The Resus Room

This month we have three really clinically relevant papers that take us from a very common ED presentation, through an everyday diagnostic dilemma, and then right into a high-risk paediatric airway. We start with abdominal pain in older adults and ask whether the history and examination are giving us as much reassurance as we think. The paper looks at how CT use, diagnostic yield, admission and surgery change with age - and whether we should think of geriatric abdominal pain as a distinct high-risk presentation. Then move on to unexplained syncope and a large UK randomised trial of immediate 14-day ambulatory ECG monitoring. The didn't reduce recurrent syncope at one year, but it found substantially more clinically significant arrhythmias, found them earlier and led to more treatment. That leaves us with a really interesting question about the difference between diagnosing more disease and improving the outcome the patient actually experiences. What will it mean for our strategies moving forwards? Finally, we look at paediatric emergency intubation through recorded video laryngoscopy. Which technical errors occur most often, which ones cluster around failure, and what can the airway coach spot early enough to change the attempt? As ever, we will take you through what the teams did, what they found, and whether any of it should change practice on your next shift. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Welcome back to September 2026's Papers of the Month, and this month we've got three papers that are really focused on the practical end of emergency and prehospital care. First up, we're looking at what happens after we've performed a prehospital RSI. We put a huge amount of emphasis on getting the induction right, but what about maintaining adequate anaesthesia afterwards? This paper looks at intermittent bolus sedation following prehospital emergency anaesthesia, the variation in dosing between patients, and whether we might actually be running the risk of under-sedating some of them and compromising their care. Then we're staying prehospital and asking a really simple question in trauma: how good are the physiological numbers we use to identify the sick patient? We've all used shock index, but could NEWS actually do a better job of predicting mortality, transfusion requirements and subsequent resource utilisation? And finally, we're back to RSI and rocuronium. A variety of dosing strategies can be seen in practice but could going higher improve first-pass success? And importantly, does that relationship still hold in patients with obesity or hypoperfusion? Three clinically relevant papers, plenty to challenge our current practice, and as always, lots to get into. Once again we'd love to hear any thoughts or feedback either on the website or via social media @TheResusRoom! Simon & Rob

This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial. What remains a bit ambiguous is the effect of that intervention. Does it play out into a mortality benefit and if so how should we redesign systems to meet a 24 hour need for this (with many prehospital critical care services not being available fully around the clock), bearing in mind competing financial priorities for optimum health care. Maybe it's okay that for some patients the anaesthetic is delayed to the Emergency Department? Worldwide, trauma accounts for an estimated 4.4 million deaths annually and carries a substantial economic burden. Despite decades of improvements in trauma systems, medications such as tranexamic acid, and the development of prehospital critical care teams, some key aspects of trauma care remain really difficult to study well. Prehospital emergency anaesthesia is a prime example. It is time-critical, ethically complex, highly operator dependent and almost impossible to study using conventional randomised trial designs. As a result, clinicians have largely been forced to rely on observational studies, despite the well-recognised problems of bias and confounding that accompany them. In this episode, we explore the existing evidence base and then focus on a landmark new study published in The Lancet Respiratory Medicine. This paper applies machine-learning techniques to a large UK trauma dataset to address the question; does prehospital intubation improve survival in patients who are predicted to need early airway intervention? We walk through how the authors developed a predictive model to identify high-risk patients, how doubly robust estimation was used to move beyond simple association, and how survival and health-economic outcomes were assessed. The results suggest a clinically meaningful reduction in 30-day mortality for selected high-risk trauma patients who receive prehospital intubation. And we're then joined by two of the study's authors, Amy Nelson and Julian Thompson. Together, we explore what these findings may mean for the future of prehospital emergency anaesthesia, how we should think about evidence in complex emergency care environments, and whether this type of analytical approach could reshape trauma research more broadly. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm. In paediatric seizures, time really matters. In this episode we take a step-by-step look at how to assess and manage a child who's seizing. We start with the fundamentals; how seizures are defined and classified, what status epilepticus actually means in practice, and why recognising it early makes such a difference. We then dig into the physiology behind seizures, exploring why early benzodiazepines work well and why delayed treatment often doesn't. Understanding what's happening at a receptor level helps make sense of when to escalate treatment and why different drugs work at different stages of a prolonged seizure. Pharmacology is a big part of this episode. We talk through first- and second-line anti-seizure medications, routes of administration, and how effective they really are. We cover the EcLiPSE and ConSEPT trials comparing levetiracetam and phenytoin, and look at newer evidence from the Ket-Mid study and what that might mean for managing refractory status and thinking about RSI. We also work through the approach to cases, pre-hospital management and in-hospital care aligned with UK and European recommendations. There's a clear focus on febrile seizures too, separating simple from complex presentations and helping you decide who needs investigating, admitting, or reassuring and discharging. As ever, the aim is to turn guidelines and evidence into something usable on the shop floor. Paediatric seizures are stressful, but with a structured approach, early treatment, and good airway management, they're absolutely manageable and we can make a real difference on outcomes. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Welcome to this special edition of Roadside to Resus where we're diving into some of the progressive and practice-defining developments in pre-hospital emergency care. This episode brings together a superb group of clinicians, educators and leaders who are shaping the future of PHEM across the UK, and we caught up with them at the recent Faculty of Pre-hospital Care Conference entitled 'The Wider World of Pre-hospital Care'! We start with Pam Hardy, the Chair of the FPHC, who offers an introduction to the College and its ongoing work to elevate standards across pre-hospital care. Next, Camella Main guides us through the brand-new Pre-hospital Maternity Decision Tool designed to support clinicians facing complex decision making in this complex group of patients. Camella breaks down how the tool came to fruition and how teams can use it to enhance safety and decision-making on scene. We then hear from Ben Sheppey, who explores the growing move to formalise and professionalise voluntary pre-hospital care. Ben reflects on the challenges, opportunities and cultural shifts required to align voluntary responders with national standards. Harriet Tucker then walks us through the new FPHC consensus statement on managing penetrating neck injuries. She distils the key principles, the recommendations, and how the guidance aims to bring clarity to one of the most complex and time-critical presentations we face. From there, Cosmo Scurr unpacks the latest AAGBI PHEA Guideline, highlighting the key movements in delivering anaesthesia in the pre-hospital environment. We also hear from Felix Wood, who provides a sharp, practical look at crush injury and crush syndrome. Finally, Zane Perkins explores the rapidly advancing world of AI in PHEM. From practical application to decision making support. Zane describes how emerging technologies have the potential to change prehospital care in ways we may have never considered before! A huge thanks to the expert speakers for their time recording highlights from the superb conference. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Whether you're just stepping into your first cardiac arrest or you've been running them since the days of paddles, this one's for you. The 2025 resuscitation guidelines have landed after further collaboration between ILCOR, the ERC and the Resuscitation Council UK and in this episode we break down exactly what's new, what's stayed the same, and how it all fits into day-to-day practice. Across the board the 2025 updates represent evolution, a steady refinement of evidence rather than wholesale change. Adult ALS remains rooted in early recognition, high-quality compressions and rapid defibrillation, but you'll notice sharper guidance around ventilation, pad positioning, and the sequence of vascular access and drugs. There's a new section on physiology-guided CPR and the emerging science behind arterial-line-driven resuscitation as we covered in the SPEAR epsiode. We also take a look at the special circumstances algorithms from hypothermia to traumatic and obstetric arrest and discuss how an emphasis on reversible causes, data-driven debriefing and system performance might reshape post-event learning. Paediatric and newborn life support see subtle but important refinements too, including pad placement, shock energy escalation, simplification of adrenaline timings and a new Out-of-Hospital Newborn Life Support algorithm aimed squarely at the pre-hospital world. All this and more in the episode! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

How, when and why to make the call… The pre-alert is one of the most powerful and sometimes most painful parts of emergency care. It can feel like the Spanish Inquisition, trigger tension between pre-hospital and ED teams, or drop another challenge into an already overflowing department. But done well, a pre-alert isn't an irritation; it's an opportunity to line up critical care for the next patient and genuinely improve outcomes. In this episode, Simon, Rob and James break down The UK NHS Ambulance Services and Emergency Department Pre-Alert Guideline, jointly released in July 2025 by RCEM and the Association of Ambulance Chief Executives. It's the first national attempt to give clear, shared expectations on who to pre-alert, what to say, and how to receive those calls, it's full of practical recommendations for both sides of the phone. We kick things off with a review of the evidence base, including brand-new studies showing just how varied pre-alert practice is across the UK. From inconsistent criteria and mixed training to the problem of "pre-alert fatigue", the data make a strong case for standardisation. We then walk through the new guideline's key principles: pre alerting for pre-specified physiological parameters or specific conditions. We finish off with top tips for making and taking better pre-alerts - selling a story, leading with the headline, and understanding what the other side actually needs. This episode combines frontline pragmatism with real-world research and might just make your next pre-alert smoother, faster, and better received. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James