Emergency Medicine Consultants Research Articles

Improving the attractiveness of an emergency medicine career to medical students: An exploratory study

To describe perceptions of medical students and emergency doctors towards careers in emergency medicine (EM), and to identify influences on career choice. A prospective, cross-sectional questionnaire study was performed in three EDs. The instrument used Likert-type items addressing: factors important in the choice of a career, factors offered by a career in EM, and opinions of EM. EM consultants and registrars and a cohort of final-year medical students participated. Overall, 22 consultants, 30 registrars and 164 students completed the questionnaire (77.1% overall response). Student interest in an EM career increased from 10/161 (6.2% [95% CI 3.0-11.1%]) before, to 26/137 (19.0% [95% CI 12.8-26.6%]) after an EM attachment (P = 0.0014). The highest proportion of students chose work-life balance as being an important factor for career choice (143/163 students, 87.7% [95% CI 81.2-92.6%]). Compared with consultants and registrars, students had negative perceptions about lifestyle factors that EM offered, as well as about the future of the specialty, job security and workplace stress. Some students also preferred careers with opportunities for research, subspecialty practice, and better pay and conditions, yet perceived EM as not offering these factors. Students considered EM as an acute, procedural, public hospital specialty, with diverse patient problems and minimal continuity of care. Smaller proportions of students considered these factors important for career choice. Increasing the attractiveness of a career in EM requires changing student perceptions of lifestyle and satisfaction benefits, access to EM subspecialties, increasing ED research, information about job security, and improved work conditions.

In children with foot and ankle injuries, does hopping count as non weight-bearing?

A pilot study of children attending an Emergency Department with foot or ankle injuries, hopping at presentation. Aims In children presenting with foot and ankle injuries, an inability to weight bear is an indication for x-ray even in the absence of other signs of bony injury. Hopping is a vigorous action, quite different to the minimal movement that children with bony injuries adopt. We propose that hopping alone, with no other clinical features of a fracture, will not be associated with bony injury on x-ray; in essence that hopping and non weight bearing are not the same entity. Methods Over a 2-year period, data was collected from children attending the department with foot and ankle injuries who hopped at presentation. The details recorded included the mechanism of injury, clinical findings, x-ray results and whether the children walked or hopped on discharge. All patients whose data was included in the study had x-rays either reported by the radiology department or by an Emergency Medicine Consultant. Results A total of 66 proformas were completed but 18 were not included in the analysis as they had significant data missing (no x-ray report, no confirmation that they hopped into the department). From the remaining 48 patients, the following results were obtained: 9 patients had fractures on x-ray and in all cases these correlated with clinical findings. The remaining 39 patients (81.25%) had no bony injury on x-ray. 26 of these 39 did have other clinical signs that would have merited x-ray. The remaining 13 children (27% of the total) had no abnormal findings on examination. All of the children with no bony injury walked from the department on discharge. A Fisher9s one-tailed test showed these results to be significant (p Conclusion This pilot study shows promising results but a larger study is required. If the results are replicated in a larger study, hopping could be distinguished from non weight bearing and, in children with injuries presenting with hopping alone and no other features to suggest bony injury, x-ray be avoided.

Main trauma conference – the first day

Main trauma conference – the first day

Survey of the use of therapeutic hypothermia after cardiac arrest in UK paediatric emergency departments

ObjectivesTo ascertain current use of therapeutic hypothermia (TH) after paediatric cardiac arrest in UK emergency departments (EDs), and views on participating in a UK randomised controlled trial (RCT) incorporating early...

Early in-hospital management of out-of-hospital cardiac arrest in Scotland

Guidelines recommend the use of mild therapeutic hypothermia (MTH) and percutaneous coronary intervention (PCI) in the early post-resuscitation management of select out-of-hospital cardiac arrest (OHCA) cases. This study aims to assess the current use of MTH and PCI in Scottish Emergency Departments (ED) and Intensive Care Units (ICU). We conducted a questionnaire survey of all the Scottish Emergency Medicine Consultants, EDs and ICUs. MTH was more commonly initiated in ICU than in the ED (19; 91 vs. 7; 37%, P<0.05). Only a minority two (11%) EDs routinely referred OHCA patients for early PCI and only three (16%) EDs receiving patients after OHCA had on-site access to PCI facilities. The use of MTH after OHCA appears to be widespread, although it is infrequently initiated in the ED. The utilization of PCI in OHCA management has yet to be widely established. Increased awareness may increase the use of promising therapies such as MTH and PCI following OHCA to save lives.

Safeguarding children: recognition and response in child protection

This course is primarily for doctors in training. The session I attended had a mixture of foundation year 2 doctors, paediatric specialist trainees and consultants, and emergency medicine specialist trainees and consultants. I did this course while I was on the acute care common stem core training level 1 in emergency medicine. Recent press coverage of high profile child protection cases has again brought into the limelight the issue of child protection. I wanted to increase my knowledge of recognition and response to children at risk of neglect or abuse, and to know how to deal effectively with the situation. The …

Current practice and opinion regarding the use of therapeutic hypothermia after cardiac arrest survival in children: a survey of UK Paediatric Emergency Medicine consultants to inform the cold-PACK study

Background and aimsTherapeutic hypothermia improves neurological outcome in adults after cardiac arrest and term neonates with hypoxic ischaemic encephalopathy. There is currently no evidence to support its use in the...

The introduction and impact of a “hot” qualitative mortality reporting system for patients dying within 24 h of admission

IntroductionIn late 2008 the consultant body at Stafford Hospital Emergency Department introduced and implemented a rapid qualitative review of all patients dying within 24 h of admission to Stafford Hospital....

A comparison of civilian (National Confidential Enquiry into Patient Outcome and Death) trauma standards with current practice in a deployed field hospital in Afghanistan

BackgroundThe National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on trauma management, published in 2007, defined standards for United Kingdom (UK) hospitals dealing with trauma. This study compared...

To ED or not to ED: NHS 24 referrals to the emergency department

IntroductionThis study aimed to compare the opinions of consultants in emergency medicine and general practitioners (GPs) on the appropriateness of NHS 24 referrals to the emergency department (ED).Methods170 NHS 24...

Content prioritisation of the College of Emergency Medicine specialty curriculum: an exploratory study using a modified Delphi approach

Aims:To determine opinion in relation to prioritisation of topics within the clinical curriculum of the College of Emergency Medicine.Methods:A modified iterated Delphi technique was used employing a participant panel of...

Emergency medicine consultants

Emergency medicine consultants

Interrater reliability of the Wells score as part of the assessment of DVT in the emergency department: agreement between consultant and nurse practitioner

Objectives:To determine interobserver variability between an emergency medicine consultant and nurse practitioners for the use of the Wells score in the assessment of deep vein thrombosis (DVT) in the emergency...

Debriefing after failed paediatric resuscitation: a survey of current UK practice

Objectives:Debriefing is a form of psychological “first aid” with origins in the military. It moved into the spotlight in 1983, when Mitchell described the technique of critical incident stress debriefing....

Emergency Ultrasound Made Easy

I was sceptical when I saw the title of this book, edited by consultants in emergency medicine from Sydney and Belfast. I asked our F2 SHO if she thought that ultrasound was easy. She said ‘no’ and looked at me as if I was stupid. She was then asked for her opinion about the claim in the book that ‘Studies have shown that it can be quickly taught and that as few as ten scans may suffice for an operator to obtain scans for a given indication’. We are both unconvinced and believe that these ‘studies’ should have been referenced. After reading further through the book, I forgave them the title. I believe it is part of a Made Easy series. It emphasises that reading this book will not enable someone to perform emergency ultrasound. It also emphasises limitations of ultrasound and stresses that it should not replace clinical judgement. After an introduction and a brief, but adequate, chapter on physics, there are chapters by a mixture of emergency physicians, radiologists, a gynaecologist and a nephrologist on clinical scenarios, followed by chapters on ‘Getting trained and staying trained’ and ‘Setting up an emergency ultrasound service’. These chapters are good brief introductions to the various techniques and are well illustrated with important points being well highlighted. There are useful chapters that cover the abdominal aorta, the abdomen after trauma, radiolucent foreign bodies, central venous access and I can even see the value in being able to ultrasound kidneys to determine to whom the patient in renal failure needs referring. I do have some misgivings about the other chapters. One of the many good pieces of advice in the introduction is that ‘there is little point performing examinations that are better performed by others unless there is a clear benefit to the patient or the department’. However, they do not seem to have adhered to this. I am unsure that with 4-h targets, UK accident and emergency departments want to take on scanning for gall bladder disease, deep vein thrombosis (DVT) or hip effusions. Should pleural effusions and ascites be drained in the emergency department unless they are so large that imaging is unnecessary? Does the cardiac arrest team really want somebody ultrasounding the heart while they are performing cardiopulmonary resuscitation? While I have misgivings about these chapters, there is one that I am convinced should not be included. The consultants in emergency medicine in my Trust agreed with me that there is no place for ultrasound for problems in early pregnancy in the emergency department. These scans should only be performed by someone who can proceed to transvaginal scanning if necessary. Of course, these misgivings are all based on experience of UK hospitals. Four of the 14 authors work in Australia and it may well be appropriate for a fellow of the Australian College of Rural and Remote Medicine to look for gallstones, DVT, etc. in their emergency department. I feel that properly trained staff in the emergency department should be performing ultrasound on appropriate cases and this book does have a role in bringing that about. It should be carried in the pocket of anyone undergoing training in emergency ultrasound for rapid reference during supervised scanning; it covers the basics well. The editors claim that ‘it is designed to be accessible and easy to use in an urgent situation’. This is not its role: if you need to refer to the basic information in this book you do not have the experience to be scanning unsupervised.

The College of Emergency Medicine 2008

What seems a long, long time ago, an overwhelming majority of the membership requested that the British Association for Emergency Medicine (BAEM) and the Faculty merge. At last this has...

Children in UK emergency departments

Healthcare provision for acutely unwell or injured children in the UK is changing fast. Paediatric emergency medicine (PEM) is now a recognised subspeciality for certification of completion of training for...

Determination of required pharmacological knowledge for clinical practice in emergency medicine using a modified Delphi technique

Aims: To identify the content of the national postgraduate pharmacology curriculum for trainees in UK emergency medicine. Methods: Modified three-round iterated Delphi technique employing a participant panel of 160 randomly...

Working together for the sick or injured child: the Tanner Report

Working together for the sick or injured child: the Tanner Report

Determination of required anatomical knowledge for clinical practice in emergency medicine: national curriculum planning using a modified Delphi technique

Objectives: To identify the content of the postgraduate anatomy curriculum for trainees in emergency medicine (EM) in the UK. Methods: Modified Delphi technique involving 160 randomly sampled consultants in EM....