Well, it’s the final day in Bournemouth for the attendees of the Royal College of Emergency Medicine Spring CPD Conference of 2022. I’m still here up in the north, and you’ll be pleased to hear that even though it was snowing when I woke up, the sun is now shining and it’s looking like a wonderful day (or at least for the next hour or so when it will probably snow again).
This conference has covered a huge range of topics to keep us up to date, and it’s been great to follow along from afar.
A great talk by Dr Abi Gupta to kick off, talking about the development of the OPAL+ scheme in the West Midlands, which aims to keep older people at home where possible, using a multi-disciplinary approach with comprehensive geriatric assessments in order to do so, and initiated by pre-hospital teams if they feel the patient would benefit. Their scheme is expanding due to its success and even now includes any adult patient with complex medical or health issues. Certainly something for us all to look into back in our own areas to try to reduce the ever expanding pressures on in-hospital services and subsequently the emergency departments.
After this, Dr Mark Baxter took us through ‘silver trauma’ and the challenges older people can present with after injury. Older people are usually normally more hypertensive, have a degree of brain atrophy, and may have pre-existing cognitive impairment. This means they don’t normally become as hypotensive with major bleeding, and can take longer to show signs of significant head injury. There are a lot of other reasons why we miss significant injuries in this population:
Mark advocated for an approach to these older patients like we would take for the younger patients with more obvious trauma – senior review, formal secondary and tertiary survey, and a multidisciplinary approach with consideration of transfer to a major trauma centre when appropriate.
Dr Kate Russ got more into learning about functional neurological disorders after seeing more and more patients presenting with these problems during the pandemic. It’s an area that she didn’t feel she knew much about, and didn’t feel well enough informed to talk to patients about, which I think is something that would resonate with most of us. One of the main issues with functional disorders relates to terminology which can be very negative or cause stigma – such as non-epileptic seizures (which only tells the patient what they don’t have), or pseudoseizures (which has connotations to suggest the patient is faking it).
There are multiple ways functional disorders can present, from seizures, to other movements, to stroke mimics. Only 20-30% have an underlying mental health or psychological element, more often functional disorders begin after a physical problem, such as illness, injury, or an operation! Managing patients with functional seizures could be thought of like managing a panic attack – with reassurance, calm environment, and minimal onlookers in the room. It’s key to be honest with patients – explaining a referral process at the same time as letting them know that you think that they have a functional neurological disorder, but ensuring that this isn’t done in a negative way.
Past RCEM Prof, St Emlyn’s clot expert, and all-round good guy Dr Dan Horner was also down at the RCEM conference this week and gave a fantastic talk about cauda equina syndrome. He’s compiling a blog post so we’ll of course link to that here once it’s been published.
Real life EM
After lunch it was rapid EM knowledge time, starting with a radiology masterclass by Prof Elizabeth Dick. This was a really interactive talk with audience members attempting to solve (or guess in my case) the CT-based conundrums. Her talk was full of top tips including using lung windows on CT abdomen to look for any free air, and some other ways CT can be used to look for things like pericarditis or coronary pathology.
Some implementation of change followed, with a presentation from Dr Beatrice Bertolusso on introducing the SNAP protocol for treatment of paracetamol overdose into her department. This reduced drug errors and length of stay. We’ve already heard about the SNAP protocol on day 1, but this was another good plug for thinking about getting it into your department, if you haven’t already. Dr Rachel Harrison has also reduced length of stay for paediatric patients by introducing rapid assessment tools and nurse-led discharge with an 84% discharge-from-triage rate for children with upper respiratory tract infection symptoms, and a 4% reattendance rate within 48 hours. Phenomenal stuff to reduce crowding with reassurance and self-care advice at the front door.
Do you know how to access telephone translation services in your hospital (without asking someone else first)? These services are crucial to not only get the history from your patient, but also to explain your examination and investigations to them to gain informed consent for these, and then the results and onward management needed in the best way for them to understand these. In order to use such a service it has to be available 24/7, easy to use, with enough devices for the whole department to use, and the staff have to know how to access it. Ms Gil Bell talked us through her quality improvement project to tackle all of these issues.
Finally a walk through some of the things we’ve gone through with Covid-19 in the last couple of years, and how things are looking moving forward. Dr Ben Marshall and Ms Harriet Launders looked at what we’ve been doing with our Covid patients, trial results that have led to our changes in practice (as well as saving patients from harm when negative results came through), and incredible resources to use with all these new medications that we’re using – such as this Liverpool Covid-19 drug interactions website. It was great to have all of the advances that have been made in the last 2 years put into this presentation, but also we need to remember that even though cases and severity might be winding down (Ed – we’ll check back in on this statement in a year or two), there will still be those who are living with long Covid who will need our care for many years to come, and Covid isn’t over just yet.
With a brief goodbye from Prof Simon Carley and Dr John Heyworth on behalf of the local organising committee, that closed what has been a great three days of learning. Hopefully you’ve gotten as much out of it as we have, but for now that’s all from us here at St Emlyn’s.
The next RCEM conference is at the ICC Belfast from 4th-6th October 2022. There are a lot of conferences in Belfast this year, including Critical Care Reviews, ICS SOA, and then RCEM so it’s a great year to see the city. We hope to see you face-to-face in the coming year (maybe even in Belfast!) so please do come and say hi!
Thanks for following along, hope you’ve learnt something, we certainly have.