RCEM Manchester Day 3

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RCEM ’15 in Manchester has been a sell out! For those of you that weren’t lucky enough to be here, here’s what’s been going on on Day 3!

Simon Carley
Coping after a terrible medical error
Simon started with by presenting a case: someone comes into the ED, gets discharged and returns the next day in cardiac arrest. “Remember that patient you saw last night” – some of the worst words you can hear in medicine.
Simon explained that there was a second victim here – the medical professional who made the error.
The fall out from these errors can go on for years – and not just the governance consequences of coroners and even the GMC – these things can come back to us as flashbacks.
How do we cope? There’s lots of popular methods out there:
  • there is a “resilience quotient” that you can check online
  • there’s mindfulness
  • there’s yoga
  • simple things like writing down three positive things at the end of every shift (instead of focussing on the single missed minor fracture)
Without support of your colleagues and a supportive system we end up creating a terrifying and torturing narrative in our heads about what happened and the possible consequences.

Staying on top of your game

Suzanne Hewitt
In EM we’re already a fairly resilient bunch. We have to be. Lots of us have what we call a “wobble”, but actually is in fact a major depressive episode. We really struggle to talk about this as individuals and as departments when someone has been off on long term stress leave.
The college has done some recent great work on this.
Suzanne had some great suggestions, with the usual basics of rest,, nutrition and micturition but also some others:
[pic via Sarah Edwards]
It’s also really important to be able to say no!
She finished the talk with, “the secret of caring for the patient is caring for ourselves while caring for the patient.”
Resilience and satisfaction in the ED: Finding the gold
Taj Hassan
Highlights that these sessions are getting more and more popular at every conference.
Taj had a whole bunch of recommendations which we managed to narrow down:
Remember that “Culture eats strategy for breakfast.” The culture in your ED is so important. Taj was bubbling over with positivity and communicated it brilliantly.


This morning RCEM15 had a reasonably well-packed presentation on FOAMed, where people who were plugged-in or wanted to plug-in after Scott Weingart’s (@emcrit) inspiring talks about being an excellent physician with a “thirst for learning”, were given ideas about how to go about it.

The first presenter was pretty disappointing of course (you wouldn’t expect much from our very own Simon Laing) (@laing_simon).

If you’re not that savvy with British humor, I (Nikki Abela) do apologise, but you should notice by now that when I say it was excellent, there is likely an element of bias (but really, bias aside, it was super).

Talking about bias though, you probably are already a FOAMed fan if you’re reading this, but I do suggest you have a listen to Simon on this podcast so that you can nod away and feel better about yourself for keeping up with the current trend in medical learning. (fashionistas have nothing on us)

Talking about trends though, Natalie May (@N_May) followed and asked if this FOAMed stuff is “just a fad”? While you have a think about that, I do suggest you go on the St.Emlyn’s website to have a read and listen to the tips she gave on keeping up to date with the tons of medical literature/education there is out there. (Yes, she’s very trendy, and had her presentation go live as soon as she finished the talk).

Salim Rezaie (@srrezaie), one of the top international academic FOAMers, told us how FOAMed helped his academic career take off.

According to him, academic FOAMed should meet 5 criteria:

  1. It has to be new idea
  2. It has to benefit the field
  3. It needs to be appraised
  4. It should be archived
  5. It should be open to feedback

I’m not going to tell you how he applied this to kick-start his now international career, however,I will share with you the following advice he gave us as a parting thought:

“You will get there whether you’re on FOAM or not, but technology will get you there faster”.

Minor Head Injury
Jonathan Benger
Jonathan started off by asking us to challenge and question bit of our practice that are established in our practice.
He spoke about the difficulty in dealing with the subtleties of minor head injury compared to the easy evident major head injury and specifically challenged how useful GCS was and maybe it was more useful as a trend rather than a one off number.
Jonathan spoke about the practice of performing pupillary reflexes on the conscious patient and spoke about it’s use to screen for penetrating eye injuries but that in a patient alert and orientated that it wouldn’t be picking up anyone with a with a 3rd nerve palsy due to herniation, you would have noticed other more obvious clinical signs before getting to the pupils!
Among the other pearls he suggested:
Paediatric Trauma is Different
Ross Fisher
Ross delivered an excellent talk on paediatric trauma with an emphasis on the fact that major trauma in children is rare and even the paediatric specialists will see this rarely. But when we do see severely injured children then a sound and thorough clinical examination is key. Make sure you check out his blog site P3.
Ross referred to the knee jerk reaction for clinicians to scan children due to fear and suggested we look at the PECARN rules on paediatric trauma and also mentioned the complete futility of FAST scanning children in trauma as it is no more use than flipping a coin!
There was a spooky mention of the numbers 37 and 73, and how they fit into paediatric trauma. No blog can do his excellent presentation any justice (that guy has skills!He even has a website on the topic), but the basic take home message is that we need to fit our head around thinking abut paediatric trauma differently.

An avulsed tooth is a medical emergency

Serpil Djamal

Serpil Djamal from dentaltrauma.co.uk spoke to us about avulsed teeth. This may not be considered by many to be the sexiest topic, but Serpil definitely had some good take home messages.

-Look for it immediately (if you can’t find it, do a CXR to make sure the tooth hasn’t been inhaled) and aim to re-implant it asap (except baby teeth, neglected mouths, gum disease):

-Hold the tooth by the crown only (holding it by the root may damage it), then hold it in place by biting on cotton wool/tissue.

-Wash it with saliva or plain water

-If it can’t be implanted immediately, place the tooth in milk

-Cover with doxycycline (pen V or amoxicillin if <12)

-Once it is in the socket, refer the patient to maxfax/on-call dentist where the tooth will be temporarily splinted before they can be discharged

 In short:

“Pick it, lick it, stick it.”

Managing anticoagulated patients following head injury
Su Mason
Head injury is obviously a common presentation to the ED. With an increasing use of anticoagulants, when these patients present with a GCS of 15 what is the risk of bleeding, who should be scanned and who should be observed??
Su presented the main findings of the study, for which the abstract can be found here

They are:

  • Complication rate is low at 6.1%
  • Delayed bleeds low at 0.16%
  • Risk of complications significantly increased in alert patients who have amnesia, vomiting, LOC and, to a lesser extent, headache
  • INR was not found to be associated with a poor outcome

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 link available here


Making Good Judgements

Simon Carley

Prof. Simon Carley (@EMManchester) gave a talk on making good judgements.  Taking a reflective look on how we think and perform in the emergency department.  He pointed out that bad decisions don’t always lead to bad outcomes – but this is called luck.  He had some suggestions to how we can improve ourselves in the ED environment:



The Essence of Emergency Medicine

Salim Rezaie

Salim Rezaie (@srrezaie) then gave us a bit of a ‘pat on the back’ during his talk on the essence of Emergency Medicine – or as he renamed it ‘The Modern Day Superhero’ with our super powers of mastery of the undifferentiated patient, our ability to risk stratify (or as Simon Carley called it, being ‘probablasticians’), to see anyone, anytime, anywhere, and to do it all with compassion and superior communication skills. However, with great power comes great responsibility and we need to continue to train ourselves, be adaptable, and make ourselves a Jack of all trades, and a master of them all.


In short, what we do matters, we rock, keep up the good work.

Voices of Essentials

During EEM 2014, we launched the onsite Hippo Education recording studio. The reason was simple: we wanted to gather the life stories of those who work the frontlines in the Emergency Department. You have all heard Mel say, “What you do matters” countless times. Now, you’ll get to hear the stories behind those words – your stories. In this new series, “Voices of Essentials,” we will bring you, with each new episode, real stories from the people who affect the lives of those seeking care in the ED.

Our first installment features Major Al Taylor and Dr. Caroline Ehrat sharing their memories of Lt. Colonel Erin Savage, a dedicated EM doctor and flight surgeon in the Royal Canadian Medical Service.

Essentials of EM ED Fellowship 2015 for US EM Residents

Hippo Education, in association with Michelle Lin’s ALiEM and Scott Weingart’s EMCrit, are very excited to announce a once-in-a-lifetime opportunity for Emergency Medicine residents. The selected residents will work side-by-side with internationally-recognized educators as part of the most popular Emergency Medicine educational conference in the world. Do not miss this chance to be a part of the EEM team!

The Essentials of Emergency Medicine (EEM) conference is one of the largest EM conferences of the year with over 2,000 participants.  This year it will be held at the Cosmopolitan Hotel from October 13-15, 2015 in Las Vegas, Nevada.  EEM is offering a mini-fellowship to eligible residents within the United States.  Those selected to participate will receive

  • FREE conference registration
  • FREE 4-night hotel stay at the Cosmopolitan Hotel of Las Vegas
  • A travel stipend

The Application Process: Only one application submission per resident. Applicants may apply through either Scott Weingart’s www.EMCrit.org or Michelle Lin’s www.aliem.com.  Applicants must be current residents in good standing at an ACGME-accredited Emergency Medicine program in the United States.  Applicants will complete a brief online application and upload material through the online form.  The application process is open now, and the deadline for submissions is June 15, 2015 at 11:59pm PST. Final decisions will be announced August 1, 2015.

 Questions? Contact us at [email protected]

EEM 2014 Top 10 Video Countdown: #1 Why we do EM

As I write this post and watch this video one more time, I am struck by how powerful a 15-minute talk at Essentials of Emergency Medicine can be. Since its inception 13 years ago, EEM’s primary focus has always been on you, the EM practitioner. Not only did Mel want to change the way we learn, but more importantly, he wanted to provide a meaningful experience to celebrate our humanity – to learn, share, laugh, and cry as a family.

In 2014, Mel Herbert opened our conference with a very personal lecture titled, “Why we do EM.” Four simple words that elicit powerfully different responses from each of us. The answer is not so simple…it invariably revolves around a personal and intimate story. So, it’s only fitting that we end this countdown with the man who started it all.

Thank you for watching the 2014 countdown, and we hope all of you will join us in Las Vegas, on October 13-15, 2015, as we write the next chapter in the evolution of EEM.

Essentials… “It’s more than education.” ™

EEM 2014 Top 10 Number 1

EEM 2014 Top 10 Video Countdown: #2 Ketamine in trauma

Ketamine in head trauma? Seriously? If you know anything about Billy Mallon, then you know that this isn’t your average, run-of-the-mill lecture! Year after year, Billy is one of the highest rated speakers at Essentials of EM. Watch this video, and you’ll see why!

Having said that, rumors having been swirling about Billy’s instant-viral “Pericoital Emergencies” talk that was supposed to be in this slot, but cooler heads prevailed. Log into your Essentials account and you’ll see why this legendary talk should remain available for subscribers only and not in the wild for the kids to see.

Subscribe today for your EEM 2014 Digital package to watch this and more than 100 spectacular talks. While you’re there, make sure to register for EEM 2015 in Las Vegas, from October 13-15. Experience the magic of Mallon live and uncensored.

Essentials… “It’s more than education.” ™

EEM 2014 Top 10 Number 2