Podcasts about resus

This month Just and I go over some old ground with new data and some ancient dentistry facts.  These papers are on the cutting edge of Resus and what you need to know in 2026

Face mask ventilation is one of those skills that can easily be overlooked. It's often seen as the simple bit of airway management — something that sits below the glamour of videolaryngoscopy, fibre-optics and endotracheal intubation. But the reality is that excellent face mask ventilation is one of the most important airway skills we have. In this episode, we take a deep dive into bag-valve-mask ventilation and airway adjuncts, exploring why this is far more than just putting a mask on a face and squeezing a bag. We discuss when facemask ventilation is indicated, how to identify patients who may be difficult to ventilate, and the practical steps that can dramatically improve success rates. We cover positioning, airway opening manoeuvres, mask seal techniques, the role of airway adjuncts and how to recognise whether your ventilations are actually working. We also look at troubleshooting common problems, the evidence comparing bag-mask ventilation with supraglottic airways and endotracheal intubation, and how to decide when it's time to move to another airway strategy. Whether you're working in the emergency department, prehospital environment or critical care, this episode is packed with practical tips, cognitive aids and evidence-based advice to help you deliver facemask ventilation with confidence and excellence. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon. Rob & James

Anaphylaxis is one of those conditions we think we have got pretty well sorted. Recognise it early, give adrenaline, support the airway and circulation, and crack on. And in fairness, for the vast majority of patients, that approach works really well. But in this Roadside to Resus episode we take a step back and ask a pretty uncomfortable question, have we actually been thinking about anaphylaxis in the wrong way? Using some fascinating new evidence from the UK National Child Mortality Database, we explore the emerging understanding that fatal food-triggered anaphylaxis may be much more of a respiratory catastrophe than the classic circulatory collapse we often picture in our heads. The findings are genuinely thought provoking. Many of the fatal paediatric cases reviewed showed overwhelming airway and breathing compromise long before cardiovascular collapse occurred, with deterioration happening frighteningly quickly in the prehospital phase.  We work through the current Resuscitation Council UK and NICE guidance, look at where diagnostic confusion still exists, and discuss why early adrenaline absolutely remains the cornerstone of treatment. But we also explore whether our mental model of anaphylaxis needs updating, particularly when it comes to respiratory assessment, escalation and oxygenation strategies. We're also incredibly grateful to be joined by Ben McKenzie, who shares the devastating personal story behind the development of the AMAX4 approach and the lessons it holds for all of us managing critically unwell patients in the ED and prehospital environment.  This is a really powerful episode about recognition, trajectory and reframing how we think about severe anaphylaxis. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

I denne sær-episode af "Det du ikke lærte i skolen" har vi besøg af Chris Turner fra organisationen "Civility Saves Lives", som sætter fokus på vigtigheden af interkollegial respekt. Pointen i dette afsnit – og i bloggen – er, at selv små former for uhøflighed kan have stor betydning. Incivility er sjældent dramatisk, men opstår ofte i det små og i en travl hverdag, hvor det let bliver overset og normaliseret. Alligevel kan det påvirke vores evne til at tænke klart, træffe beslutninger og samarbejde effektivt – især under pres. Heldigvis er det noget, vi kan arbejde med gennem øget opmærksomhed og små ændringer i vores daglige praksis.Vi søsætter samtidig med udgivelsen af denne podcast og blog kampagnen "Respekt Redder Liv", i samarbejde med Chris Turner og Civility Saves Lives.Har du fået lyst til at læse eller høre flere afsnit af "Det du ikke lærte i skolen" kan du finde dem her. Som altid er I velkomne til at komme med feedback, som kan gives i form af kommentarer her på siden eller direkte til akutmedicineren@gmail.com

Timely and effective defibrillation is fundamental to excellent outcomes in cardiac arrest care. But there is a growing body of evidence suggesting that how we deliver those shocks may matter just as much as when we deliver them. Over the last few years we've seen increasing interest in alternative defibrillation strategies, particularly AP pad positioning and double sequential external defibrillation, and the potential impact they can have on outcomes in refractory VF. The DOSE-VF trial was a landmark trial in the area, showing markedly better survival to hospital discharge with both vector change defibrillation and DSED compared with standard antero-lateral pad positioning. Since then, further analyses have suggested that the timing of DSED shocks, pad positioning and the vectors of defibrillation my all play an important role in improving the chances of ROSC and good neurological recovery. Now we've got new evidence from Sheldon Cheskes and colleagues exploring what may actually be driving these improved outcomes. Is it simply that AP pad positioning delivers more current? Or is there something more important about the direction that current travels through the myocardium? The findings from this piece of the puzzle has potential to change the fundamentals of resuscitation strategies. In this episode we take a deep dive into the emerging evidence around defibrillation, what the latest guidelines are saying and, importantly, what this means for practice. We're also hugely fortunate to be joined by Sheldon Cheskes himself to talk through the science behind defibrillation, the evidence and how systems can implement change. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & James

JEMS Development Editor Mike Brown sits down with Jonathan Epstein, who leads the American Red Cross healthcare product management team, to unpack the Red Cross's new Resuscitation Suite. Jonathan explains how the suite reimagines BLS, ALS and pediatric/neonatal resuscitation with EMS-first blended learning, a “practice as you perform” approach that embeds local protocols and integrated cognitive aids, including a digital app with step-by-step algorithms and clinical decision support. They discuss adaptive learning and computer-adaptive testing that shrink classroom time, an upcoming VR pathway that delivers team-based practice and certification, and realistic expectations for AI, dual sequential defibrillation and mechanical CPR. Ventilation, measurement and device design are highlighted as targets for education and engineering solutions.

Decision making sounds like a slightly academic, niche topic… but in reality, it sits underneath every single thing we do in emergency and pre-hospital care. Every patient contact, every test we order, every treatment we start and every one we choose not to – is a decision made in an environment that is time critical, information-light and full of uncertainty. In this episode we take a step back and look at how we actually make decisions at the front door and on the roadside. We talk about why the importance of the decision really matters, not just whether a diagnosis is possible, but how severe it is, how common it is, and whether finding it will genuinely change what we do for the patient. We explore pre-test probability and prevalence, and why knowing how often a condition really occurs in the group of patients in front of you is one of the most powerful tools in emergency medicine. We then move into testing. What actually counts as a test? It's not just bloods, scans and ECGs. It's how someone looks, how they move, what hurts when you examine them and how the story fits together. From there, we build into likelihood ratios and Bayesian thinking; how a piece of information should genuinely shift your estimate of risk, rather than just making you feel more or less comfortable. We also tackle test and treatment thresholds; the idea that there are times when we should stop chasing a diagnosis, and times when the probability is high enough that we should treat without waiting for more tests. Finally, we bring all of this back to real life, with human factors, competing priorities and the reality that sometimes the technically "correct" decision isn't the best decision in that moment. This one is all about becoming more comfortable with uncertainty and making better decisions because of it. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Case-gennemgang, hvor vi tager os tiden vi ikke har til daglig til at forberede os på at modtage patienten ud fra kapitler i tekstbøgerne Rosen's og Tintinalli'sLæs blogversionen her"Sådan gør de altså i Amerika" er et initiativ på RESUS-platformen, hvor vi med udgangspunkt i specifikke cases gennemgår kapitler i Tintinalli's og Rosen's Emergency Medicine for at illustrere hvad der i udlandet i hvert fald anses som den korrekte akutmedicinske tilgang til den aktuelle patientcase. Tintinalli's og Rosen's er store (og dyre) bøger, som det trods en varm anbefaling herfra, ikke kan forventes at alle vil hverken kende til eller eje. Af den årsag kommer blogversionen af denne podcastserie også til at fungere som notedeling af vores gennemgang af kapitlerne.Det skal selvfølgelig understreges at der her er tale om international, og særligt amerikansk, teoretisk baggrund for behandlingen og vi henviser selvfølgelig til altid som udgangspunkt at følge lokale og nationale retningslinjer.I dette afsnit af "Sådan gør de altså i Amerika" tackler vi det pædagogisk udfordrede akutmedicinske emne "Dermatologi" baseret på kapitlerne:Tintinalli's Sektion 20 Kapitel 248-253Rosen's Sektion 9 kapitel 110Har du fået lyst til at læse eller høre flere afsnit af "Sådan gør de altså i Amerika" kan du finde dem her.Vi inviterer som altid til at I som brugere af platformen kommer med feedback, både i form af ris og ros, så vi kan bruge denne optagelse til at gøre gennemgangene endnu mere anvendelige for jer. Feedback kan gives i form af kommentarer her på siden eller direkte til akutmedicineren@gmail.com

This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial. What remains a bit ambiguous is the effect of that intervention. Does it play out into a mortality benefit and if so how should we redesign systems to meet a 24 hour need for this (with many prehospital critical care services not being available fully around the clock), bearing in mind competing financial priorities for optimum health care. Maybe it's okay that for some patients the anaesthetic is delayed to the Emergency Department? Worldwide, trauma accounts for an estimated 4.4 million deaths annually and carries a substantial economic burden. Despite decades of improvements in trauma systems, medications such as tranexamic acid, and the development of prehospital critical care teams, some key aspects of trauma care remain really difficult to study well. Prehospital emergency anaesthesia is a prime example. It is time-critical, ethically complex, highly operator dependent and almost impossible to study using conventional randomised trial designs. As a result, clinicians have largely been forced to rely on observational studies, despite the well-recognised problems of bias and confounding that accompany them. In this episode, we explore the existing evidence base and then focus on a landmark new study published in The Lancet Respiratory Medicine. This paper applies machine-learning techniques to a large UK trauma dataset to address the question; does prehospital intubation improve survival in patients who are predicted to need early airway intervention? We walk through how the authors developed a predictive model to identify high-risk patients, how doubly robust estimation was used to move beyond simple association, and how survival and health-economic outcomes were assessed. The results suggest a clinically meaningful reduction in 30-day mortality for selected high-risk trauma patients who receive prehospital intubation. And we're then joined by two of the study's authors, Amy Nelson and Julian Thompson. Together, we explore what these findings may mean for the future of prehospital emergency anaesthesia, how we should think about evidence in complex emergency care environments, and whether this type of analytical approach could reshape trauma research more broadly. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

I denne fjerde udgave af vores pædiatriske særepisoder af RESUS-podcasten gennemgår vi sammen med akutpædiater Mikel Alberdi-Saugstrup tilgangen til det den pædiatriske patient med akut astmaanfaldCase fra ALiEM (Academic Life in Emergency Medicine) - "EM ReSCU Peds" (Emergency Medicine Resident Simulation Curriculum for Pediatrics). Tilgængelig på: https://www.aliem.com/emrescupeds-em-resident-simulation-curriculum-pediatrics/

50 minute presentation from the Rural Virtual Conference Series Feb 2026. This is Jonathan's answer to the request: "present a step by step cognitive plan for resuscitation (and understanding what may be going on) of the very sick patient in the rural setting". This video is also hosted on Vimeo, to watch or available for download. vimeo.com/1157712792

Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm. In paediatric seizures, time really matters. In this episode we take a step-by-step look at how to assess and manage a child who's seizing. We start with the fundamentals; how seizures are defined and classified, what status epilepticus actually means in practice, and why recognising it early makes such a difference. We then dig into the physiology behind seizures, exploring why early benzodiazepines work well and why delayed treatment often doesn't. Understanding what's happening at a receptor level helps make sense of when to escalate treatment and why different drugs work at different stages of a prolonged seizure. Pharmacology is a big part of this episode. We talk through first- and second-line anti-seizure medications, routes of administration, and how effective they really are. We cover the EcLiPSE and ConSEPT trials comparing levetiracetam and phenytoin, and look at newer evidence from the Ket-Mid study and what that might mean for managing refractory status and thinking about RSI. We also work through the approach to cases, pre-hospital management and in-hospital care aligned with UK and European recommendations. There's a clear focus on febrile seizures too, separating simple from complex presentations and helping you decide who needs investigating, admitting, or reassuring and discharging. As ever, the aim is to turn guidelines and evidence into something usable on the shop floor. Paediatric seizures are stressful, but with a structured approach, early treatment, and good airway management, they're absolutely manageable and we can make a real difference on outcomes. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

RESUS Visus er et nyt indslag i RESUS-podcasten, hvor vi gennem visualisering af cases med sindrige detaljer forsøger at forankre viden om både tekniske og ikke-tekniske færdigheder og differentialdiagnostisk udredning. Vi anbefaler kraftigt at du hører podcast-afsnittet et sted hvor der er mindst muligt støj, mulighed for fordybelse og helst med et par gode (noise-cancelling) hovedtelefoner, for at få mest muligt ud af lytteoplevelsen.I denne første udgave af RESUS Visus fortælles et vaskeægte akutmedicinsk jule-eventyr, som bringer os igennem både traumegennemgangen og den differentialdiagnostiske udredning af sympatikusstorm med hallucinationer. Rigtig glædelig jul - og i særlig grad til alle jer der passer vagten i akutmodtagelsen her i juledagene!Podcasten er skrevet og redigeret af Emil Iversen, indlæst af Jon Munk Poulsen og venligst peer-reviewed af akutmediciner extra-ordinaire, Charlotte Møgelvang

Welcome to this special edition of Roadside to Resus where we're diving into some of the progressive and practice-defining developments in pre-hospital emergency care. This episode brings together a superb group of clinicians, educators and leaders who are shaping the future of PHEM across the UK, and we caught up with them at the recent Faculty of Pre-hospital Care Conference entitled 'The Wider World of Pre-hospital Care'! We start with Pam Hardy, the Chair of the FPHC, who offers an introduction to the College and its ongoing work to elevate standards across pre-hospital care.  Next, Camella Main guides us through the brand-new Pre-hospital Maternity Decision Tool designed to support clinicians facing complex decision making in this complex group of patients. Camella breaks down how the tool came to fruition and how teams can use it to enhance safety and decision-making on scene. We then hear from Ben Sheppey, who explores the growing move to formalise and professionalise voluntary pre-hospital care. Ben reflects on the challenges, opportunities and cultural shifts required to align voluntary responders with national standards. Harriet Tucker then walks us through the new FPHC consensus statement on managing penetrating neck injuries. She distils the key principles, the recommendations, and how the guidance aims to bring clarity to one of the most complex and time-critical presentations we face. From there, Cosmo Scurr unpacks the latest AAGBI PHEA Guideline, highlighting the key movements in delivering anaesthesia in the pre-hospital environment. We also hear from Felix Wood, who provides a sharp, practical look at crush injury and crush syndrome. Finally, Zane Perkins explores the rapidly advancing world of AI in PHEM. From practical application to decision making support. Zane describes how emerging technologies have the potential to change prehospital care in ways we may have never considered before! A huge thanks to the expert speakers for their time recording highlights from the superb conference. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

I denne tredje udgave af vores pædiatriske særepisoder af RESUS-podcasten gennemgår vi sammen med akutpædiater Mikel Alberdi-Saugstrup tilgangen til det den pædiatriske patient med kramper og status epilepticus

Kritisk gennemgang af litteratur med fokus på klinisk anvendelighed og hvilke faldgruber vi skal passe på når vi overfører resultaterne til vores egne patienter⁠Læs blogversionen her⁠I denne udgave af "Men hvad betyder det?" gennemgår Emil og Jon fire særligt udvalgte akutmedicinsk relevante artikler og forsøger at koge dem ned til deres relevans for dig som akutmediciner på gulvet i akutafdelingen. Emnerne i denne omgang omfatter:Incidens af patologiske fund på CT cerebrum hos ældre med mildt hovedtraumeEffekten af konservativ behandling uden intubation af intoksikerede patienter med GCS ≤8Præcisionen af Wells score + akutmedicinsk POCUS for DVT Kliniker gestalt (mavefornemmelse) vs. risikoscorer i detektionen af sepsisFår du ikke stillet din evidens-sult her på siden, så ⁠læs vores andre "Men hvad betyder det?" episoder her⁠. Som altid er I meget velkomne til at komme med feedback i kommentarfeltet her på siden eller direkte til akutmedicineren@gmail.com

How, when and why to make the call… The pre-alert is one of the most powerful and sometimes most painful parts of emergency care. It can feel like the Spanish Inquisition, trigger tension between pre-hospital and ED teams, or drop another challenge into an already overflowing department. But done well, a pre-alert isn't an irritation; it's an opportunity to line up critical care for the next patient and genuinely improve outcomes. In this episode, Simon, Rob and James break down The UK NHS Ambulance Services and Emergency Department Pre-Alert Guideline, jointly released in July 2025 by RCEM and the Association of Ambulance Chief Executives. It's the first national attempt to give clear, shared expectations on who to pre-alert, what to say, and how to receive those calls, it's full of practical recommendations for both sides of the phone. We kick things off with a review of the evidence base, including brand-new studies showing just how varied pre-alert practice is across the UK. From inconsistent criteria and mixed training to the problem of “pre-alert fatigue”, the data make a strong case for standardisation.  We then walk through the new guideline's key principles: pre alerting for pre-specified physiological parameters or specific conditions.  We finish off with top tips for making and taking better pre-alerts - selling a story, leading with the headline, and understanding what the other side actually needs. This episode combines frontline pragmatism with real-world research and might just make your next pre-alert smoother, faster, and better received. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

a focus on its acute presentations and the care we can deliver to improve outcomes for our patients. Sickle cell disease (SCD) is a lifelong inherited blood disorder that affects over 15,000 people in the UK, and millions worldwide. It's caused by the production of abnormal haemoglobin molecules, which distort red blood cells into a crescent, or “sickle,” shape. These rigid cells can block small blood vessels, leading to painful vaso-occlusive crises and organ damage. While the condition has long been most prevalent in parts of Africa, the Middle East, the Mediterranean and India, today it's a global health issue, and one we encounter regularly in UK emergency care. Tragically, failings in care have too often led to avoidable harm. The 2021 parliamentary report “No One's Listening” laid bare some of these cases, highlighting missed opportunities, poor awareness, and systemic issues that cost lives, such as the death of Evan Nathan Smith. So why are we revisiting this now? In 2024, RCEM published new Best Practice Guidelines on managing sickle cell disease in the ED. These provide clear, evidence-based standards for recognition, triage, analgesia, infection control, and safe discharge. In this episode, we take you through the key elements; Pathophysiology – how a genetic mutation drives sickling, vaso-occlusion and inflammation. Clinical presentations – from painful crises and acute chest syndrome, to stroke, anaemia, infection, priapism and pregnancy-related complications. Recognition and triage – why timely pain control within 30 minutes is a must, and how to spot red flags. Investigations and treatment – including the role of reticulocytes, the importance of knowing a patient's baseline haemoglobin, and principles of analgesia, transfusion, oxygen, and supportive care. Discharge and ongoing care – ensuring safe, joined-up planning, and involving haematology and specialist pathways wherever possible. The take-home message? Every sickle cell crisis is a medical emergency. We need to listen to patients, escalate early, involve haematology, and deliver care that meets the standards they deserve. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

In the second half of this two part episode, Dr. David Leon unpacks some of the most hotly debated topics in resuscitation—fluids, blood products, ECMO, and post-arrest care. He breaks down the pros and cons of crystalloids (yes, even the “pasta water” debate), explains why lactated Ringer's is often preferred over normal saline, and dips into the use of albumin and colloids. Dr. Leon also discusses the promise and challenges of extracorporeal life support (ECLS), the evolving role of targeted temperature management (TTM), and even peeks into what advances the future might hold. It's a thoughtful, forward-looking conversation every resuscitationist should hear. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this high-yield two part episode, we dive into the evolving world of resuscitation with Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis. From the shift in priorities from ABC (Airway-Breathing-Circulation) to CAB (Circulation first) to the practical use of peripheral vasopressors and rapid infusion catheters, this episode breaks down how frontline ED care is adapting to sicker patients, longer ICU boarding times, and limited resources. Tune in for insights on advanced access strategies, pre-hospital blood products, and why old tools, like whole blood and vasopressin, are making a powerful comeback. What do you think of Dr. Leon's tips? Are you using these tools in your practice? We'd love to hear from you. Share them with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. David Leon, Assistant Professor of Emergency Medicine and Anesthesia at UC Davis Resources: American Heart Association (AHA) Algorithms Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; American Heart Association. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. PMID: 38108133. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

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

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

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

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

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

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

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

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