The Resus Room
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...
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This month we’re heading firmly into the prehospital and community space, looking at how we make decisions when the diagnostics are limited and the system around us is evolving. We start with a really practical question around traumatic pneumothorax. How good are we, clinically, at spotting the patients who actually need urgent decompression? This paper takes a hard look at the performance of the classic signs we’re all taught, and challenges just how much we can rely on them in isolation when it really matters . From there, we move into one of the biggest ongoing debates in...
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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...
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March’s Papers of the Month is here and we’ve got three absolute crackers to get stuck into. First up, we head prehospital to explore pseudo-pulseless electrical activity. This review challenges us to rethink how we approach organised electrical activity without a pulse. We discuss the role of POCUS, the concept of treating profound shock rather than “arrest,” and what this means for decision-making and management. Next, we move to cardiac arrest physiology with a systematic review examining intra-arrest diastolic blood pressure and coronary perfusion pressure. We take a look at the...
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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...
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Welcome back to February’s Papers of the Month! We start this month looking a the right place to perform a prehospital anaesthetic. Traditionally we've been taught it should be somewhere with 360-degree access to allow the greatest safety, which means intubating in an ambulance and other locations are a no-go. But does it actually reduce complications, and what about other locations and situations? This paper explores whether location is associated with outcomes, or whether it might actually be a reasonable and sometimes advantageous to forgo that 360 access. We've talked a lot about pad...
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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...
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Welcome to January’s Papers of the Month, which marks 10 years of the podcast! First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quantifies the impact of post-RSI hypotension in a dramatic way and the associated increase in 30-day mortality. Our second paper moves into the world of stable supraventricular tachycardia,...
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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. ...
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December brings us to the final Papers of the Month for 2025 and we’re finishing the year with three studies that challenge assumptions across critical care and resuscitation! This time questioning the role of arterial lines in shock, looking at the true prognostic value of end-tidal CO₂ in cardiac arrest and finally to airway management in neonates. We start in the ICU with the EVERDAC trial, a large multicentre RCT exploring whether early arterial catheterisation in shock truly changes outcomes. This challenges some of the papers we've recently looked at recently which champion the...
info_outlineWelcome 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