Earlier this month I attended the RCEM Annual Scientific Conference in Gateshead. It was a great event, and there is a lot of content to cover. So, I’m just going to focus on a few things that I thought might be of interest. If you want more of a detailed overview of the conference then head over to the St.Emlyn’s blog where you’ll find separate overviews of each day.
- The sky isn’t always bluer
When things seem bad in blighty I hear colleagues talk about the lure of moving overseas, to work in different health care systems, that don’t face the same woes as us. Many of these staff look into moving to Australasia. However, the ACEM President told us that things are not all what we might hope down under. Indeed, many Australasian Emergency Departments are struggling with exit block, budget cuts, limited mental health services and long waits. So, if it’s better weather you’re after, Australasia might be the place to go, but it appears crowding can not be so easily escaped. [I’m sure CJ will be able to tell is more about this in blogs to come].
- “Repeat ECG in 20mins”
There is wide variation in how long clinicians seem to want to wait before a doing a repeat ECG to look for dynamic changes. Hesham Ibrahim stunned us all with some serial ECGs that he had taken from a patient, initially found to have De Winters, as it progressed into a traditional “STEMI” ECG. Not only did these changes progress rapidly within seconds to minutes (maybe 20 mins for a repeat is too long, and we should just go straight back and do the repeat if one is requested) but Hesham challenged us to treat these patients with the same urgency as we do those with clear STEMIs on their ECGs.
- Pre Alert Fatigue
I think this is something that will be familiar to many of us. The number of standby calls that we receive in the ED seems ever increasing, and as such the impact of these calls is probably less than what it used to be. Unless, of course, it is a red standby, which still manages to kick us into action. There was some suggestion that using NEWS2 to identify sick patients might help to streamline standby calls, possibly used in conjunction with specific conditions that require specialist teams to respond, such as in stroke or major trauma.
- Activated Charcoal
Use of activated charcoal seems unfashionable of late – in fact I can’t even recall the last time I saw it used. We were encouraged not to be put off using it if the patient presents over one hour since taking their overdose, and that we probably need to be using larger doses to see a real benefit – more like 2-3 tubs, rather than just the one. Aspiration rates are pretty low if you’re giving it to alert patients and more work is ongoing to see if it’s use can be better targeted.
- EoL care
Palliative Medicine Consultant, Kathryn Mannix, reminded us that with improvements in medicine and changes in healthcare culture, current generations have forgotten what dying is like. As such, we may have to explain to friends and relatives what the process of death is, so they are not shocked or upset by what they might experience when witnessing a loved one die. She recommended we formulate and practice a “coma talk” so that we can manage people’s expectations, and ask relatives about their other experience of death in order to ensure fears are allayed.
- Calcium in major haemorrhage
Now this is something new that I learnt which will definitely change my practice. There is an anticoagulant in bags of red cells which binds to calcium. Resulting in hypocalcaemia in patients receiving blood transfusions, which in turn makes them coagulopathic, and we all know coagulopathies in patients receiving massive transfusions is bad news. So, from now on, I’m going to be looking at giving patients calcium alongside blood transfusions.
Next year the RCEM Annual Scientific Conference will be held in Manchester, 12-14thOctober. Hope to see a few of you there.
[RCN Emergency Nurse Competencies: CD1, CD2, GNP6]