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Authors: Nikki Abela, Andy Neill, Simon Laing  / Codes: AP1, DP1, DP2, NeoC1, NeuC11, NeuC12, NeuP2, NeuP5, SLO1, SLO5 / Published: 09/03/2016

Welcome to the RCEM CPD event in Leeds.

We’re here to give you updates and some pearls that we’ve gleaned from the conference.

The second day in Leeds had a presidential opening by RCEM’s very own Cliff Mann, who gave a very reassuring talk about the pressures we are all facing in the emergency department with an average 25% increase in ED attendances and 74% increase in admission rate since 2011.

He talked us through all the things the college is doing to support this phenomenon, including lobbying for ‘A&E Hub’ and the ‘STEP Campaign’.

Neurology

The presidential theme continued with two of the four candidates for Cliff’s post (ballots closed today, so we should soon know who his successor will be). Taj Hassan sarted with useful neurological nuggets, followed by an excellent talk by Katherine Henderson, who spoke about what singles TIA out from migranes.

She also spoke about the ABCD3-1 score, which is replacing the ABCD2 score as an advanced risk prediction score for TIAs.

Continuing on the neuro theme, consultant neurologist Marc Randall spoke about a topic which makes many EM physicians’ brains hurt – headache.

He said we should really be thinking about headaches associated with pathology, and really and truly, if the patient is >50 years, has come by ambulance and has some neurological disturbance, then they are more likely to find something on imaging causing their headache.

Now there has been some talk on FOAMed about discharging “query SAH” after a negative CT without an LP due to some good evidence out there (St.Emlyns have a good blog on SAH, which I suggest you read), but this talk is a good reminder of the other differentials, including carotid artery dissection, subdurals and PRES.

Dermatology

His talk was followed by a dermatology session by Philip Laws, entitled, “Doctor, is my rash serious?” The answer to that is “Probably not.” But there are some dermatological conditions which should get under your skin like SJS, DRESS syndrome and erythroderma, so don’t get too comfortable if you can’t exclude the non-benign stuff.

Top Papers

The top papers of 2015 followed, which included, unsurprisingly, the REVERT trial (honestly, if you haven’t heard about it, you really need to– we have a podcast on it too).

For reference, I have included Fiona Lecky’s exhaustive list below:

  1. Validating the ICMED(International Crowding Measure in Emergency Departments)
  2. Impact of prehospital transfer strategies in major trauma and head injury: systematic review, meta-analysis, and recommendations for study design
  3. The changing face of trauma in the UK
  4. Trial of Early, Goal-Directed Resuscitation for Septic Shock 
  5. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. 
  6. PAin SoluTions In the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department
  7. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study.
  8. A profile of suspected child abuse as a subgroup of major trauma patients.
  9. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study

Paediatrics

The day continued after lunch with a paediatric theme and Stephen Hancock ran us through how to care for the critically ill child.

Every department should have a resus bay which we can transform into a mini-critical care bed for a sick child, he pointed out, so these are skills we should all be able to provide.

“Do the basics, and do them well,” he reassured us, reminding us not to forget that IO access, and temperature control should be our friends.

Also, don’t forget the simple things when dealing with kids, e.g. some drugs take very long to draw up, so think about them early (have you ever asked a nurse to draw up prostin??).

Deirdre O’Donnell followed with a run through of paediatric allergy. Now, hopefully we are all happy with our bread and butter ED things like anaphylaxis, but what about angioedema (no, steroids and anti-histamines are NOT useful for angioedema, so reach for the C1 esterase inhibitor early), for cow’s milk protein intolerance? Well, she told us about the COMISS scoring system, which is worth a read.

Moving on with neonatology, Sam Oddie talked us through many EM physicians’ worst nightmare: a newborn in the ED. A new thing, he said, was deferred cord clamping, which allows the neonate to get about 30ml/kg more blood transfused.

That’s it for today. The conference was great, and we hope these highlights were useful. Don’t forget to follow the #RCEMCPD16 feed on twitter, and we will be back tomorrow to bring you some more FOAMy goodness.

References:

  1. Kiyohara, T., et al. (2014) ABCD3 and ABCD3-I Scores Are Superior to ABCD2 Score in the Prediction of Short- and Long-Term Risks of Stroke After Transient Ischemic Attack. Stroke 2014 ; 45: 418-425.
  2. St.Emlyn’s: Let’s talk about subarachnoid haemorrhage
  3. RCEM: Policies
  4. RCEMFOAMed: Ready Steady Blow
  5. Nestle Health Science: COMISS