Well, isn’t this exciting! An actual real-life live conference with real-life people all together learning about hot topics in emergency medicine in real-life once again!
This week sees the St Emlyn’s team return to live conferencing with the Royal College of Emergency Medicine Spring CPD Conference. We’ve not been allowed out since ICS SOA in December 2019 and so it’s great that RCEM have put together a fantastic three days in sunny Bournemouth.
Simon, Rick and Iain are all there but I actually haven’t travelled down from the north to do the real-life bit. Luckily technology has prevailed and I’ve been eagerly watching and learning from my sofa at home (though with a little bit of #FOMO).
Whether you’ve been watching online or there in person we hope you’re having a great experience. If you haven’t been able to attend then our accompanying blog posts are here to share some of the highlights. Here’s day 1!
After some opening welcome from the local organising committee, we got right down to business with the three most important topics at any EM conference: POCUS, helicopters and ketamine.
Only kidding… well, almost. Mr Jim Connolly is a huge POCUS afficionado and well known for his extensive knowledge and experience on the subject. He led an interactive session (even at one point featuring a mini-golf course!) on ultrasound use in primary surveys. Point of care ultrasound is all about knowing your pre-test probabilities, asking the right questions, and choosing the right patients to undergo the investigations and it’s key to bear that in mind. It can be a key tool to use if used properly. It was great to see Jim discuss not only some of the values of ultrasound but also some of the pitfalls to be aware of.
There were also some great tips coming out of his talk on how to simulate various chest pathologies without injuring anyone.
After a quick break, Dr Chris Hill told us about his top 5 trauma papers from recent times, with some great take home messages and areas of future research.
Neurosurgery always seems like a mysterious beast to those of us working in the ED. Dr Andy Eynon and colleagues have worked hard to create pathways in Wessex to reduce delays in transferring patients with time-critical neurosurgical emergencies to the regional neurosurgical centre. Such measures as liaising with local ambulance services to set up a specific high priority request, creating a pathway for automatic transfers, and making decisions based on the patients rather than the bed status, have all helped to transform the experiences for patients with these problems.
The afternoon session was all about the cardiovascular, and comprised a wide range of topics.
Our own Prof Rick Body was down in Bournemouth too, and not talking about troponins this time! Rick gave a clear and concise run through of some of the indications, issues, and initial management (Ed – that was a bit of a stretch just for the alliteration) of anticoagulants in the ED. There will be a blog coming soon to accompany Rick’s talk and we’ll add in the link here once it’s up.
Dr Nada Al-Sakini gave us a good talk through some of the problems patients with adult congenital heart disease may present to the emergency department with. The key messages were to ask for help early – your local cardiologists are usually very helpful but it’s often necessary to contact your regional ACHD centre. If you have cardiac anaesthetists in your hospital then they are a valuable source of knowledge as well.
Whilst palpitations are generally viewed by clinicians in the emergency department as “ok until proven otherwise”, there are some significant causes that we see that need further investigations or management. Dr John Paisey, consultant cardiac electrophysiologist, gave us his top tips, and reminded us that not all palpitations are cardiac, so to keep that in mind when seeing such patients. The history is key, and red flags should be explored such as chest pain, breathlessness or syncope. Ask about past medical history such as known structural heart disease, or major non-cardiac comorbidity family history of sudden cardiac death. On the ECG itself, things such as very frequent/polymorphic VEs, NSVT >5 beats, sustained broad complex tachycardia, or any resting abnormalities such as long QT or pre-excitation should also prompt you to think about onward referral/admission.
Patients who can be reassured and discharged are generally those with symptoms of ectopics without any red flags who are happy to be reassured. Otherwise there are a few other options depending on your setup (maybe you have access to rapid access clinics, cardiology outpatient investigations or appointments, and of course admission is still on the table if needed) so definitely something to explore with your local cardiology service.
Lastly for this block, a reminder from Dr Hesham Ibrahim to be cautious with things that look like ventricular tachycardia – check the rate and think electrolytes and drugs before leaping down the cardioversion route (which could be detrimental to your patient).
All the ologies
To round off, a whizz through some specialties, starting with dermatology. A great talk from Dr Deepa Bangaru-Raju on the rarer skin things such as DRESS syndrome, SJS and TEN reminded us to really examine rashes carefully and look for the red flag signs (such as Nikolsky sign), as well as organ involvement. It’s not all about steroids so don’t start them until dermatology give the go ahead!
We also heard from the NPIS (Newcastle) director Dr Ruben Thanacoody, for a toxicology update. Some departments (such as Virchester) have now converted to the SNAP regimen for paracetamol overdose and it was great to hear some of the evidence behind both this new one and the and original regimen. Ruben also briefly touched on button battery ingestion, where honey has a role prehospitally, with sucralfate solution used once in hospital. He also highlighted that there have recently been a few changes to the recommended antidotes stock lists so it’s worth ensuring those have been looked at for your own department.
Dr Katherine Henderson, RCEM President, gave a superb address to close off day 1, running through some key messages from the last year, particularly around safety alerts and trying to improve things in our emergency departments for our patients.
She also talked about decision making, which is a topic close to Simon’s heart, and explored how we interact with colleagues to think about decisions we make in the emergency department. When someone runs a case by you, ask them about their thought processes, not just the eventual outcomes. It’s better to consider differential diagnoses and disregard them than to never have thought about them in the first place. Katherine closed by asking us to think about how we will apply the knowledge we’ve learnt from this conference, and how we will share it with our teams back home.
Well, this was a fantastic first day, we’ve had some brilliant talks (though not able to include them all in this blog!) and it’s very much set the scene for rest of the conference. I also just want to add in a huge mention to Dr Russell Gritton (@Medic_Russell on Twitter) here too, who has been tweeting some high quality key points from all the speakers’ talks throughout the day. It’s been a superb effort and has really helped me to consolidate some of those points in my own mind by reading his tweets alongside watching the conference. Definitely worth looking at the threads he has produced for each talk.
Now, if you’ll excuse me I’m off to my own drinks reception. See you tomorrow!