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

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References

The role of the HINTS exam, TriAGe+ score, and ABCD2 score in predicting stroke in acute vertigo patients in the ED. Topple. Am J Emerg Med. 2025

Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025

Incidence of Acute Kidney Injury After Exposure to Intravenous Contrast in Emergency Department Patients Presenting for Stroke. Faruqi. J Emerg Med. 2025

St Emlyns JC: Pre Hospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest – data from 21 years at London’s Air Ambulance

Joint Advisory Statement between Royal College of Radiologists & Royal College Emergency Medicine regarding Emergency Computed Tomography scans and the use of Intravenous Iodinated Contrast Agents