Papers of May 2021

Welcome back to May’s Papers of the Month Podcast!

Three more papers for you on three varied topics. We start off with the use of end tidal carbon dioxide in the content of prehospital head injuries.Taking a look at a paper delving a bit deeper into the utility of end tidal CO2 when compared with arterial CO2 measurements on arrival in ED, in patients having received a prehospital anaesthetic; how accurate is end tidal and what level should we be aiming for?

Next we consider the importance of frailty in the outcomes of our older trauma patients and the ability of three different screening tools in identification of this cohort of high risk patients presenting to our hospitals.

Finally we take a look at a treatment which some prehospital services have already employed and others are considering; the use of CPAP for patients presenting with acute respiratory distress. Does the evidence support its use?

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

Simon & Rob

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References & Further Reading

End-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after prehospital emergency anaesthesia: a retrospective observational study. James Price. Emerg Med J. 2020

Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study.Jarman H. .Scand J Trauma Resusc Emerg Med. 2021

Is a definitive trial of prehospital continuous positive airway pressure versus standard oxygen therapy for acute respiratory failure indicated? The ACUTEpilot randomised controlled trial. Fuller G. BMJ Open. 2020

Finn JC, Brink D, Mckenzie N, Garcia A, Tohira H, Perkins GD, et al. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial. Emergency Medicine Journal. 2021:emermed-2020-210256.

RCEMLearning; EMJ Podcast April 2021

Course Content

4 Comments

  • Dear Team,

    as usual I enjoyed your review of the paper of the month.
    One point on your comments on the 3rd paper (Simon I think) regarding the measurement of respiratory rate in patients in respiratory distress. If the patient is monitored via end tidal CO2 nasal canula, the monitor records data during care. Paramedics and researchers can then rely on objective assessment, unlike the subjective (and open to bias) counting breathing rate method.

    Keep up the great work.
    Kind regards.
    Damien “Frenchy” Gaumont.

  • Dear Simon & Rob
    Thank you for including our prehospital CPAP study in your May 2021 Podcast. It was particularly pleasing that you acknowledged the importance of dyspnoea from a patient’s perspective. We actually had some difficulty getting the paper published because of concerns that it wasn’t powered for ‘hard outcomes’ ie intubation or mortality. (Even though it is the largest prehospital CPAP RCT published to date.)
    Just a minor point – but I wondered if the reference for the paper could be added to the webpage: https://www.theresusroom.co.uk/courses/papers-of-may-2021/

    Finn JC, Brink D, Mckenzie N, Garcia A, Tohira H, Perkins GD, et al. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial. Emergency Medicine Journal. 2021:emermed-2020-210256.

    Cheers, Judith

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