Opioid toxicity is a major and growing challenge across the UK and beyond, with nearly 10 deaths every day from opioid overdose and over a million adults using Class A drugs annually, the impact on emergency services is enormous.

In this episode, we’re diving deep into the recognition and management of acute opioid toxicity in the emergency setting, including the reversal using naloxone.

We’ll run through;

• The scale of the problem, including the rise of novel synthetic opioids like fentanyl and nitazenes.
• A breakdown of opioid pharmacology, including receptor types, potencies, and onset of action.
• How to identify classic and mixed presentations of opioid overdose.
• Best practice on naloxone dosing, routes of administration, and when to start infusions.
• The risk of acute withdrawal and how to manage it with care.
• How to approach mixed overdoses, cardiac arrests involving opioids, and nebulised naloxone.
• And finally, the importance of holistic care, safeguarding, and onward referral to support recovery.

Whether you’re in ED, prehospital care, or just want to sharpen your tox knowledge, this episode’s packed with take-home learning. Oh, and yes... Gangs of London gets a shout-out too.

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 April's Papers of the Month!

First up this month we have a think about posterior circulatory strokes, which can mimic benign vertigo, and can be really tricky to differentiate between a completely benign issue or a stroke that is really important to pick up. Clearly imaging everyone is one option but completely impractical when you consider the gold standard of MRI. So having a bedside tests to rule in or out the diagnosis of stroke would be a huge help. Our first paper looks at the use of three bedside scoring systems; HINTS, TriAGe+ and ABCD2 scores in ED for patients presenting with possible posterior circulatory strokes. How accurate are they and can we reliably incorporate into our practice?

Next up is traumatic cardiac arrest. This has obviously got a very high mortality rate. One of the interventions that might improve mortality (for some mechanisms and patients) is a resuscitative thoracotomy, however this is a really significant intervention and we want to ensure we are targeting it at the patients that may benefit. A great paper has just been published from London Air Ambulance which might just help us to identify those patients who would benefit with more certainty, along with those where futility has already been reached.

Finally we take a look at acute kidney injury (AKI) and its association contrasted scans. Contrast induced nephropathy (CIN) has historically been a concern, particularly for patients with chronic kidney disease, with contrast causing direct injury and limited blood flow. But recent studies have questioned the actual risk of CIN & there’s been a more recent RCEM statement on the topic, but we thought this might be a nice opportunity to refresh and look at a recent paper on the topic.

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

Simon & Rob

Welcome back to The Resus Room! This time, we’re diving into the fascinating and often overlooked world of electrical injuries. From household mishaps and workplace accidents to tasers and even lightning strikes, electrical injuries can range from minor shocks to life-threatening cardiac arrests.

As always, we’ll be taking you through the full spectrum of care, from first contact at the roadside to critical management in resus. And let’s be honest, there’s a real lack of clear guidance out there when it comes to managing these cases. So, we’ve done the legwork, scoured the literature, and we’re here to make sense of it all.

In this episode, we’ll cover:

• Pathophysiology; how electricity interacts with the body and why not all shocks are created equal.
• Classification; what makes a low-voltage injury different from a high-voltage one, and why that matters.
• Prehospital & ED Management; who needs an ECG, who needs admission, and what to do with those tricky "seemingly fine" patients.
• Special cases; tasers, lightning strikes, and the unique challenges they pose.

One of the big questions we’ll be tackling: Does everyone who gets an electric shock need to go to hospital? We’ve all seen them, the patient that has a shock at work, but they feel fine. So, do they need a work-up, or can they safely go home?

So, grab a coffee (or maybe a non-conductive beverage of choice), and let’s get stuck in to Electrical Injuries!

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

Simon, Rob & James