The lecture theatres were somewhat quieter after a night of #FOAMaoke the previous evening, but despite our resident queen of the mic Nat May not being able to video-link in from down under, we had a good showing and a great sing! Luckily St.Emlyn’s is here again to give you the recap of what you missed on the last day of EuSEM18. If you need a reminder of what we learnt from the first three days, you can check out our blogs on Day 1, Day 2 and Day 3.
In the neurology stream we heard some brilliant talks from Jeff Perry and Peter Johns. Jeff has done a huge amount of research into subarachnoid haemorrhage, and it’s a topic I myself am very interested in – indeed my first ever clinical blog post for St.Emlyn’s was on SAH and I regularly trawl for the latest research. Inevitably Jeff’s name pops up a lot so it was great to see him at EuSEM18. He spoke on the Ottawa SAH rule as a way to try to reduce over-investigation of what is a very low-prevalence but high-significance condition. It has a very specific set of inclusion/exclusion criteria so it’s important to ensure that your patient fits these if you are going to use it in clinical practice, and he also noted that care should be taken in sickle cell or anaemic patients as there’s not enough evidence that early CT is good enough to exclude SAH in this group. Nat has blogged about the Ottawa SAH rule before, so be sure to check out what we at St.Emlyn’s think about it! Jeff’s second talk later in the day was about predicting stroke risk and how the ABCD2 score isn’t great at this. His team has been working on using CT scan findings as well as the Canadian TIA score (I’m not sure why it’s not the Ottawa TIA score like every other decision aid his team comes up with but maybe they decided they needed to branch out!) to try to establish which patients are high risk to enable more effective onward management. The main learning points from these talks are that we still aren’t great at risk-stratifying brain badness and there’s still a lot of work to do!
Good reminder in the ABCD2 score from Perry. For clinical features you get either 2 for limb weakness or 1 for speech. You don’t score for both. #EuSEM18
— Andy Neill (@AndyNeill) September 12, 2018
Peter is a vertigo expert and I really enjoyed listening to his two talks on his approach to the patient with vertigo in the emergency department. With some fantastic videos of patients with positive signs, he made the HINTS plus test and Dix-Hallpike test/Epley manoeuvres much more understandable and the messages from Twitter suggested a renewed confidence in clinicians’ ability to perform these tests as a result. It’s important to remember that Dix-Hallpike should only be performed in those patients with short episodes of vertigo, whereas HINTS plus is reserved for chronic constant vertigo. Don’t forget that there are different types of BPPV requiring varied movements in order to treat these and as an emergency physician you need to be aware of all of these, so make sure you check out his videos on the topic.
Annemarie Lassen spoke on meningitis with some good tips on improving the management of these patients. In the ED I suspect we don’t do many lumbar punctures (sadly) but it will depend on where you work of course! The key things are to make sure cultures are taken early, and that a diagnosis of meningitis is sometimes difficult to make in the ED as many of the early symptoms – weakness, confusion, fever, headache, fatigue, can be non-specific and quite common presentations to our departments either alone or in combination.
Forget the classical triad of fever, neck stiffness and altered mental status for bacterial meningitis (only 44% have all three). Add in headache and 95% patients will have at least 2 out of 4! Lassen #EuSEM18
— Chris Gray (@cgraydoc) September 12, 2018
Andy Neill gave another fab talk on a diagnosis that we probably don’t consider enough in the emergency department, and certainly is one that I know less about than I should, so it was brilliant to learn from him on cerebral venous thrombosis – the “DVT of the brain”. Like he did for his talk on PE, he also put together a blog which you can read here. The main things I learnt from his talk were that this is a diagnosis I don’t consider nearly enough (though it is rare and accounts for less than 1% of stroke), and also that it can cause bleeding and infarct appearance on CT scanning leading to satisfaction of search if you just stop there once you’ve seen these!
Presentation: can be very sick or relatively well
Pathology: clot leads to raised ICP, venous engorgement, infarct +/- haemorrhagic transformation. Can lead to seizures, coma, death #EuSEM18
Less sick patients present with thunderclap headache. CT usually normal. May be a …
— Anu Mitra (@AcmeDR) September 12, 2018
…role for LP here (to finish Anu’s tweet).
Over in the meet the editors session you could find out first hand how journal editors select papers for inclusion, and Colin Graham (editor of the European Journal of Emergency Medicine) and Ellen Weber (editor of the Emergency Medicine Journal were there with their top tips. They included knowing some of the questions editors think about when reading submitted papers, such as why they should publish your paper? Is it an important topic? Does this paper help with any knowledge gaps in the area? It’s important to try to sell your research question, not your results! Great advice for anyone hoping to publish their work.
Leadership is a tough topic and Adan Atrihan used his experiences and lessons learnt from key figures and mentors in his career to give a brilliant presentation on how we can be better. Through quotes from these mentors he inspired the audience to try to think about ways they can change their practice.
Great talk from @GoodCPR about things we can do to be better leaders in ED. Summary: be kind, clean up your mess, know how to, and do everyone's job, take time to pee before you can't, carry what you need, arrive early to forge your team and spot problems from the start #EuSEM18
— Richard Muswell (@7c6Richard) September 12, 2018
It wasn’t long then before everyone gathered back in the main auditorium for the closing ceremony – a great part of which was that it was live-illustrated by a very talented artist! We already knew the next conference was going to be in Prague, but it was useful to see a video introducing the city to those who hadn’t been there before, along with some information about the location and what Prague has to offer from a non-clinical point of view (apparently over one hundred karaoke bars… watch this space…!)
Well, that’s it from us at St.Emlyn’s from the EuSEM and RCEM conference in Glasgow. Lots of learning points to take away and a really enjoyable few days in Scotland. The weather held up pretty well too! Thank you for coming along with us for the ride, and we hope to see you in Prague for EuSEM 2019!
Acknowledgement – Title photo from the tweets of @RCEMdean
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