the NICE guidelines on the topic.

So, whether you're on the frontlines of paediatric emergency medicine or just brushing up on your knowledge, this episode…hopefully…will be packed with practical insights to enhance your care in those patients with bronchiolitis or even the differentials!

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Happy New Year!!!

We hope you've had some time off over the festive period and now we're back to kick start the new year with three more great papers.

Syncope is common presentation to the Emergency Department, accounting for 1% of presentations. Without a clear precipitant of the event it can be challenging to identify those patients who have a higher risk of associated morbidity and mortality, and furthermore those who would benefit from further investigation and observations. Our first paper looks at syncope risk-stratification tools and sheds some light on their utility.

Acute exacerbations of COPD with acute type 2 respiratory failure and frequently treated with non-invasive ventilation (NIV), with high flow nasal oxygenation a treatment normally for patients in type 1 respiratory failure. However our second paper is a fantastic RCT looking at the the application of either NIV or high flow nasal oxygenation in those type 2 COPD exacerbations, are both options for our patients?

Finally, since the advent of trauma networks in the UK, prehospital patients have been triaged to the most relevant centre based upon trauma triage tools. Our third paper looks at the performance of these tools and gives valuable insights for both those clinicians using the tools and those receiving trauma patients in both MTCs and other trauma units.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob