Lunch was brilliant with a choice of Irish stew, salmon and tortelloni. I went for Irish stew and probably had one too many potatoes. This was the reason I had to excuse myself from one of the afternoon lectures. Apologies to one of my bosses Dan Horner. However to be fair I have read and referred to his excellent trust guideline on the hospital website many times over the last couple of years. It has always been a pleasure to learn from his in depth knowledge on every aspect of VTE.
Emma Greenwood from Belfast spoke about her top five medical papers in 2018. LOMAGHI study has conclusively proven the benefit of IV magnesium in atrial fibrillation and I would change my practise on this topic. In pregnant patients with suspected VTE I learnt that d-dimer is relevant and pregnancy adapted YEARS algorithm is a useful decision making tool. I also learnt that there is current evidence which shows no correlation between IV contrast and AKI and the next time there is a delay in imaging due to 'waiting for results', I will be able to counter it with current evidence. OVIVA study has shown the lack of superiority of intravenous antibiotics over oral in orthopaedic infections. However I am not sure I will change current management before this is accepted by orthopaedic colleagues who will be most affected by this change in practise and the medico legal pitfalls are too high to make this change.
Ian Beardshell from Belfast gave an entertaining and energetic presentation on how we are practising emergency medicine the wrong way around. I would not change departmental practise of waiting for investigations until the clinician has seen the patient. However I will try and practise the habit of not looking at the results even before seeing the patient. I think the right order would be ambulance notes, triage notes, history from patient, examine patient, provisional diagnosis including differentials and then look at the results. It was good to have a gentle revision on snouts, spins and likelihood ratio. I am sure I will remember it for another 24-48 hours.
James Shawbrook from Belfast talked about Chest Radiology in ED patients. Key messages were difficult chest drains in loculated pneumo thoraxes(luckily we can leave that headache for the interventional radiologists, however identifying one is our headache), looking at the aortic calcific plaques in relation to the arch of the aorta, use of ECG gated CT to improve imaging(ECG gated CT is a nifty way to scan during the diastolic phase of the heart) and a message as simple as clotted blood is more dense than liquid blood.
Madeline Sampson(Belfast) gave a talk on radiology in blunt trauma. She focused primarily on CXR with useful tips on apical pleural cap, mediastinal shift, mediastinal widening, aortopulmonary window etc. It was a bit of a throw back to pre whole body CT for trauma times. Working in a MTC we often have a low threshold for CT and therefore sometimes often overlook the usefulness of a CXR. Since coming back from the conference I have had at least 2 patients with blunt thoracic trauma who had significant findings on CT which could have been missed on CXR. I do have my sympathies for colleagues in non MTC units where it can be rather difficult to get the radiologist to agree on a CT.
Tajek Hassan(President RCEM) gave a fantastic lecture on various issues he faces as President. He is like a movie star and I enjoyed his candid comments on how difficult the job of the President can be. Political correctness and risk of being misreported by the media is a potential hazard. I think he has done a remarkable job during his tenure and I am certain the president elect Katherine Henderson would continue to build on the work and success of her predecessors. I was disappointed to learn that the Indian foreign office refused to give Dr.Hassan a visa because of his Pakistani ancestry. I am ashamed of this silly stupid behaviour and I hope in future such stupidity does not happen and citizens of both countries can live in peace and visit each other's countries.
That brought us to the end of day 1. The drinks reception was excellent with informal conversations and wine flowing well. The canapes were excellent. Personally it was only marred for me by the unfortunate experience of having a unpleasant conversation with one of the vice presidents of RCEM, who took objection to my comments on twitter about the RCEM presidential elections. I think such behaviour should not happen in a meeting of fellow professionals and it was more like a silly confrontation at 11 pm in a local bar with a drunken man. The vice President of RCEM is a respected position and in a forum of colleagues he should have behaved in a more civil manner irrespective of his feelings about my twitter comments. On my side I can only apologise for my twitter comments and in future will avoid any personal comments on social media.
That's all for now.
More about day 2 and 3 in subsequent blogs.
Ps. Irish whiskey and live traditional music in Irish bars are a delight and I had an excellent evening at the Crown and Fibber Magee.
Picture below taken in Salford Quays. Maybe it will tempt somebody to come work for the excellent team at Salford Royal ED.
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