SLO3: Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop
SLO6: Proficiently deliver key procedural skills needed in Emergency Medicine
RC3. COPD
RC3. Organ donation
RP5. Respiratory failure
RP6. Sepsis
RP7. Shock
PhP2. Overdose
This was the first face to face day regional teaching day since the pandemic had started. Due to local centre restrictions, we were limited with our numbers and so the session became a hybrid session with participants on site and at home via Zoom. The participants were all Emergency Medicine Trainees in higher specialty training at different stages. In total we had 10 in-person participants and approximately 15-20 online participants.
The theme of the day was resuscitation and critical care and we had a range of speakers from respiratory medicine, critical care medicine and Emergency medicine. Each speaker gave an engaging talk about their area of interest and important learning points for EM registrars.
Our first speaker was Mr Matthew Quint one of the respiratory physiotherapy specialists giving us a recap of non-invasive ventilation, some ideas for troubleshooting and helpful tips and trips.
Our 2nd talk was from Dr Richard Clinton, ICU consultant and clinical lead for the trust for organ donation. The talk was about organ donation and touched upon communication during end-of-life care. Organ donation is a subject that rarely comes up in day-to-day ED practice and normally happens in ICU. However, as future ED consultants, we do need to know about this sensitive subject. The strategy document can be found here
The take home points were:
The final talk was from our own Dr David Slessor, an ED and ICU consultant and senior editor of the critical appraisal website The Bottom Line (https://www.thebottomline.org.uk/).
The talk was about the use of vasopressors in ED. His talk encouraged to not flog our shocked patients with fluid if we hypovolaemia had been addressed and the patient was still shocked. He talked about different vasopressors we had available in the ED and different situations where we could consider their use. Many of the audience felt that the initiation of vasoactive drugs in the ED was something that ED clinicians should be trained in but the cultures in most departments involve contacting and waiting for critical care teams to review the patients first. It was encouraging hearing an ICU consultant support ED clinicians starting vasoactive drugs for appropriate patients.
The in-person participants had the opportunity to take part in 2 simulated scenarios, one scenario was a complex respiratory scenario the 2nd was a complex cardiovascular scenario.
Case: 80 year old man with a past medical history that includes COPD/HTN/T2DM has been brought into ED with worsening SOB for 3/52.
On examination he is found to have reduced air entry on the left side and a CXR is organised. The CXR on first glance shows a pneumothorax but on second look there was a concern this could be a bullae.
• Maintain calm leadership throughout complex case.
• Demonstrate situational awareness as patient status changes
• Working through disagreement with other specialty doctors
• Correctly interpret a chest x-ray and distinguish pneumothorax from large bullae
• Demonstrate awareness of indication and contra-indications of intercostal chest drain
• Plans for intra-hospital transport of acutely unwell patient
• Very interesting case, pause for thought and good learning points.
• Nice routine case that we might encounter at work and might provoke "debate" among specialties etc
• Interesting clinical dilemma and discussion
• interesting case that is highly relevant
• Insight into clinical scenarios for examination purposes
Case: A 65 year old man has taken an intentional overdose of 30 x 10mg amlodipine tablets and 20 x 5mg ramipril tablets 2 hours ago.
During the case he continues to deteriorate despite fluid resuscitation and the critical care team are tied up with their own emergency. The ED registrar with a team of nurses have then got to manage the patient themselves and utilise available resources.
Non-technical factors:
• Maintain calm leadership throughout complex case.
• Demonstrate situational awareness as patient status changes
• Organising staff to prepare vasopressor preparations
Technical factors:
• Recognise complications of ramipril and CCB overdose
• Demonstrate awareness of acute management strategies
• Particularly demonstrate ability to prescribe peripheral vasopressors and use safely
• Demonstrate knowledge of applicable resources to help manage with the case e.g. TOXBASE
• Demonstrate awareness of high dose insulin therapy
• Very well organised, and very common scenario seen in the ED.
• Good reminder of poly pharmacy OD
• This was my first virtual experience and I found it very enjoyable. I learn much more from observing as a visual learner and this gave me that opportunity
• Really good effort for first "hybrid" session - thank you Abi, James, Anoop, Chris and Ben (and speakers).
• Really enjoyed in person, think it’s much more beneficial to learning and education
