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 Trau…

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://parto…

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…

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 read about i…

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 read more ab…

This podcast is dedicated to the memory of Emmanuel Cauchy. George’s adventures! Grading frostbite Stages of frostbite. From Cauchy et al, 2016. Grade 1Grade 2Grade 3Grade 4Stages of frostbite. From Cauchy et al. 2001 The GELOX study The Hyperbaric oxygen study described by Carron is now in print and available here. Guidelines The guidelines mentio…

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 lecture. Although a face…

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 …

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. OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA OLYMPUS DIGITAL CAMERA Mosquito born disease Malaria risk areas. From: https…

Guidance documents College of Paramedics Statement on Intubation, available here. AAGBI Safer Prehospital Anaesthesia 2017, available here. Positioning From: http://anaesthesiatoday.blogspot.com/2013/03/10-common-procedural-basics_29.html Recommended Rich Levitan resources Podcast 70 – Airway Management with Rich Levitan Airway axes From: McGuire B…

From: https://www.bbc.co.uk/news/uk-wales-46441129 From: https://www.ultimatekilimanjaro.com/blog/should-i-use-supplemental-oxygen-on-kilimanjaro/ A portable hyperbaric chamber (Gamow bag)From: https://litfl.com/hypothermia/Classic stretcher techniqueImprovised rucksack stretcher technique Want to know more? This is one of the organisations Lucy me…

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 40%, alcohol is on board 4 stages of Immersion associated with p…

https://phemcast.co.uk/wp-content/uploads/2020/05/covid-02-05-2020-18.41.mp3 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…

https://phemcast.co.uk/wp-content/uploads/2019/09/infant-with-fluid-clarification.mp3 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. From: https://www.jems.com/2017/02/28/an-overview-of-ems-pediatric-airway-management/ ‘B’ a…

https://phemcast.co.uk/wp-content/uploads/2019/07/back-pain_final-12072019-17.13.mp3 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 S…

https://phemcast.co.uk/wp-content/uploads/2019/03/f-psychosomatic-final-31032019-08.27.mp3 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 mo…

https://phemcast.co.uk/wp-content/uploads/2019/03/ketfinal.mp3 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 drug…

https://phemcast.co.uk/wp-content/uploads/2019/01/stroke_final.mp3 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 t…

https://phemcast.co.uk/wp-content/uploads/2018/10/head-injury_final.mp3 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…

https://phemcast.co.uk/wp-content/uploads/2018/07/mi.mp3 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 …

https://phemcast.co.uk/wp-content/uploads/2018/04/lost-final.mp3 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 ev…

https://phemcast.co.uk/wp-content/uploads/2018/01/checklists_final.mp3 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 retail…

https://phemcast.co.uk/wp-content/uploads/2018/01/txa-final.mp3 The paper which we discuss in the interview is available open access here How does tranexamic acid work? Taken from: https://pbrainmd.wordpress.com/2015/10/15/1335/ Critical appraisal aids To understand more about hierachy of evidence and how a systematic review fits into this please h…

https://phemcast.co.uk/wp-content/uploads/2017/12/tp2-final-11_11_2017-00-30.mp3 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 ph…

https://phemcast.co.uk/wp-content/uploads/2017/12/tp-1-fin-11_11_2017-00-08.mp3 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: Fr…

https://phemcast.co.uk/wp-content/uploads/2017/11/io-fin-10-11-2017-22-41.mp3 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…

https://phemcast.co.uk/wp-content/uploads/2017/11/basics-2-07112017-08-42.mp3By clarebosanko

https://phemcast.co.uk/wp-content/uploads/2017/10/basics-fhec-06102017-20-17.mp3By timnutbeam

Guest contributor: Lauren Weekes https://phemcast.co.uk/wp-content/uploads/2017/09/et-06092017-16-24.mp3 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: Metabolic…

https://phemcast.co.uk/wp-content/uploads/2017/07/surg.mp3 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 a…

https://phemcast.co.uk/wp-content/uploads/2017/06/vent-final.mp3 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 I’m afraid we are n…

https://phemcast.co.uk/wp-content/uploads/2017/03/broken.mp3 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 exp…

https://phemcast.co.uk/wp-content/uploads/2017/01/blood-final-27012017-11-55.mp3 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 ‘kno…

https://phemcast.co.uk/wp-content/uploads/2017/01/end-of-year-30122016-16-33.mp3 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 …

https://phemcast.co.uk/wp-content/uploads/2016/12/final-thora.mp3 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: Poli…

https://phemcast.co.uk/wp-content/uploads/2016/12/vent-final.mp3 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 …

https://phemcast.co.uk/wp-content/uploads/2016/09/breaking-bad-final.mp3 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#…

https://phemcast.co.uk/wp-content/uploads/2016/07/final-gentle-patient-handlig.mp3 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 sta…

https://phemcast.co.uk/wp-content/uploads/2016/06/stress-2.mp3 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:…

https://phemcast.co.uk/wp-content/uploads/2016/06/maternal-collapse-06062016.mp3 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…

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. https://phemcast.co.uk/wp-content/uploads/2016/04/chem-final.mp3 There are a multitude of professio…

https://phemcast.co.uk/wp-content/uploads/2016/04/ph-sepsis-10042016-08-56.mp3 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 know…

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! https://phemcast.co.uk/wp-content/upl…

https://phemcast.co.uk/wp-content/uploads/2016/02/amputation.mp3 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 …

https://phemcast.co.uk/wp-content/uploads/2016/01/chemical-incidents.mp3 We hope you enjoyed this PHEMCast. Please feedback your comments via the blog, twitter or email us on PHEMCAST@gmail.com. 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 c…

https://phemcast.co.uk/wp-content/uploads/2015/12/episode-3-hyperoxia.mp3 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 f…

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. https://phemcast.co.uk/wp-content/uploads/2015/09/pelvis-final-1.mp3 As always, please get in …

Here it is – our very first podcast, and guess what – it is on supraglottic airways! https://phemcast.co.uk/wp-content/uploads/2015/08/version-2-lma.mp3 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 Facul…