PHEMCAST

Further reading Matt has kindly provided a list of references from his Trauma Care talk which this podcast is based on: Peri-operative and critical care management of the brain – current evidence. Anaesthesia: Vol 77, No S1. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition Vasopressors in Trauma: A … Continue reading Vasopressors in Trauma

Read more about the Cochrane injuries group: https://injuries.cochrane.org/about-us-0 Have a listen to the earlier TXA podcast here: https://phemcast.co.uk/2018/01/18/episode-26-tranexamic-acid/ Do you want to revise your clotting pathways and the mechanism of action of TXA?! Here are some links to the excellent Life in the Fast Lane: https://partone.litfl.com/clotting.html https://partone.litfl.com/unclotting.html The Resus Room podcast which discusses Tim and … Continue reading TXA – an update

Road traffic collisions are a leading cause of death and injury. Following a road traffic collision many patients will remain trapped in their vehicle. Extrication is the process by which injured or potentially injured people are removed from their vehicle by the rescue services. Rescue service training focuses on the absolute movement minimisation of potentially … Continue reading Extrication

This is the book Jon quotes, “Pain is a symphony…” The International Association for the Study of Pain’s revised definition of pain is available here. If you’d like to read more about ‘nocebo’ i.e. the non-pharmacological adverse effects of an intervention, have a look at this article. Penthrox For more information on Penthrox, you can … Continue reading Pain (& analgesia)

Before you listen to this new podcast, we encourage you to go back and have a listen to Episode 16: Blood which we released in 2017 outlining the available evidence about prehospital blood, and the background to the RePHILL trial. The RePHILL (Resuscitation with Pre-Hospital Blood Products) original paper is available here, and you can … Continue reading RePHILL

This podcast is dedicated to the memory of Emmanuel Cauchy. George’s adventures! Grading frostbite The GELOX study The Hyperbaric oxygen study described by Carron is now in print and available here. Guidelines The guidelines mentioned by Chris can be found on the Wilderness Medical Society website. References Cauchy et al. The value of technetium 99 … Continue reading Cold Injury

Some useful videos: Hopefully you found the podcast interesting, but since this is quite a visual topic we have put together some videos to demonstrate some of the pathologies discussed and what they look like on ultrasound: How does ultrasound work? Want to know how to use ultrasound? This is a whole 45 minute introductory … Continue reading Ultrasound

Definitions UK definition (RCEM): It describes the sudden onset of aggressive and violent behaviour and autonomic dysfunction, typically in the setting of acute on chronic drug abuse or serious mental illness. Australian definition (NSW Health): Behaviour that puts the patient or others at immediate risk of serious harm and may include threatening or aggressive behaviour, … Continue reading Acute behavioural disturbance

This was a joint podcast with our friends & colleagues at WEMCast – to hear more from them, have a look at their podcast back catalogue, and there’s more information on the World Extreme Medicine website. Mosquito born disease Malaria is transmitted through the bite of an infected female Anopheles mosquito. It is widely distributed … Continue reading The Jungle

Guidance documents College of Paramedics Statement on Intubation, available here. AAGBI Safer Prehospital Anaesthesia 2017, available here. Positioning Recommended Rich Levitan resources Airway axes Epiglottoscopy Bimanual Laryngoscopy Further resources https://www.resus.com.au/apnoeic-oxygenation-resuscitation-time/ https://anaesthetists.org/Home/Resources-publications/Guidelines/Safer-pre-hospital-anaesthesia Click here to hear what our friends over at the Resus Room think about Airways 2 References (kindly shared by Rich) Davis DP et … Continue reading Intubation

From: https://www.bbc.co.uk/news/uk-wales-46441129 From: https://www.ultimatekilimanjaro.com/blog/should-i-use-supplemental-oxygen-on-kilimanjaro/ Want to know more? This is one of the organisations Lucy mentions: British Exploring And this is the Global Health MSc The Wilderness Society Guidelines are available here. This is the link to the Wilderness Medical Society. Consensus statement from the UIAA on People with Pre-Existing Conditions Going to the Mountains, … Continue reading Altitude

Some facts Drowning is important: 1,000 people drown every day, 2 every 3 minutes, 41 per hour. It is the world’s 3rd leading cause of accidental death: 3.6 million people over 10 years. Disease of youth 64% < 30 years old 43% < 15 years old 25% < 5 years old Male: female ratio 2:1 In … Continue reading Drowning

Case definition Current case definition for COVID-19 can be accessed here. Risk stratification This is the Emergency Medicine Specialty guide we discussed in the podcast, which includes use of the NEWS and 40 step test (edit: since recording the podcast yesterday (!) we’ve been made aware of the Sit to Stand test). Here is a … Continue reading Episode 36: COVID-19

A: Optimal airway position for infants Note how a rolled towel is placed under the baby’s shoulders to allow space for the occiput and avoid flexion of the neck and airway. ‘B’ assessment Video links to examples of children with signs of respiratory distress: Stridor Grunting Increased work of breathing ‘D’ assessment Example video showing … Continue reading Episode 35: The collapsed infant

So, where is the Cauda Equina? From Core EM How does a herniated disc cause CES? This fab infographic summarising the key points about the CES guidance was produced by @DrLindaDykes and @saspist. Here is the full guideline from The Society of British Neurological Surgeons and The British Association of Spinal Surgeons. NICE guidance on Low back … Continue reading Episode 34: Back pain

Many thanks to Suzanne O?Sullivan for her time in putting this podcast together. Her excellent books ?It?s all in your head? and ?Brainstorm? are well worth a read.   It is certainly one of the PHEMcast recordings which is going to change my own practice the most.   We can all find these patient?s challenging … Continue reading Episode 33: Psychosomatic Illness

      Huge thanks to the team at World Extreme Medicine and WEM Cast for sharing the interview with Richard Harris.       Dosing These are a guide only, each patient will need a bespoke approach depending on their pre-existing condition, degree of cardiovascular compromise, conscious level and drugs already administered. Clearly you … Continue reading Episode 32: Ketamine

  The Danish mnemonic to help remember the elements of a cerebellar neurological examination: There are lots of Youtube videos to demonstrate these signs, here are a few which I thought were particularly helpful: Disdiadochokinesis Ataxia Nystagmus Intention tremor If you would like to read more, there is a blog post Martin and I wrote … Continue reading Episode 31: Stroke & Dizziness

Quite a few of our previous podcasts include content which is relevant to this Head Injury one. Why not go back and have a listen to: Episode 3: Hyperoxia Episode 20: End Tidal Carbon Dioxide Episode 28: LOST (Low Output State in Trauma) Munroe-Kellie Doctrine The Munroe-Kellie Doctrine is illustrated by the following pictures: Or, … Continue reading Episode 30: Head injury

  Another invitation to the Trauma Care Conference this year inspired us to combine two of the excellent speakers into this podcast considering major incidents. Thanks to both our speakers for sharing their talks from the conference.   Trauma Care offer more than the annual conference; there are monthly webinars and regional meetings too, click … Continue reading Episode 29: Major Incidents

  Cardiac arrest is the end point, it is the symptom, not the diagnosis. The pathophysiological process varies, and this is particularly relevant in trauma vs medical. In medical cardiac arrest, the pathological processes tend to affect the heart?s ability to pump: eg primary cardiac event, chemical/electrolyte abnormality, but full circulation. In trauma the process is … Continue reading Episode 28: LOST

We recommend reading Atul Gawande’s book ‘The Checklist Manifesto’. It’s a well written, fascinating story about the introduction of the WHO Safer Surgery checklist and the impact it had. This link will take you straight to Amazon if you want to buy a copy (other internet retailers exist!!) To understand the how human factors failed … Continue reading Episode 27: Checklists

  The paper which we discuss in the interview is available open access here How does tranexamic acid work? Critical appraisal aids To understand more about hierachy of evidence and how a systematic review fits into this please have a look at these resources available from the Cochrane group. http://consumers.cochrane.org/levels-evidence http://training.cochrane.org/path/grade-approach-evaluating-quality-evidence-pathway The CASP checklist can … Continue reading Episode 26: Tranexamic Acid

Where can you undertake decompression of a pneumothorax? Be particularly careful when using the 2nd intercostal space mid-clavicular line that you are sufficiently lateral. For example, here are the locations identified as ‘2nd ICS mid clavicular line’ amongst 25 EM physicians in a 2005 EMJ paper. The Three Kings: George Clooney’s recommended approach to decompression … Continue reading Episode 25: Tension pneumothorax 2

Firstly, go and read Simon and Tim Harris’ great 2005 paper on the subject which we reference repeatedly in the podcast. It is available free open access here. A pneumothorax exists when air accumulates in the potential space between the visceral and parietal pleura: A tension pneumothorax exists when the air in the pleural cavity … Continue reading Episode 24: Tension pneumothorax 1

The various devices which Tony discusses are: This video shows the rapidity of infusion entering the circulation from a humeral IO. This is the paper mentioned by Tony, which shows the stepwise improvement in mortality amongst combat casualties from military conflict 2003-2012, including the ‘unicorn’ graph: Anatomy of bones and the humerus related to intraosseus access … Continue reading Episode 23: Intraosseus access

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Guest contributor: Lauren Weekes What is ETCO2? % or partial pressure of carbon dioxide measured somewhere near the mouth at the end of a normal exhalation (hence end tidal, end of tidal volume breath) To get a measurement the following systems need to be functioning: Metabolically active tissue to produce CO2 Circulation & cardiac output … Continue reading Episode 20: End Tidal Carbon Dioxide

  The West Midlands surgical skills course offers cadaveric training for PHEM and EM practitioners on rare life saving procedures. Click here to go straight to their page. Anatomy The Guidelines Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk et al. Difficult Airway Society: Intubation guidelines working group. British Journal … Continue reading Episode 19: Surgical Airway

Many apologies for the delay in the release of this podcast! A second apology is due for the sound quality – it was recorded at a ‘live’ HEMS base – this has led to lots of background noise I am afraid. We have done our best to edit this out / reduce its effect but … Continue reading Episode 18: The Ventilator Part 2

This episode has been compiled over a year – many thanks to our four contributors, who have shared their stories and knowledge. They were interviewed at TraumaCare 2016, TraumaCare 2017 and the BASICS/FPHC Conference 2016. If you ever need to talk about the impact of stresses and work experiences on you, please find a friend, … Continue reading Episode 17: Broken? Impact on the rescuer

  There is the potential for significant controversy in this month?s episode ? and we would really appreciate the feedback of the prehospital community on this one. We have held the ?no clear fluids? mantra close to our hearts for most of our prehospital careers. We ?know? that giving sea water to our patients, and … Continue reading Episode 16: “Blood”

Paediatric Trauma TARN report: Severe Injury in Children Simulation ATACC:The Anaesthesia Trauma and Critical Care course Thanks to Mark Forrest (@ObiDoc) for sharing these videos: References Spurr J, Gatward J, Joshi N, Carley SD. Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. EMJ. 2016. Bredmose PP, … Continue reading Episode 15: Paediatric Trauma & How to Do Sim

  Details of the surgical skills course mentioned in the podcast can be found here: https://wmstc.co.uk/portfolio/phem-ess/ The Sydney HEMS Traumatic Cardiac arrest operating procedure can be viewed on their website, and there are a number of useful references within the document: Policies and Procedures An excellent ‘how to do it’ paper, published in 2005, by … Continue reading Episode 14: Thoracotomy

Ventilation – a dark art. Difficult to be a master, easy to be average (or terrible)! This is “part 1”, which includes some of the basic (and not very basic) concepts behind ventilation. We recorded over 60 minutes of excellent content with George – we will post more below as soon as it is edited. … Continue reading Episode 13: The Ventilator

YouTube videos: From the police officer?s perspective: https://www.youtube.com/watch?v=toaA_TNwcxg From the mother?s perspective: https://www.youtube.com/watch?v=0KJZXOKStao The paper about watching resuscitation is this one: http://www.nejm.org/doi/full/10.1056/NEJMoa1203366#t=article This is a section taken from the London Ambulance Service clinical bulletin, from 2011, which includes the SPIKES mnemonic: The alternative mnemonic mentioned in the podcast is GRIEV_ING, which has been developed for use in … Continue reading Episode 12: Breaking Bad News

  The paper we mentioned by Jonathan Benger and Jules Blackham can be accessed here: https://sjtrem.biomedcentral.com/articles/10.1186/1757-7241-17-44 Stable versus unstable spinal injury The location of an injury and involvement of different structures defines the stability of a spinal injury. Anterior column: anterior longitudinal ligament and the anterior half of the vertebral body/disc. Middle column: posterior half of the vertebral … Continue reading Episode 11: Gentle Patient Handling

Big thanks to Anand Swaminathan @EMSwami, Chris Nickson @precordialthump, Jesse Spurr @Inject_Orange, Chris Hicks @HumanFact0rz, and Tom Evens @doctomevens Their pre-workshop reading/listening recommendations: http://stemlynsblog.org/englishman-south-africa-robert-lloyd-st-emlyns/ http://emcrit.org/podcasts/toughness-michael-lauria-i/   Bandwidth   Visualisation tips:  

Apologies for the quality of the sound ? we recorded in a very echo-ey office! The Royal College of Obstetricians and Gynaecologists (RCOG) green top guideline is accessible here: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_56.pdf We have talked about ramping previously, in Episode 6: Oxygenation. This is how a pregnant patient should be positioned for airway manoeuvres and interventions, for … Continue reading Episode 9: Maternal Collapse

The recent resurgence in this method of suicide has put emergency responders at a significant increase of serious injury and death. This podcast discussed the current most frequent methods of attempted and successful inhalational suicide  – keep safe.     There are a multitude of professional and advisory websites out there. We are keen not … Continue reading Episode 8: Chemical Suicide

We hope you enjoyed our sepsis podcast. It is obviously a huge topic and there is lots of information to cover; a couple of other recently released podcasts are available which are produced with the Emergency Medicine community in mind, but will no doubt expand your knowledge.   St Emlyns Induction podcast on Sepsis. March … Continue reading Episode 7: Sepsis

To provide a bit of balance following our earlier hyperoxia podcast, this episode we are discussing circumstances when we want to deliver extra oxygen to patients and ways to do this effectively, including an interview with Sydney HEMS Consultant Yash Wilmalasena on apnoeic oxygenation. Hope you find it useful!   Some of the stuff we … Continue reading Episode 6: Oxygenation

    Welcome to PHEMCAST episode 5: Amputation One of the things we never want to have to do, but need to be prepared for. Have a listen, consider your kit, your top-cover arrangements, and when and how you may need to get this done. This podcast covers, which patients to consider, how to do … Continue reading Episode 5: Amputation

We hope you enjoyed this PHEMCast. Please feedback your comments via the blog, twitter or email us on [email protected]. The NARU video we mention in the podcast can be accessed here: http://naru.org.uk/videos/ior-nhs/ And the paper we discuss is: Chilcott RP. Managing mass casualties and decontamination. Environmental International. 2014; 72: 37-45. This is the Step 1,2,3 … Continue reading Episode 4: Chemical incidents

  Hello and welcome to our next episode ? we hope you enjoy it. This episode concentrates on hyperoxia ? the delivery of lots (often too much) oxygen and the harms it may cause our patients. We both had colds – many apologies for the blocked noses and many sniffs! We hope you find it … Continue reading Episode 3: Hyperoxia

Sorry for the slight delay releasing our ?October? podcast ? but here it is (note how it is cunningly labelled Episode 2)! This month we are reviewing the evidence for the pelvic binder and discussing scenarios in which it should (and should not) be used. As always, please get in touch with questions and comments, … Continue reading Episode 2: The Pelvic Binder

Here it is – our very first podcast, and guess what – it is on supraglottic airways! This first episode reviews the history of the laryngeal mask airway and we discuss the relative benefits and risks of supraglottic airway devices. We’ve interviewed Dr Rob Moss, author of the Faculty of Prehospital Care (FPHC) Consensus Guidelines … Continue reading Podcast: September 2015: The LMA