Welcome back to Papers of the Month! Three more papers to both inform and challenge our practice across the spectrum of emergency care.

First up we look at a systematic review and meta-analysis on noradrenaline vs adrenaline for our medical post-ROSC patients; what evidence exists out there and should we all be delivering noradrenaline as our first line treatment for those with shock?

Next up a paper to really challenge the treatment algorithm for status epilepticus in paediatrics, with an RCT of midazolam and ketamine versus midazolam alone. There are some huge differences here in the form of termination rates and some great discussion to be had around the specifics of the paper and how that might translate into future practice.

Finally we look at a paper assessing the impact of i.m. versus i.v. metoclopramide for migraines and acute severe headaches. The paper looks at the impact of length of stay within the Emergency Department and also the efficacy of the treatment.

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

Simon & Rob

It’s something we all encounter in emergency and prehospital care, probably more than anything else, yet it’s a topic we’ve not given a full episode to… until now!

Up to 70% of prehospital patients and 60–90% of ED attendees report pain, with half of all ED presentations having pain as the primary complaint. That’s millions of patients across Europe every year and we’re not always optimising our approach!

In this episode, we’re diving deep into acute pain management; from understanding the complex biopsychosocial definition of pain, right through to tailored pharmacological and non-pharmacological strategies, plus everything in between.

We’ll be looking at how we define and assess pain and the importance of validating patient experience. Then we’ll work through management options: from paracetamol to ketamine, NSAIDs to regional anaesthesia, and talk through barriers like bias, opiophobia, and the persistent inequalities in analgesic delivery.

We'll also shine a light on special groups; from paediatrics to chronic pain patients and those with opioid use concerns, finishing with key takeaways on safe discharge planning.

This one’s about being better at recognising, respecting, and relieving pain. Because pain is an emergency, and we’ve got the tools to do something about it.

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

Simon, Rob & James

Welcome back to June 2025's papers podcast!

Having been cynical about CPR feedback devices in the past we take a look at a recent paper on their use and their potential impact to both ROSC and survival for patients, when compared to standard practice; is it time to integrate them more definitively into our practice?

Next up we take another look at the use of adrenaline in traumatic arrest. We've covered this before and there's some interesting data and discussion to be had around the topic and the paper.

Finally, we all know about the unprecidented pressure on ED’s and all forms of healthcare at the moment. Many patients waiting for hours and hours to be seen. But there may be systems and routes by which others can be identified with lower acuity presentations that may not need to wait overnight for long periods, and our final paper looks at this with a paper on 'deflection'.

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

Simon & Rob