Welcome back to the podcast!

We've got three papers this month covering the breadth of Emergency Care presentations and locations; from prehospital arrests, ketamine for analgesia in trauma and those complex elderly patients presenting with abdominal pain.

First up we look at the use of prehospital thrombolysis for out of hospital cardiac arrest, something some critical care services are using for suspected PEs and MIs. But what are the outcomes for these patients and how accurate are the clinical suspicions that lead to the thrombolysis?

Next up we look at an excellent prehospital RCT, PACKMaN, on the use of ketamine vs morphine for patients with pain following trauma. Is ketamine safe? Is it superior? And what is the side effect profile of each of these approaches? We're also lucky enough to have the lead author, Mike Smyth, come on to give his thoughts on the paper and what it might mean for clinical practice

Finally we have a think about abdominal pain in the elderly population. Without a cause for the pain being found this can feel like a very high risk group of patients to discharge. Our final paper helps quantify that risk further, inform our decision making and identify factors that are associate with an increased morbidity and mortality.

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

Simon & Rob

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 April's Papers of the Month!

First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at the use of three bedside scoring systems; HINTS, TriAGe+ and ABCD2 scores in ED for patients presenting with possible posterior circulatory strokes. How accurate are they and can we reliably incorporate into our practice?

Next up is traumatic cardiac arrest. This has obviously got a very high mortality rate. One of the interventions that might improve mortality (for some mechanisms and patients) is a resuscitative thoracotomy, however this is a really significant intervention and we want to ensure we are targeting it at the patients that may benefit. A great paper has just been published from London Air Ambulance which might just help us to identify those patients who would benefit with more certainty, along with those where futility has already been reached.

Finally we take a look at acute kidney injury (AKI) and its association contrasted scans. Contrast induced nephropathy (CIN) has historically been a concern, particularly for patients with chronic kidney disease, with contrast causing direct injury and limited blood flow. But recent studies have questioned the actual risk of CIN & there’s been a more recent RCEM statement on the topic, but we thought this might be a nice opportunity to refresh and look at a recent paper on the topic.

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

Simon & Rob