The St.Emlyn’s virtual hospital podcast

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Induction podcast. Managing upper GI bleeding in the ED.

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As part of our induction series we look at the management of upper GI bleeds in the ED.

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Induction podcast. Back pain in the ED

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Another induction podcast on a common condition in the ED. Back pain in the ED - it's not all musculoskeletal and there are some really risky diagnoses out there that you need to think about.

Back pain is a multi system disorder....., until you can prove otherwise.

Don't forget to listen to Iain's talk on chronic pain link here.  https://vimeo.com/97811644

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Red flag symptoms and analgesia advice below.

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Asthma Induction Podcast. St.Emlyn’s

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Iain and Simon discuss the initial management of severe and life threatening asthma in the resus room.

Another podcast in the induction series aimed at new starters in Emergency Medicine.

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The ED approach to the kid with shortness of breath. St.Emlyn’s

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Iain Beardsell and Natalie May talk you through a wise and safe approach to the child with moderate shortness of breath. Listen and learn from the St.Emlyn's team.

Induction to EM. Shortness of Breath. St.Emlyn’s

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Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about:

  • Pneumonia
  • Asthma/COPD
  • Pulmonary Embolism
  • Acute left ventricular failure
  • Pneumothorax

 

Breathless Patients Podcast

In this podcast Iain and Simon discuss their approach to breathless patients in the ED which we hope will provide you with a good starting point.

 For those of you who are more visual learners here is the video recorded a few years ago for SEMEP featuring our very own Iain Beardsell.

http://vimeo.com/35310564

 

Take Home Points

  • Oxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia kills
  • Always rule out life threatening causes first
  • These patients are sick - do not be afraid to ask advice from a senior colleague early
  • Look for clues - you don't have to wait until the penultimate page of the story to solve the mystery.


What have you learned about breathless patients?

 Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute setting - and can save lives. So yes, when you first approach a patient who is short of breath, get that oxygen on while you make your assessment then think about the finer points of respiratory failure afterwards. 

Where do I begin?
A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs (especially respiratory rate), looking for clues as to the underlying cause of their breathlessness, remembering the five common causes. 

What treatments might be useful?
A small fluid bolus might help and carries relatively little risk; think about the need for nebulised bronchodilators for patients with asthma or COPD, and remember that antibiotics given early to patients with sepsis save lives.
If the patient has pain we should definitely treat that too.

Which investigations might help me find out more?

  • A chest x-ray is often useful in patients who are short of breath; your ED seniors might be able to use bedside ultrasound to further ascertain the underlying pathology, so get help early!
  • ECGs are often useful in these patients
  • Blood gases can also provide lots of useful information - think carefully about whether you need arterial gases and if so, please use local anaesthetic.
  • If nothing makes sense - get a blood sugar, remembering that metabolic disease may cause an acidosis, presenting with an increased respiratory rate (although not often true dyspnoea).
  • And GET SENIOR HELP (including getting your seniors to assess you for those all-important workplace-based assessments; definitely start those early)


Other resources

Chest Radiographs

One of the key investigations in patients with shortness of breath is the humble chest radiograph. There are some phenomenal FOAM resources for interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).

Chest X-Ray Anatomy  -  Chest X-Ray Abnormalities  -  Chest X-Ray Systematic Approach

Blood Gases

Think! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...

Further Reading on Shortness of Breath

The Flipped EM Classroom - Shortness of Breath (with further links).


Natalie May

 

Induction to EM. An approach to headache in the ED. St.Emlyn’s

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HORIZONS.jpgWe've all had headaches, but not often severe enough to prompt us to seek help in an Emergency Department.

In our practice 10% of patients who do present to the ED  with a primary presentation of headache will have serious pathology and our job as Emergency Physicians is to work out who these are. Key to this is actively ruling out the life-threatening and life-changing diagnoses:

  • Subarachnoid Haemorrhage
  • Meningitis
  • Tumours and Space Occupying Lesions
  • Temporal Arteritis

Listen to Simon and Iain discuss how to approach these patients here

Further Resources

Headaches at Life in the Fast Lane - a great summary from the LiTFL crew

NICE Guidelines (NCG150) - diagnosis and management of headaches; there's a flowchart and some red flags although you could read the St Emlyn's summary here!

Headache from the Flipped EM Classroom

Induction to EM. Staying safe in your first job. St.Emlyn’s

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If you're starting out in EM then it can be a scary time. Iain and Simon talk through some of the initial anxieties and ask what you need to know to be safe, sensible and super.

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