The Resus Room

Tracheostomy and laryngectomy emergencies are classic high-acuity, low-frequency situations. They do not happen every day, but when they do, airway problems can develop quickly, and the wrong intervention can make things significantly worse.
In this episode, we work through the practical approach to these patients, starting with the most important distinction: a patient with a tracheostomy may still have a patent upper airway, whereas someone who has undergone a total laryngectomy is an obligate neck breather. That single anatomical difference determines where oxygen and ventilation need to be delivered.
We'll look at the different tubes, cuffs, inner cannulas, speaking valves and humidification devices you may encounter, before moving through the common causes of deterioration, particularly obstruction, displacement and bleeding.
Using the National Tracheostomy Safety Project's green and red emergency algorithms, we break management down into simple, sequential steps: apply oxygen, remove attachments, remove the inner cannula, pass a suction catheter, deflate the cuff when appropriate and remove a non-functioning tube when necessary.
These cases can initially feel intimidating, but a calm, structured approach can make them far more manageable.
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 July's Papers of the Month.
This month we've got three papers that tackle some of the biggest questions we face in emergency and critical care medicine. They're all very different studies, but each one looks at an intervention that many of us use, or at least think about, on a regular basis.
First up, we look at ARISE FLUIDS, a major trial examining one of the longest-running debates in sepsis care. Should we be reaching for fluids or vasopressors first in septic shock? We've spent years worrying about giving too much fluid, and equally worrying about starting vasopressors too early. This study gives us some of the best evidence yet about what happens when we take a more restrictive fluid approach and start vasopressors earlier.
Next, we move to cardiac arrest and the BIHCA trial, looking at sodium bicarbonate during in-hospital cardiac arrest. Despite guideline recommendations and a lack of convincing evidence, bicarbonate continues to be used in many arrests around the world. This study finally gives us some high-quality data on whether it's actually helping our patients.
And finally, we head back to the ECG with a fascinating paper looking at the lead V5 T-wave to R-wave ratio as a marker of right ventricular dysfunction in pulmonary embolism. It won't change practice tomorrow, but it raises some interesting questions about what the ECG may still have to tell us about risk stratification in PE.
So let's get into it!
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob

Face mask ventilation is one of those skills that can easily be overlooked. It's often seen as the simple bit of airway management — something that sits below the glamour of videolaryngoscopy, fibre-optics and endotracheal intubation. But the reality is that excellent face mask ventilation is one of the most important airway skills we have.
In this episode, we take a deep dive into bag-valve-mask ventilation and airway adjuncts, exploring why this is far more than just putting a mask on a face and squeezing a bag. We discuss when facemask ventilation is indicated, how to identify patients who may be difficult to ventilate, and the practical steps that can dramatically improve success rates.
We cover positioning, airway opening manoeuvres, mask seal techniques, the role of airway adjuncts and how to recognise whether your ventilations are actually working. We also look at troubleshooting common problems, the evidence comparing bag-mask ventilation with supraglottic airways and endotracheal intubation, and how to decide when it's time to move to another airway strategy.
Whether you're working in the emergency department, prehospital environment or critical care, this episode is packed with practical tips, cognitive aids and evidence-based advice to help you deliver facemask ventilation with confidence and excellence.
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon. Rob & James

This month's episode takes us deep into trauma care, but not just the medicine we deliver but also the systems, circumstances and social factors that shape who survives and who doesn't.
We start by looking at a remarkable paper from Gaza describing the use of ultrasound-guided pericardiocentesis, large-bore drainage and intrapericardial tranexamic acid as definitive management for penetrating cardiac tamponade. In a setting where immediate thoracotomy simply wasn't always possible, the authors report some pretty incredible survival figures and challenge a lot of the dogma around penetrating cardiac injury. It's a fascinating example of innovation being driven by necessity.
We then move onto a huge epidemiological study from the London Trauma System exploring when and where trauma deaths occur in a mature major trauma network. The findings are stark — most deaths now occur before hospital arrival, often within minutes, and many from potentially reversible causes. It really makes us think about where the next advances in trauma care need to happen.
Finally, we finish with an incredibly important and sobering paper examining knife-related deaths in children and young people across England. This isn't just about anatomy and interventions — it's about deprivation, adverse childhood experiences, safeguarding and public health. It's a paper that's difficult to read at times, but absolutely essential for anyone involved in emergency and prehospital care.
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob

Anaphylaxis is one of those conditions we think we have got pretty well sorted. Recognise it early, give adrenaline, support the airway and circulation, and crack on. And in fairness, for the vast majority of patients, that approach works really well. But in this Roadside to Resus episode we take a step back and ask a pretty uncomfortable question, have we actually been thinking about anaphylaxis in the wrong way?
Using some fascinating new evidence from the UK National Child Mortality Database, we explore the emerging understanding that fatal food-triggered anaphylaxis may be much more of a respiratory catastrophe than the classic circulatory collapse we often picture in our heads. The findings are genuinely thought provoking. Many of the fatal paediatric cases reviewed showed overwhelming airway and breathing compromise long before cardiovascular collapse occurred, with deterioration happening frighteningly quickly in the prehospital phase. 
We work through the current Resuscitation Council UK and NICE guidance, look at where diagnostic confusion still exists, and discuss why early adrenaline absolutely remains the cornerstone of treatment. But we also explore whether our mental model of anaphylaxis needs updating, particularly when it comes to respiratory assessment, escalation and oxygenation strategies.
We're also incredibly grateful to be joined by Ben McKenzie, who shares the devastating personal story behind the development of the AMAX4 approach and the lessons it holds for all of us managing critically unwell patients in the ED and prehospital environment. 
This is a really powerful episode about recognition, trajectory and reframing how we think about severe anaphylaxis.
Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob