The St.Emlyn’s virtual hospital podcast

The St.Emlyn’s virtual hospital podcast header image 1
August 22, 2014  

Syncope. Induction podcast with St.Emlyn’s

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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.

vb

S

August 7, 2014  

Understanding Troponin Part 2. St.Emlyn’s

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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:

So, 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.

Rick

DOI: 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.

August 6, 2014  

Exeter CEM conference with Adam Reuben

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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.
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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 here

vb

S

August 3, 2014  

Induction to EM. Shortness of Breath. St.Emlyn’s

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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:

  • Pneumonia
  • Asthma/COPD
  • Pulmonary Embolism
  • Acute left ventricular failure
  • Pneumothorax

 

Breathless Patients Podcast

In 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 Points

  • Oxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia kills
  • Always rule out life threatening causes first
  • These patients are sick - do not be afraid to ask advice from a senior colleague early
  • Look 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 patients
  • Blood 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 resources

Chest Radiographs

One 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 Approach

Blood Gases

Think! 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 Breath

The Flipped EM Classroom - Shortness of Breath (with further links).


Natalie May

 

August 1, 2014  

Induction to EM. An approach to headache in the ED. St.Emlyn’s

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HORIZONS.jpgWe'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 Haemorrhage
  • Meningitis
  • Tumours and Space Occupying Lesions
  • Temporal Arteritis

Listen to Simon and Iain discuss how to approach these patients here

Further Resources

Headaches at Life in the Fast Lane - a great summary from the LiTFL crew

NICE 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