The Resus Room
This month we've got another really varied mix of papers that all have the potential to influence everyday emergency and prehospital practice. We start by asking a question that's becoming increasingly relevant as prehospital critical care teams develop ever more advanced capabilities: are all those extra interventions costing us precious scene time, and if so, how much? We then move into post-cardiac arrest care with one of the biggest oxygen trials we've seen to date, looking at whether aiming for conservative oxygen targets actually improves neurological outcomes after ROSC. Finally,...
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Tracheostomy and laryngectomy emergencies are classic high-acuity, low-frequency situations. They do not happen every day, but when they do, airway problems can develop quickly, and the wrong intervention can make things significantly worse. In this episode, we work through the practical approach to these patients, starting with the most important distinction: a patient with a tracheostomy may still have a patent upper airway, whereas someone who has undergone a total laryngectomy is an obligate neck breather. That single anatomical difference determines where oxygen and ventilation need to be...
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Welcome back to July's Papers of the Month. This month we've got three papers that tackle some of the biggest questions we face in emergency and critical care medicine. They're all very different studies, but each one looks at an intervention that many of us use, or at least think about, on a regular basis. First up, we look at ARISE FLUIDS, a major trial examining one of the longest-running debates in sepsis care. Should we be reaching for fluids or vasopressors first in septic shock? We've spent years worrying about giving too much fluid, and equally worrying about starting vasopressors too...
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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...
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This month’s episode takes us deep into trauma care, but not just the medicine we deliver but also the systems, circumstances and social factors that shape who survives and who doesn’t. We start by looking at a remarkable paper from Gaza describing the use of ultrasound-guided pericardiocentesis, large-bore drainage and intrapericardial tranexamic acid as definitive management for penetrating cardiac tamponade. In a setting where immediate thoracotomy simply wasn’t always possible, the authors report some pretty incredible survival figures and challenge a lot of the dogma around...
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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...
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This month’s Papers of the Month is a real mix of papers that challenge some of the things we think we know, whilst also highlighting just how important systems and processes are in improving patient care. We start with intracerebral haemorrhage and the tricky issue of blood pressure management. We’ve all been taught that early, aggressive blood pressure reduction is key, but this paper raises some important questions about whether we may sometimes be overshooting. It looks at whether rapidly driving the blood pressure down really improves outcomes, or whether going too low may actually be...
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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...
info_outlineWelcome 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