Papers of December 2020

Welcome back to December’s Papers of The Month Podcast! Three more papers for you which will challenge and inform you practice.

First up we have a look at a systematic review and meta-analysis which considers the fluid choice in resuscitating those patients with suspected traumatic brain injury in the prehospital setting; should we be reaching for the hypertonic solutions, or is an isotonic fluid such as normal saline adequate?

Next we take a look at a paper that has received a lot of online discussion which looks at the two approaches of antibiotics or surgery for an appendicitis. This is a randomised control trial that looks to answer a question that the literature has dipped into over the last few years, but this RCT goes that bit further and will help give patients a good idea of the pro’s and con’s of each approach.

Finally we take a look at the UK national approach to oxygenation strategies in those patients receiving a prehospital emergency anaesthetic. How many clinicians provide PEEP, how commonly implemented is apnoeic oxygenation and do we all ventilate through apnoea? Gaining an understanding as to where our practice sits compared to others gives us the opportunity to consider the potential benefits and downsides of various strategies and may help unify practice to more streamlined working and better outcomes for our patients. We also get the opportunity to hear thoughts on the subject from one of the authors Dr. Amar Amshru, Emergency Medicine and and Pre Hospital Doctor in London and with Kent Surrey and Sussex Air Ambulance.

Enjoy!

Simon & Rob

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References & Further Reading

Prehospital fluid administration in patients with severe traumatic brain injury: A systematic review and meta-analysis. S F Bergmans.Injury. 2020

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. CODA Collaborative. N Engl J Med. 2020

Oxygenation strategies prior to and during prehospital emergency anaesthesia in UK HEMS practice (PREOXY survey). Adam J. Boulton. Scand J Trauma Resusc Emerg Med. 2020

St Emlyns; Antibiotics or Surgery for Appendicitis

Broome Docs; Appendicitis: Surgery vs Antibiotics

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