Podcasts about resus

Welcome back! First up a paper to challenge the way we think about rhythm recognition in cardiac arrest to start with, looking at the rate of VF identified on echo but not on the defibrillator. We have a huge amount of strategies to rule out acute coronary syndrome in the UK, our next paper looks at the clinical effectiveness of these, whilst also giving us some hugely important information about the incidence of ACS in those presenting to Eds. Finally we look at a paper quantifying the effect of hypertonic saline in those patients with a TBI. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom. We'll be taking a short break over the summer, but will be back in September with another Papers of the Month and Roadside to Resus, until then have a fantastic summer! Simon & Rob

This is a pretty special episode! If you're involved in cardiac arrest management or care of critically unwell patients then there's some ground breaking practice we'll be discussing with the two founders of the SPEAR course; Jon Barratt; Lt Col, British Army Emergency Medicine and PHEM Consultant, University Hospitals of the North Midlands Clinical Lead - Research and Clinical Innovation, Yorkshire Air Ambulance MERIT Consultant, West Midlands Ambulance Service Senior Lecturer, Academic Department of Military Emergency Medicine Paul Rees; Surgeon Commander Royal Navy Consultant, East Anglian Air Ambulance & Barts Heart Centre Lead for Resuscitation Barts Health NHS Trust Reader in Cardiology & Resuscitation, University of St Andrews & QMUL London Defence Lead for Endovascular Resuscitation SPEAR co-founder Ultimately in the episode we navigate through to the delivery of endovascular resuscitation both pre and in-hospital, building on the fundamentals of care and logistics which enable its delivery. We'll be covering; Blood pressure monitoring both invasive and non-invasive, the evidence and the cohort of patients we should be targeting with invasive blood pressure monitoring Delivering complex medical interventions in unpredictable circumstances and environments Balancing the benefits of interventions with time required and workflow REBOA for medical arrests, the theory and the ERICA trial Improving recognition of ROSC The SPEAR course How to prepare services and departments for upcoming advances in resuscitation There is something for everyone in here and a huge thanks to Jon and Paul for their time. Make sure to check out the links to the papers discussed in the episode below. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

It's something we all encounter in emergency and prehospital care, probably more than anything else, yet it's a topic we've not given a full episode to… until now! Up to 70% of prehospital patients and 60–90% of ED attendees report pain, with half of all ED presentations having pain as the primary complaint. That's millions of patients across Europe every year and we're not always optimising our approach! In this episode, we're diving deep into acute pain management; from understanding the complex biopsychosocial definition of pain, right through to tailored pharmacological and non-pharmacological strategies, plus everything in between. We'll be looking at how we define and assess pain and the importance of validating patient experience. Then we'll work through management options: from paracetamol to ketamine, NSAIDs to regional anaesthesia, and talk through barriers like bias, opiophobia, and the persistent inequalities in analgesic delivery. We'll also shine a light on special groups;  from paediatrics to chronic pain patients and those with opioid use concerns, finishing with key takeaways on safe discharge planning. This one's about being better at recognising, respecting, and relieving pain. Because pain is an emergency, and we've got the tools to do something about it. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Show notes by Heather Lean ACP, BSc ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠podcast.RnRRounds.ca⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Show notes by Heather Lean ACP, BSc ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠podcast.RnRRounds.ca⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

This week, we have another MiM25 presentation from Dr John Quinn discussing Damage Control Resuscitation in large-scale combat operations, particularly in Ukraine. He shares insights from his extensive experience in emergency medicine and highlights the unique challenges faced in combat medicine, including medical logistics, terminology, and telemedicine. Dr. Quinn emphasises the importance of training, clinical governance, and the need for effective blood supply management in austere environments. The conversation also touches on the evolving practices in casualty care and the impact of modern warfare on medical operations.TakeawaysUkraine has surpassed NATO in counterinsurgency experience.Effective medical planning is crucial for combat operations.Telemedicine enhances clinical decision-making in remote areas.Logistical challenges significantly impact casualty evacuation.Understanding the terminology is essential for interoperability.Innovations like RBOA are being utilised in combat medicine.Training and capacity building are vital for partner forces.Blood supply issues are critical in combat settings.Tourniquet management is a significant concern in Ukraine.Plasma is being used due to a lack of blood supply.Chapters00:00 Introduction to the CoROM Podcast00:45 Dr. John Quinn's Background and Experience02:13 Key Assumptions in Damage Control Resuscitation03:42 Medical Planning in Large-Scale Combat Operations05:11 Challenges in Medical Logistics and Command07:35 Understanding Terminology and Echelons of Care09:58 Tactical Combat Casualty Care and Innovations11:52 Telemedicine's Role in Combat Medicine13:47 Challenges in Casualty Evacuation15:40 Logistical Challenges in Blood Supply17:34 Wounding Patterns and Weapon Systems19:50 Medical Evacuation in Challenging Environments22:35 Training and Capacity Building in Ukraine24:59 Clinical Governance and Standards in Ukraine27:39 Transfusion Practices and Challenges30:54 Addressing Tourniquet Issues and Training33:39 Plasma Use and Blood Supply Challenges36:51 Conclusion and Future Directions

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

The hardest thing in medicine is to dial back a treatment.Link to full podcast:⁠https://spotifycreators-web.app.link/e/06Azb81cTSb⁠Thank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

We know the right answer, but we still don't follow it!Link to full podcast:https://spotifycreators-web.app.link/e/06Azb81cTSbThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

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 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

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

Why are they changing MARCH to Resus before managing the Chest? Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-214-TCCC-Updates-e2to67f Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

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

This is an episode we've been wanting to cover for a long time now! In it we explore the challenges in entering and developing in prehospital critical care, which translate into pretty much developing in any new role both in and out of health care. We cover some pretty personally challenging experiences and the strategies that both clinicians new to prehospital critical care may find useful to employ. We also discuss how supervisors can use these techniques to both guide and support new clinicians.  The four main areas discussed are; Decision making Prioritisation of tasks Leadership Incorporating evidence based medicine into practice We wrap up exploring how reflection can be used to accelerate growth as a clinician but also the risks of over-reflection! We really hope you enjoy the episode and would love to hear any thoughts or feedback on the episode both on the website and via social media. Simon & James

We know what it does, but does it really have a real place in DCR? Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-care-Podcast-210-Logistics-of-Labs-e2rv043

Motor vehicle collisions or road traffic collisions are a massive problem worldwide. Data from the World Health Organisation reports that there are around 1.2 million deaths every year and this is the leading cause of death internationally for children and young adults aged 5-29 years.  In the UK there are around 1,500 deaths annually and also around 60,000 patients with significant and life changing injuries, which is 7 patients every hour!! So anything we can do to improve patient care following an MVC is definitely a worthwhile venture. We've looked at Extrication here on the podcast before but we're back on it again because today the Faculty of Pre Hospital Care have released their Consensus Statement on Extrication Following a Motor Vehicle Collision.  The statement builds on the work from the EXIT project and the research that has helped inform our understanding of multiple factors of extrication. The statement will inform a change of practice for both clinicians and non-medical responders and in this episode we run through the statement with two of it's authors and discuss the practical applications. Make sure you take a look at the new Consensus Statement itself and the background evidence which is all linked to on the website. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

In this episode we're going to be running through adrenal presentations; both Adrenal insufficiency and Adrenal Crisis. There are some parts of these that aren't completely understood and a lack of a universal definition of Adrenal Crisis, but both insufficiency and a crisis are similar problems at different points on a spectrum and solid understanding of the endocrinology and physiology can really help to improve care in this area. There is huge potential for improving current morbidity and mortality. We'll run through both primary and central adrenal insufficiency, describe how this leads to different effects on mineralocorticoids and glucocorticoids and the signs and symptoms that will occurs as a result.  Many of the patients presenting to the department will be unknown to have adrenal insufficiency and we'll run through those who are at higher risk, including a huge group due to ongoing medication, who may be those on steroid doses much lower than you would previously have considered as significant.  NICE published their most recent guidance on Adrenal Insufficiency in August this year and we'll be referring to a lot of this as we run through the episode.  We'll finish up looking at the critical presentation of Adrenal Crisis and the emergency and ongoing management, along with how we support patients with insufficiency to prevent a crisis occurring.  Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

It's claimed inaction from successive governments in the face of obvious and alarming issues at University Hospital Limerick has contributed to the death of Clare teenager Aoife Johnston. It follows the publication of former Chief Justice Frank Clarke's independent investigation, which found the circumstances of Aoife's death at UHL's Emergency Department in December of 2022 "were almost certainly avoidable". Due to the gross level of overcrowding on the night, Aoife was not taken to the Resus area of the ED, but rather Zone A' where sepsis forms were not kept and therefore nurses and doctors in the area "appeared to be unaware" of her condition. Ennistymon based MidWest Hospital Campaign Spokesperson Marie McMahon whose husband passed away on a trolley at UHL in 2018 insists nothing has improved despite years of problems.

Clare's Government TD claims the findings of the Clarke Report have copperfastened the need for the expedited delivery of a new Emergency Department in Ennis. It comes as the latest report into the death of Shannon Teenager Aoife Johnston at University Hospital Limerick has determined the circumstances in which she died were "almost certainly avoidable". The fundamental issue according to the former Justice Clarke's report was the delay in treatment provided to Aoife Johnston. The Shannon teenager presented at ED at 17:39pm on Friday, December 17th with a letter from an out of hours GP service querying sepsis, but would not receive the appropriate medication for another 12 hours. National Sepsis guidelines stipulate that treatment should take place within an hour, at this point Aoife had just been triaged and upon triage, Aoife was sent to Zone A of the Emergency Department, where sepsis forms were not kept. This was due to the "grossly overcrowded" nature of the Resus area, and according to Justice Clarke this "undoubtedly contributed to the fact that it appears that none of the nurses or doctors in Zone A were aware of Aoife's condition. Ennistymon-based MidWest Hospital Campaign Spokesperson, Marie McMahon, whose husband Tommy Wynne passed away after waiting 36 hours on a trolley at UHL in 2018, feels elected representatives have failed to learn lessons from consistently poor patient outcomes at Dooradoyle and says a new Emergency Department in Ennis is desperately needed. On the night of December 17th, there were 191 patients in attendance at the ED, who were looked after by just 19 staff nurses and one clinical nurse manager, with breaks covered by nurses not trained in emergency medicine. In Zone A, where Aoife was originally sent, there were 67 patients who were tended to by just 4 nurses. Justice Clarke concluded in his report that unless bed capacity is addressed at UHL, the ED will regularly be under pressure and the risk of re-occurrence will inevitably be present. The investigation also referenced the 2008 Horwath Report, which paved the way for the closure of the A&Es at Ennis, Nenagh and St.John's in favour of a centre of excellence with increased inpatient bed capacity at UHL. Justice Clarke noted these beds did not materialise and led to clear consequent pressure at UHL and although a HIQA review is underway to determine if another ED is needed in the region, the results are not expected until next summer. Clare Fianna Fáil TD Cathal Crowe, who's a member of the Oireachtas Health Committee believes the people of the MidWest will remain second class citizens until a new ED is provided in Ennis, and he says the findings of the Clarke report copperfasten the need for this process to be expedited. Meanwhile, the solicitor for the family of Aoife Johnston says they're still waiting for answers. Six people are facing a disciplinary process, but their identities have not been revealed. The Johnston's solicitor, Damien Tansey says there were flaws with the independent investigation.

This is the Little Resus that could! We are covering Neonatal Resuscitation on this episode, simplifying the most complex, most scary aspects of caring for the tiniest humans. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here. Cite this podcast as: Briggs, Blake. 234. . September 17th, 2024. Accessed [date].

PE's (or Pulmonary Emboli) are a key part of Emergency Care, something that many of us will consider as a differential diagnosis multiple times of a daily basis, in a similar way to acute coronary syndrome, so we need to be absolute experts on the topic! A PE normally occurs when a Deep Vein Thrombosis shoots off to the pulmonary arterial tree, occurring in 60-120 per 100,000 of the population per year The inhospital mortality is 14% and the 90 day mortality is around 20%. But this is proportional to its size, and risk stratifying PE's once we've got the diagnosis is really important. PE is a real diagnostic challenge and less than 1 in 10 who are investigated for a PE end up with the diagnosis, so knowing the risk factors, associated features and thresholds for work up are really important. There are some key concepts in risk stratification and particularly in test thresholds that we'll cover in this episode that are applicable to all of our practice…..we're excited! Getting these right helps us to avoid missing the diagnosis and equally importantly ensure we aren't ‘over testing' & ‘over diagnosing' because investigation and treatment for a PE isn't without it's own risks. In the episode we'll talk in depth about factors associated with presentation, risk factors, investigations and finally onto treatments, covering the whole spectrum from low risk PE's up to those with massive PE's and cardiac arrest. The evidence base behind the work up and treatments is truly fascinating and we hope you find this episode as eye-opening as we did to prepare for! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

This week, Aebhric O'Kelly talks with the faculty from Tactical Medicine North from Ukraine. The College was invited to return to Ukraine to teach the DCR-U course for the TacMedNorth faculty. Summary Tactical Medicine North in Ukraine is focused on teaching prolonged casualty care and damage control recess. They started gathering information and teaching combatants in 2022 during the full-scale invasion. Their courses range from basic to advanced levels, including AEMT courses and blood resuscitation training. The goal is to provide proper training and knowledge to combat medics and non-medics. The experience of running the advanced damage control recess course was positive, with motivated students who wanted a deeper understanding of medicine. The use of guidelines and documents was emphasised to ensure proper care. The future goal is to spread the training and continue teaching at a high level. Keywords Tactical Medicine North, Ukraine, prolonged casualty care, damage control recess, combat medics, EMT courses, blood resuscitation, guidelines, training Takeaways Tactical Medicine North focuses on teaching prolonged casualty care and damage control recess in Ukraine. They offer a range of courses, from basic to advanced levels, including AEMT courses and blood resuscitation training. The use of DHA CPGs guidelines and documents is emphasised to ensure proper care. The goal is to spread the training and continue teaching at a high level. Chapters 00:00 Introduction and Background of Tactical Medicine North 03:36 Teaching Prolonged Casualty Care 08:10 The Need for a Damage Control Recess Ukraine Course 14:20 Impact of the Course on Students' Perspective 19:46 Importance of Guidelines and Documents in Tactical Medicine 23:47 Future Plans for Tactical Medicine North 30:54 Continuing Training and Education 35:41 Conclusion and Thanks

Acute Kidney Injury is common, complicated and holds significant morbidity and mortality. But...if we recognise it, we can make a real difference to our patients' outcomes. In this episode we run through the anatomy, physiology and aetiologies. We have a think about the multitude of definitions of AKI and then take each of the pre renal, renal and post renal categories and think about the ways we can optimise our care in each. We also have a think about who needs to be admitted and who can be safely managed in the community. This was a hugely valuable episode for us all to research and bring clarity to a complicated topic, we hope it does the same for you too! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we look at hypocalcemia in trauma and the diamond of death. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

In dieser Folge erzählt Deborah von ihren zwei außenklinischen Geburten. *** Die Shownotes findest du hier. Hier geht es zum Geburtsgeschichten Newsletter. Unterstütze den Podcast auf buymeacoffee.com/geburt Folge direkt herunterladen

This podcast episode focuses on the importance of measuring urine output as a cheap and effective method for monitoring hemodynamics in prolonged field care. The hosts discuss the benefits of using a Foley catheter for urine measurement and emphasize the need for proper sterility during the procedure. They also touch on the topic of hypotensive resuscitation and the challenges of managing patients with low blood pressure in a prolonged field care setting. Takeaways Measuring urine output is a simple and cost-effective way to monitor a patient's hemodynamic status in a prolonged field care setting. A Foley catheter is a reliable tool for measuring urine output and can provide valuable information about a patient's overall health. Proper sterility is important when inserting a Foley catheter to prevent infections. Hypotensive resuscitation is a complex topic that requires further discussion and consideration in the context of prolonged field care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

We've covered Cardiac Arrest management (as in the medical delivery of it) in a previous Roadside to Resusepsiode. Since then we've had some updates with Paramedic-2, Refractory VF, Airways-2  and a whole host of other papers. But what we haven't talked much about is the art of creating the environment, space & workflow to deliver the best medical care possible.  Whilst these might seem like less exciting and important parts of the package, they probably require a greater degree of skill and knowledge than running the medical aspects of the arrest. To do them with excellence you need to anticipate every single objective/obstacle that could stand in your way, including the medical interventions involved and the challenges of that unique case and environment.  In this episode we run through the aspects of a cardiac arrest right from the initiation of the case to the clearing/transfer to onwards care. We talk about the use of immediate, urgent and definitive plans and then run through how these translate into both in-hospital and prehospital arrests. We personally got a lot out of preparing and thinking about this episode, so we hope you find it useful too! We'd love to hear any thoughts or feedback on this slightly different style of episode either on the website or via X @TheResusRoom! Simon & James

Welcome back to the podcast and three great papers for May's episode! First up we take a pretty deep look into refractory VF. This follows on from our our review of DOSE-VF in December '22's papers of the month and our recent Roadside to Resus on the topic. In that we discussed the possibility that many of the cases we see at pulse checks as being refractory VF may actually have had 5 seconds or more, post shock, where they jumped out of VF but then reverted back into it. This paper is a secondary analysis of DOSE-VF and reveals what really happen to these 'refractory VFs' by interrogating the defibrillators. What difference will it make to our strategy for recurrent and refractory VF? Next up we take a look at elderly patients presenting to the Emergency Department with abdominal pain with an analysis of the features that predict a serious abdominal condition. Lastly we look at the how different pressures exerted to the facemask when ventilating neonates can make in terms of bradycardia and apnoea. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Hannah Wilson is joined by Stephen Clifford-Franklin from Resus Rangers, who provide Quality First Aid Workshops, Assemblies & Educational Resources for Teachers of Primary School Children across the UK. They explore what the requirements are and what opportunities Resus Rangers can provide to meet them. Find out more at resusrangers.com.

LISTENER DISCRETION IS ADVISED PMID: 35832199

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

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

In this episode we look at bag size in Resus, GTN dose for SCAPE (O), button battery honey fixes and ask the question: is pregnancy a disease?  There is a ton of other topics to make you tink about what we do in the ED..

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

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

Fever is an incredibly effective mechanism to fight off pathogens. Clearly, whilst many illnesses that cause a fever don't require anything more than the body's natural response, there are some patients in which a fever might represent a serious illness. Differentiating those serious illnesses from self-limiting presentations can be tricky at times, but can also be anxiety provoking for clinicians and parents, or carers of that child.  In children the limited communication can make the diagnostic challenge of the origin of the fever a real challenge, along with the added difficult of gaining some tests. Differentiating those with a benign disease from those with a life threatening presentation can be a daunting challenge. The numbers of presentations to healthcare providers are staggering. Paediatric fever has been reported to represent as high as 15-25% of all presentations in primary care and emergency departments, so massive numbers. Thankfully the prevalence of serious infections in children is low and is estimated at

We know it's the festive season but we thought we'd try and cover an issue from which there appears to be no escape and is a particular problem at this time of year, queuing! Whether we like it or not, this has become a factor for all of us working in emergency care, whether its delays getting your patient into the department, queueing down the corridor into ED, a prolonged stay in ED for an appropriate ward, or even in a physical queue to get out of the ED and onto an appropriate bed! We are looking after our patients for significantly longer than we're used to and this pushes the patient and the clinician into an area of care in which we have limited experience and comfort. Rather than accepting delays and ignoring their inevitable impact on patient care, we need to move towards equipping ourselves with the skills and knowledge to fill that care vacuum and ensure that excellence in patient care continues throughout their time with the ambulance service. So with that in mind, in this episode we're going to think about some of the considerations and interventions that are required to ensure our patients remain safe and comfortable throughout their queueing experience. And to do that we're going to draw on the concept of prolonged field care. An article by Aehbric O'Kelley and Tom Mallinson recently authored a paper published in Journal of paramedic practice entitled “Prolonged field care principles in UK paramedic practice”. That article really provided the idea and stimulus for this episode, so thanks to them for all of the hard work and once you've listened to us waffle on you should head across to their paper for a far more eloquent explanation of it all! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

We've talked about Aortic Dissection before in our Roadside to Resus episode and the huge difficulties in picking out these rare but potentially devastating cases and this month we've got a fantastic paper on the topic! The DAShED study looks at patients presenting with symptoms that could be suggestive of aortic dissection and helps us understand the diagnostic challenge and approach to acute aortic syndrome, along with testing the characteristics of a number of decision tools. Next up we look at a paper from Bendszus, an RCT of medical versus thrombectomy and medical treatment for acute ischaemic strokes with a large infarct, with some really powerful results. Finally we look at a paper that shows some staggeringly different ROSC rates for patients in cardiac arrest depending on the size of the ventilation bag used! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Blood gases are really commonly used in ED, Critical Care, Respiratory Medicine and Prehospitally. In fact, you'd do well to walk 10 meters in an ED without being given one to sign off! But it's for good reason, because they give you additional information about what's going on from a respiratory and metabolic perspective in the patient. And it's probably worth mentioning at this point, this episode is going to be pretty ‘science-heavy', there should be something in here for everyone; from the clinician that's been looking at these things for the last 30 years, to those that haven't started interpreting gases. So arterial blood gases can tell you about the efficacy of the patients ventilation in terms of their partial pressures of oxygen and carbon dioxide levels and also from a metabolic perspective about other disorders of their acid-base balance.  In the episode we'll be covering the following; -Overview of blood gases -Respiratory & metabolic sides of the gas -Acidaemia -Alkalaemia -Bicarbonate or base excess? -Compensation -Oxygenation -Anion gaps -System of interpretation -Venous gases -Clinical application & examples of interpretation We'll be referring to the equation listed on our webpage, so make sure you go and have a look at that and all the references listed. Once you've listened to the podcast make sure you run through the quiz below to consolidate the concepts covered with some more gas examples and of course get you free CPD certificate for your TheResusRoom portfolio! Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

This month Zack gives some pearls from his travels to Prague for Jan Behlolavek's ECPR school, Poland to meet with Marek Dabrowski, and ELSO with the entire crew.  Zack also interviews Saul Levine for the first of what may be a recurring conversation about the San Diego Resuscitation Consortium.  His efforts along with Kristi Koenig, Shawn Evans, Todd Baumbacher, and many others have paved the way for an OHCA ECPR protocol that may change more than just San Diego cardiac care.  Listen to Saul explain how the first 3 months of this process has expanded the minds of what cardiac arrest care can look like.

In this episode we're going to cover the ‘atraumatic' or ‘spontaneous' pneumothoraces and focus on some new key guidelines from the British Thoracic Society which came out in July this year and also look at the relevant evidence on the topic. There are pretty significant changes in the BTS guidance, it's no longer about finding a pneumothorax, working out if it's primary or secondary and then acting dependant on the size. It's now moved more towards looking at how the patient is clinically, taking into account the symptomatology, any big risk characteristics, whether it's primary or secondary and then thinking about the patients wishes and priorities and nuancing the management plan towards those.  This episode builds on some of the concepts we discussed in our Traumatic Pneumothorax podcast, so make sure you give that one a listen before clicking play on this one! We'll be looking at the presentation, evidence, management and follow up, along with some trials that you can get involved in to help develop practice even further. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

Janz D, Casey J, Semler M, et al. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. Lancet Respir Med. October 2019. https://www.ncbi.nlm.nih.gov/pubmed/31585796.

Delivering excellent End of Life Care in the Emergency Care is a real challenge but also a huge privilege and has formed some of the most rewarding parts of our careers to date. We've been really keen to End of Life Care as a topic for a while now. Many, if not all of you, will have been out to these patients or received them in your ED.  They aren't simple cases to manage, with lots of issues around scope of practice, lack of alternative care pathways, confusion surrounding legal documentation and many studies have identified a lack of education around palliative care. In this episode we'll do our best to demystify those medico-legal terms, talk about care pathways and options that may be available to us, have a think about how we can talk with patients about death and then go on to discuss the clinical care we might need to deliver and the wider holistic nature of caring for these patients and their loved ones. We're lucky enough to be joined by Ed Presswood, who's a palliative care consultant and clearly an expert on the topic. We gained a massive amount from this episode and we hope you find it really useful too. You'll find the hyperlinks to some fantastic resources on the topic over on the webpage at TheResusRoom. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

Welcome back to the podcast, coming to you all the way from Australia! Rob and James were fortunate enough to be invited to deliver the keynote and an airway masterclass at this year's Australian College of Paramedicine International Conference. At what was an amazing meeting, they were lucky enough to be able to catch up with some of the fantastic speakers to hear the key parts of their talks. In this episode you'll hear from; Richard Armour, Mobile Intensive Care Ambulance Paramedic at Ambulance Victoria and PhD Candidate at Monash University; Identifying patients requiring chest compressions at overdose prevention sites Nick Roder, MICA Flight Paramedic Educator, Ambulance Victoria and Teaching Associate, Monash University; Intubation in the setting of airways and inhalation burns Dr Tegwyn McManamny, Intensive Care Paramedic and Lead Patient Review Specialist, Ambulance Victoria; Care of the Older Person - Delirium and Paramedic Detective Olivia Hedges, Palliative Care Connect Lead, Ambulance Victoria; Palliative Care Connect Program Chelsea Lanos, Advanced Care & Community Paramedic Researcher; Organ donation after out-of-hospital cardiac arrest in Canada - a potential role for paramedics A huge thanks to ACP for the invite, Zoll for the support of the podcast and conference and to the fantastic speakers for giving ip their time to talk to us. We'll be back with another Roadside to Resus episode for you next week on End of Life Care. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom and we'll see you back in September! Rob & James

So in this episode we're going to run though the primary survey in trauma. This clinical assessment helps us identify and treat life threatening injuries and to rapidly intervene and correct them, so getting it right really matter1.  How this is done is hugely dependant upon the setting (either pre or in-hospital) as it is affected by the access to the patient, the number of people there to contribute to care and the challenges that the scene or hospital environment might hold. We run through a model of primary survey that looks to gain as much information as possible in a rapid and effective pattern and discuss the slightly different approaches we all take, along with  rationale behind them. Finally we cover the communication of the primary survey to the team, strategies that we can undertake to achieve this and how this can affect the momentum and onwards care of the patient.  We found this a really useful topic to consider in some depth and we hope it's of use to you too! Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

This is the first of two episodes looking at pneumothoraces. In this episode we're going to start out by taking a look at traumatic pneumothoraces. Traumatic pneumothoraces are present in about a fifth of multiple trauma patients, so it's not infrequent to come across them and they can obviously occur in those with isolated chest injury too. Thoracic trauma occurs in around two thirds of multi-trauma cases and is classified as the primary cause of death in a quarter of trauma patients. The clinical assessment carries with it a fair amount of dogma, including looking for tensions with tracheal deviation, so we'll be running through what the signs we should look for actually mean. Then we'll move on to a detailed discussion about investigation strategies before finally looking at the guidelines and evidence on the topic, including which we have to intervene with, which we probably shouldn't and those in which there is much uncertainty... Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James ps; if you're interested in getting your site involved with the CoMITED Trial then email comited-trial@bristol.ac.uk