I thought I will blog about my first day at RCEM spring CPD for my own benefit and also give a little overview of what happened for the benefit of colleagues who have not been able to to attend.
First of all what a brilliant city Belfast is and I regret not visiting this fantastic city more often which is only an hour away by flight from Manchester. Usual morning registration and coffee with one too many 'light bites' setting me up. Forgot all about the apple on the table. Ian Crawford(Belfast) gave a warm welcome to all in his inaugural speech and then it was soon the first session.
Brendan McGrath(Manchester) spoke about the various presentations and complications we can expect in ED from patients who have a tracheostomies. Main take home message for me was oxygen, secretions, differentiating tracheostomy patient from laryngectomy patients, remembering that they are complex medical patients and there might been an alternative reason for the breathlessness and importance of checking that your department has the right equipment and training for staff. Please check out www.tracheostomy.org.uk, www.globaltrach.org and NTSP app for more information.
Chetan Trivedi(Brighton) spoke about his endeavour to develop a decision rule for when to image in facial injuries. Particularly liked his own personal approach to rule out imaging with safety netting. Take home messages for me where children are different and should rarely be imaged, think of radiation exposure and review existing referrals to maxillo-facial team at local ED. I think we can soon expect a gold standard guideline from him.
Filipe Dhawahir- Scala(Manchester) gave an entertaining talk on when to wake up an opthalmologist. Loved his flamboyant style of presentation. Take home messages don't use cotton bud for removing corneal foreign bodies, ulcers from contact lens use can go badly wrong very soon, importance of identifying papilloedema, identifying the dangerous red eye(Acute Glaucoma), CT in suspected metal projectiles in eye ball(do not waste time doing an X-ray), simplicity of doing a lateral canthotomy and infections in post op patients. Please have a look at BEECS(British emergency eye care society) and if possible attend one of their annual meetings.
Peter Johns(Ottawa) gave a head spinning talk on vertigo. I managed to stay with him until Dix-Hallpike test, Epley Manouvre, HINTS plus but lost it when he went to Horizontal canal BPPV(apparently 30% of BPPV). Take home message for me was keep revisiting these tests and manouvres, however in practise this is a specialist area and cannot be done in an busy UK emeregency department and there is possible a case for dedicated vertigo clinics in every region. More importantly identifying the patient with a central pathology using HINTS plus and being aware of vestibular migraine as a diagnosis.
Diana Hulbert (Southhampton) gave possibly the most important talk of the day on tried and tested methods for looking after the team in ED. Main take home message was the engage with other members of your team and taking time to know them. I think every senior emergency clinician has a moral responsibility to look after junior colleagues. If we cannot have compassion for our own team then we cannot deliver compassionate treatment for our patients. Learnt about Schwartz rounds for the first time but was even more surprised when a few persons in the audience raised their hands to tell they do it in their departments. I think the college needs to highlight this often neglected part of working in emergency medicine. Personally I have occasionally felt more lonely in a crowded ED than in the middle of a woods.
Chris Moulton spoke about GIRFT(get it right first time) and why it is soon coming to a hospital near you. I think the data gathered from this project will go a long way in having fact based discussions with the management and other specialities. It is still early days but I am sure all emergency departments and physicians will soon be talking about the data gathered from this project. My own person feeling was I wish there was a qualitative element to these quantitative measures because nothing can be more misleading than pure numbers without the qualitative element which can only be provided by qualitative research and assessments.
Soon it was time for lunch. For me it is time to take a shower and head to the conference venue. I will try to keep this going till the end of the conference if I can. If I have not then it is probably because of the excellent Irish Whiskies and hospitality. Have a great day.
Picture taken inside the apartment I am staying in with my brother(he is an emergency physician too).
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