They said Marvel’s Avengers: Infinity War was the biggest crossover event in history, then along came a joint conference between the Royal College of Emergency Medicine and the European Society For Emergency Medicine. I think we all know who the real winner is here, and it’s certainly not those stone-hunting, caped and suited superhero-powered gods, let me tell you. #dust
As with most epic conferences, the St.Emlyn’s team is here to soak up the knowledge first hand, as well as leading the learning from the stage. Not one but all three of our professors are discussing vital topics this week: Simon Carley is talking about story-telling and narratives in medical education on Tuesday afternoon with a bumper blog post to accompany this huge and interesting topic. If you haven’t already guessed what Rick Body is involved with then where have you been?? He’s involved with a massive seven sessions across the conference, largely related to troponin, and I personally can’t wait to find out what else he’s been up to in the last year. Lastly but not leastly (it’s a word, honest) Dan Horner (more on him later!) is giving two talks on venous thromboembolism, including important updates for the emergency physician on Tuesday morning, which you should definitely not miss. We’ve also got other members of the wider St.Emlyn’s team here at EuSEM/RCEM (we’ll go with EuSEM from now on to make things easier) but we’ll discuss them in the relevant blogs for their talks.
It’s going to be a great four days, and we’ll be doing our best to bring you our picks from across the conference each day, but for now, here’s a recap of what went down on day 1 – Sunday!
To kick off – the toxicology stream. Bruno Mégarbane reminded us how even unfamiliar drugs (such as Baclofen) can cause serious problems in overdose. It’s all too easy to ignore drugs you don’t know much about, or that you assume to be less potent, as part of a mixed overdose, focusing instead on the more recognisable drugs. It’s so important to assess all drugs the patient has taken, using Toxbase advice to aid you in decision making. James Dear from nearby Edinburgh reminded us that admission from paracetamol overdoses equal those from neck of femur fractures – a big part of our workload in the ED. We treat them all the same though, a weight based n-acetylcysteine regime regardless of dose, time, pre-morbid state, liver injury. Is this right? There may be new biomarkers in the future that we can use to stratify risk and adjust treatment doses to the patient. This may improve outcomes and reduce potential side effects. It will be interesting to see if these microRNA biomarkers take off in the next few years. Frédéric Lapostolle also gave us some top tips for toxicology, including learning your toxidromes to help more easily narrow down what your patient may have taken, and…
Toxicology Top Tips from Lapostolle at #EUSEM18— Richard Muswell (@7c6Richard) September 9, 2018
3. Only do (or wait for results of) lab tests when it'll change your management
The infectious diseases stream had some fantastic pearls of wisdom which I was following thanks to the keen tweeting fingers of Matt Mak. Jim Ducharme’s talk on pneumonia was well received, not only discussing clinical management (keep searching for the bugs, make sure you are certain this isn’t PE or heart failure), but working in some Bayesian theory at the same time. Our own Rich Carden wrote a fantastic blog all about the Bayes which you should definitely check out.
Seeing blood test results before you see a patient biases your clinical interpretation because there is no pre-test probability #EUSEM18— Matt (@themattmak) September 9, 2018
Such an important point and one that I regularly put into teaching our foundation doctors around the ED – it’s so crucial to go and see the patient rather than biasing yourself towards a potential diagnosis though reading old letters/notes or looking at the lab results/radiology results before you’ve even taken the history. Just go and see the patient!
Some of the key messages from the infectious diseases stream can be summed up by a series of tweets from Matt relating to a quiz that David Carr curated. It’s a lot more information than I could possibly sum up on this blog, so ensure you check those out for some insightful ID knowledge.
Cellulitis + unstable vitals = necrotising fasciitis. Cellulitis + opioid requirement = necrotising fasciitis #EUSEM18— Matt (@themattmak) September 9, 2018
One thing we can definitely improve on in the ED is our management of patients with pain. Over in the analgesia/sedation stream Agnès Ricard-Hibon reminded us that we don’t use regional blocks often enough for our patients. It’s such a simple procedure that can make a huge difference but is often unnecessarily time-consuming if your department doesn’t have the right equipment in an accessible place. Carlos Garcia Rosas highlighted a need for multimodal analgesia (sometimes us ED physicians do need reminding!), and Fiona Burton described how she is trying to work out whether TCI (target controlled infusion of anaesthesia) could work for us in the emergency department. Now, as an ED/ICM trainee currently relaxing on 6 months of anaesthetics (Ed – don’t get any ideas…) I’ve been doing a few lists where we use propofol TCI to gain deep sedation, for example egg retrieval relating to IVF. Once the sudoku is done I’ve used my remaining time to chat to the consultants about what they think about using it in the ED for things like shoulder reductions. I’ve had a lot of mixed views. To me it seems like the use of TCI for prolonged deep sedation for procedures with constant stimuli is a different situation to the usual brief but severely painful stimulus that comes with joint reductions, so this talk was interesting and I look forward to seeing the results of her team’s research in the future.
Venous thromboembolism is always a hot topic, and our very own Dan Horner headed up the stream with a talk on diagnosis of massive PE. You can read his blog that links into the talk here. And, no conference would be complete without a stellar talk on human factors, this time from Tom Evens with some brilliant lessons on bandwidth and how we cope after mistakes are made.
When your cognitive bandwidth is overloaded, brain stops functioning effectively, rather like computer / internet connection buffering. Awareness that bandwidth is overloaded also fails to work. Leads to errors and cognitive biases #EuSEM18 @DocTomEvens— Anu Mitra (@AcmeDR) September 9, 2018
Of course the opening ceremony should always fall at the end of the day, and EuSEM maintained this fine tradition. Ahmed Kazmi, a GP and comedian did a fantastic job of warming the audience up with some top jokes about how GPs are just like emergency physicians – everyone always wants to know when we’re going to specialise. Some prestigious speakers inspired a desire to be and do better in our emergency departments all across Europe, including Roberta Petrino – president of EuSEM, and Taj Hassan – president of RCEM.
A fantastic first day to kick off the EuSEM congress 2018 in Glasgow. Whichever tracks you followed, we hope you had a good time and learnt something, and would be delighted to hear what your favourite bits of the day were. Let us know! Join us again for our catch ups of the rest of the conference.
Thanks for reading, before you go please don’t forget to