The St.Emlyn’s Podcast
2014-08
Episodes
Friday Aug 01, 2014
Ep 12 - Intro to EM: The patient with headache
Friday Aug 01, 2014
Friday Aug 01, 2014
We've all had headaches, but not often severe enough to prompt us to seek help in an Emergency Department.In
our practice 10% of patients who do present to the ED with a primary
presentation of headache will have serious pathology and our job as
Emergency Physicians is to work out who these are. Key to this is
actively ruling out the life-threatening and life-changing diagnoses:Subarachnoid HaemorrhageMeningitisTumours and Space Occupying LesionsTemporal ArteritisListen to Simon and Iain discuss how to approach these patients hereFurther ResourcesHeadaches at Life in the Fast Lane - a great summary from the LiTFL crewNICE Guidelines (NCG150) - diagnosis and management of headaches; there's a flowchart and some red flags although you could read the St Emlyn's summary here!Headache from the Flipped EM Classroom
Sunday Aug 03, 2014
Ep 13 - Intro to EM: The patient with shortness of breath
Sunday Aug 03, 2014
Sunday Aug 03, 2014
Breathless patients are a challenge in the ED. Shortness of
breath can be a frightening presenting complaint for both patients and
doctors. As always, think about the possible life threatening causes and
actively rule them out. For breathless patients think especially about:PneumoniaAsthma/COPDPulmonary EmbolismAcute left ventricular failurePneumothorax Breathless Patients PodcastIn
this podcast Iain and Simon discuss their approach to
breathless patients in the ED which we hope will provide you with a good
starting point. For
those of you who are more visual learners here is the video recorded a
few years ago for SEMEP featuring our very own Iain Beardsell.http://vimeo.com/35310564 Take Home PointsOxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia killsAlways rule out life threatening causes firstThese patients are sick - do not be afraid to ask advice from a senior colleague earlyLook for clues - you don't have to wait until the penultimate page of the story to solve the mystery.What have you learned about breathless patients? Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute
setting - and can save lives. So yes, when you first approach a patient
who is short of breath, get that oxygen on while you make your
assessment then think about the finer points of respiratory failure
afterwards. Where do I begin? A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs
(especially respiratory rate), looking for clues as to the underlying
cause of their breathlessness, remembering the five common causes. What treatments might be useful?
A small fluid bolus might help and carries relatively little risk;
think about the need for nebulised bronchodilators for patients with
asthma or COPD, and remember that antibiotics given early to patients
with sepsis save lives. If the patient has pain we should definitely treat that too.Which investigations might help me find out more?A
chest x-ray is often useful in patients who are short of breath; your
ED seniors might be able to use bedside ultrasound to further ascertain
the underlying pathology, so get help early!ECGs are often useful in these patientsBlood
gases can also provide lots of useful information - think carefully
about whether you need arterial gases and if so, please use local
anaesthetic.If nothing makes sense - get a blood sugar,
remembering that metabolic disease may cause an acidosis, presenting
with an increased respiratory rate (although not often true dyspnoea).And
GET SENIOR HELP (including getting your seniors to assess you for those
all-important workplace-based assessments; definitely start those
early)Other resourcesChest RadiographsOne
of the key investigations in patients with shortness of breath is the
humble chest radiograph. There are some phenomenal FOAM resources for
interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).Chest X-Ray Anatomy - Chest X-Ray Abnormalities - Chest X-Ray Systematic ApproachBlood GasesThink! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links).Natalie May
Wednesday Aug 06, 2014
Ep 14 - Exeter CEM conference with Adam Reuben
Wednesday Aug 06, 2014
Wednesday Aug 06, 2014
Adam Reuben is a super chap. A rugby playing, friendly, engaging, hard working, researching, teaching emergency physician from Exeter in the lovely county of Devon. In addition to being generally awesome he is also the convener of this year's College of Emergency Medicine conference in Exeter from the 9th to the 11th of September 2014. There is still time to come and the program looks really good and features some fantastic presenters.
#AWESOME ALERT - CLIFF REID WILL BE THERE - YOU HAVE TO BE TOO!!!!I'll be there with many others from St.Emlyn's so if you see me say hi.You can see the program herevbS
Thursday Aug 07, 2014
Ep 15 - Understanding Troponin Part 2
Thursday Aug 07, 2014
Thursday Aug 07, 2014
Recently we published part one of our series on cardiac troponins. If you haven't checked it out yet, you can find it here.
In the second part, we're going to take a look at high sensitivity
troponins and some of the more advanced areas around understanding
cardiac troponin and its use in practice. We'll give you a quick run
down on the troponin lingo - the language you need to be able
to speak in order to fully understand how to use high sensitivity
troponin in your practice, including terms like the limit of blank, limit of detection, co-efficient of variation and 99th percentile.We'll also ask whether Joe Lex had a point when he stirred up controversy around these assays with this legendary tweet:What if we called it "low specificity troponin" instead of "high sensitivity troponin?" Would that knock some sense into people?— Joe Lex (@JoeLex5) October 9, 2012So, check out the associated BLOG POST here and listen to the podcast. There is more on diagnostics and troponin to come very soon.Hope you enjoy! Please keep the feedback, questions and comments coming. As always, we'd love to hear from you.RickDOI:
Much of my research work involves HsT. To help with this I have
received reagents from companies who make HsT assays, but I not received
any other financial benefit or gifts in kind as part of my work and
have no financial ties to any companies.
Friday Aug 22, 2014
Friday Aug 22, 2014
This podcast is part of our induction series for new docs starting in UK emergency departments. You can check out the full post and supporting materials over at the main St.Emlyn's website.vbS