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

Welcome back to Papers of the Month! Three more papers to both inform and challenge our practice across the spectrum of emergency care.

First up we look at a systematic review and meta-analysis on noradrenaline vs adrenaline for our medical post-ROSC patients; what evidence exists out there and should we all be delivering noradrenaline as our first line treatment for those with shock?

Next up a paper to really challenge the treatment algorithm for status epilepticus in paediatrics, with an RCT of midazolam and ketamine versus midazolam alone. There are some huge differences here in the form of termination rates and some great discussion to be had around the specifics of the paper and how that might translate into future practice.

Finally we look at a paper assessing the impact of i.m. versus i.v. metoclopramide for migraines and acute severe headaches. The paper looks at the impact of length of stay within the Emergency Department and also the efficacy of the treatment.

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

Simon & Rob