Monthly round up Feb March 2024

Podcast – February and March 2024 Monthly Update – mCPR, Resus research, decompensated liver disease and more

Welcome to the St Emlyn’s Monthly Medical Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Simon and Iain will bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development. Whether you are a seasoned practitioner or just starting your journey in the field, our podcast aims to provide valuable knowledge and foster a community of learning and support.

In this round-up of February and March 2024, we talk about a wide range of issues relating to emergency medicine, including decompensated liver disease, mechanical CPR, frailty, global health and more

Listening Time – 24:42

Mechanical vs manual CPR for inhospital cardiac arrest

A recent study published in Resuscitation examined the outcomes of mechanical CPR (MCPR) versus manual CPR in in-hospital cardiac arrest cases. Despite the logistical advantages of MCPR, such as freeing up personnel and consistent compressions, the study revealed a lower survival rate to discharge compared to manual CPR (11.8% vs. 16.9%).

While mechanical CPR offers certain operational benefits, the lack of evidence supporting improved outcomes suggests that high-quality manual CPR remains preferable in most in-hospital settings. This finding aligns with practices in regions like Victoria, Australia, where manual CPR is prioritized.

Conference – Top Resus papers for The Big Sick 2024

We review the top resuscitation papers discussed at The Big Sick Conference 2024. Key topics include airway management, with evidence showing increased mortality from ED intubation versus OR intubation and improved first-pass success with video laryngoscopy. Haemorrhage control is debated, with studies questioning the efficacy of REBOA and cryoprecipitate. In cardiac resuscitation, alternative defibrillation strategies show promise for refractory VF. The post highlights the importance of continued research and careful application of findings in clinical practice.

Conference – CPD Update for UoT CPD conference Whistler 2024

The blog post on St. Emlyn’s provides a CPD update for the UoT CPD conference in Whistler 2024. Key topics include:

  1. Airway Management:
    • Freund study: “Watch and wait” approach for comatose poisoning patients reduces intubation rates.
    • Video vs. direct laryngoscopy improves first-pass success rates.
    • Mac 3 laryngoscope blades show better first-pass success and view quality compared to Mac 4.
  2. Resuscitation Techniques:
    • Smaller ventilation bags may reduce return of spontaneous circulation.
    • REBOA’s effectiveness in trauma is questioned.
    • CRYOSTAT-2 trial: Cryoprecipitate showed no significant benefit in major hemorrhage protocol.

Decompensated liver disease in the ED

Decompensated liver disease, often seen in emergency departments, is becoming increasingly prevalent. This condition involves chronic liver disease patients experiencing acute failure, characterized by jaundice, ascites, and hepatic encephalopathy. Notably, identifying the most specific sign, asterixis (the hepatic flap), is crucial.

The key to managing these patients lies in aggressively searching for underlying causes such as infections, GI bleeds, and alcohol withdrawal. Spontaneous bacterial peritonitis (SBP) is a common and severe infection in these patients, often presenting with minimal symptoms. Performing ascitic taps and administering appropriate antibiotics are essential steps.

There’s a need to shift our mindset from seeing these patients as futile cases to recognizing opportunities for intervention. Effective management includes addressing AKI, hyponatremia, and ensuring prophylactic anticoagulation to prevent venous thromboembolism. By focusing on comprehensive care, we can significantly impact patient outcomes.

Are long waits in the ED lethal for elderly patients?

A study from France investigated the effects of long waits in emergency departments on patients over 75. The findings were stark: those who stayed overnight had a significantly higher mortality rate (15.7%) compared to those admitted to wards before midnight (11.1%). This highlights the critical need to reduce prolonged stays for elderly patients.

The study underscores the importance of minimizing wait times in EDs to improve outcomes for elderly patients. This involves not only managing patient flow more efficiently but also addressing systemic issues that contribute to delays, such as resource allocation and staffing.

The Global Health Map

There’s an initiative to create an interactive map for connecting UK emergency care practitioners involved in global health. This map, hosted on the RCEM website, displays the global health engagements of UK colleagues to promote collaboration, mentorship, and sustainable global health efforts. Users can share their projects, filter results by type of work, and connect via a central email. The project encourages participation to enhance the network and improve global health work efficiency.

Podcast transcription

Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!

Cite this article as: Iain Beardsell, "Podcast – February and March 2024 Monthly Update – mCPR, Resus research, decompensated liver disease and more," in St.Emlyn's, May 9, 2024,

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