Welcome back to February's Papers of the Month.

Across these three papers, a common theme emerges: many of the things we do every day are based on habit, extrapolation, or long-standing belief rather than direct evidence from the patients and settings we work in. These studies don't give us easy answers, but they do ask better questions — and that's exactly what Papers of the Month is about.

We start in the prehospital environment, looking at airway management and the question of where intubation actually happens. The idea that we need perfect conditions and 360-degree access before attempting an airway is deeply ingrained, particularly in prehospital care. But real life is messy. This paper explores whether intubating inside an ambulance is associated with worse outcomes or complications, or whether it might actually be a reasonable — and sometimes advantageous — option when time and context matter.

Next, we move into cardiac arrest and one of the most basic interventions we perform: defibrillation. Specifically, pad position. Anterior–lateral versus anterior–posterior placement is something many of us were taught early on, often without much discussion. This study looks directly at patients with shockable out-of-hospital cardiac arrest and asks whether initial pad position influences return of spontaneous circulation and downstream outcomes. It's a simple intervention, but one that could have important implications for practice.

Finally, we take on one of the most debated topics in emergency and critical care airway management: ketamine versus etomidate for induction. This large, pragmatic randomised trial examines whether sedative choice affects mortality and peri-intubation cardiovascular collapse in critically ill adults. It challenges some widely held assumptions, particularly around haemodynamic stability, and provides some much-needed clarity in an area that has generated more opinion than data for years.

Taken together, these papers remind us that resuscitation is built on dozens of small decisions. February's Papers of the Month isn't about changing practice overnight — it's about thinking more carefully, questioning dogma, and understanding the evidence behind the choices we make every day.

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 January's Papers of the Month, which marks 10 years of the podcast!

First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quantifies the impact of post-RSI hypotension in a dramatic way and the associated increase in 30-day mortality.

Our second paper moves into the world of stable supraventricular tachycardia, asking whether an elevated troponin level in this cohort predicts short-term cardiovascular events. Troponin testing in SVT is common but debated: is it useful, or is it a diagnostic red herring?

Finally, we look at BICARICU-2, a major multicentre RCT examining sodium bicarbonate for severe metabolic acidemia in patients with moderate–severe AKI. We explore what this means for bicarbonate use for this group of patient, both in terms of mortality rates and the need for renal replacement therapy.

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

Simon & Rob