Blog: old

Important information for HEFT EMCAST users

So this is just a really quick message regarding HEFT EMCAST and what’s happening to the feed over the next few days just incase there we’re to be any glitches!

We’re changing our hosting service over this week. Hopefully you won’t need to do anything at all regarding where you can find us on iTunes/your podcast apps the feed you’re using should stay the same. When you refresh the feed later this week it should automatically change to ‘HEFT EMCAST; the new feed’

The feed should still be here and the icon you’ll find will be

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All episodes from January onwards will be on here. We’ll be adding the back catalogue ones to different feed; heft emcast the archives very soon and we’ll let you know the details of that as soon as it’s complete

So hopefully you’ll notice a change in the iTunes icon, a few changes to the number of episodes available and the new ‘papers of April 2016′ appearing in your feed on the 1st april.

Just incase the transition goes wrong we’ll put any relevant messages on the website and the twitter account @heftemcast with a link to any new details you might need

Hope to speak to you on the other side on april 1st and finger’s crossed you won’t have to change any of your settings/subscriptions

Thanks for your support with the podcast and I’ll speak to you on friday!!

Does the airway matter to trainees?

A while back we conducted an online survey asking clinicians about what matters to them when picking their consultant post.

Some centres may feel disadvantaged by trauma reconfigurations if they are not MTCs but there is something that appeals to trainees more than working in an MTC and even better it’s achievable in every single department.

Some of you have asked for the reference so here it is……

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Apnoeic Oxygenation

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Today we are going to look at the procedure of apnoeic oxygenation during emergency RSI. Essentially, this procedure delivers oxygen to the alveoli after neuromuscular blockade and the onset of paralysis. This increases the period of safe apnoea before oxygen saturations fall <90%.


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ALS Updates; ERC Guidelines 2015

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So following on from our recent blog on the European Resuscitation Council’s 2015 guidelines on traumatic cardiac arrest (which are just a part of the new ERC guidelines), we thought we’d just run through some of the changes that caught our eye in the rest of the guideline. When you’ve got a free hour or two, make sure you take a look at the rest of the guidelines yourself here.


Traumatic Cardiac Arrest; ERC Guidelines 2015

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The management of a traumatic cardiac arrest is undoubtably stressful. Practices varies from centre to centre and clinician to clinician. A lot of attention in Emergency Medicine is now being paid to cognitive readiness. If a critical decision on how you are going to act can be made before the event this significantly reduces the stress and errors made in such a situation.


A great new UK Prehospital Podcast

If you’ve ever been lucky enough to work with Tim Nutbeam and Clare Bosanko, you’ll know they’re superb EM and PHEM physicians who are passionate about delivering high quality, patient centred cutting edge care.

I’m massively excited that they’ve set up a new FOAM resource based around prehospital care in the UK with the first post on LMA’s covering PALM, LMAs in cardiac arrest and much more.

Sadly we can’t clam this is our work but it looks great! Have a listen and check out the website. You can also follow them at PHEMCAST it genuinely is going to be awesome!!

Keeping upto date in EM

HEFTEMCAST was setup for those of us lucky enough to work at the Heart of England Emergency Department, to help pool our resources with regards the evidenced based medicine that we talk about every day on the shop floor. It allows us to share projects and assignments for all to benefit from and to facilitate interaction between friends and colleagues working different sides of the 24 clock.


Atrial Fibrillation in the ED

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The way in which patients with AF present unsurprisingly makes a huge difference to the appropriate treatment and management plan, this may range from nothing at all right through to DC cardioversion. It’s really important to manage this group correctly though and have a sound understanding on the topic as timely appropriate treatment can significantly reduce morbidity and mortality, whereas inappropriate treatment can lead to an increase in the M&M.


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So day 1 was pretty phenomenal and day 2 certainly has a lot to live up to, again it was impossible to catch all of the great talks due to so many superb concurrents but here is a taster of some of the sessions…..


‘When to stop resuscitation’ from Roger Harris and followed on from Cliff Reid’s talk from last year on ‘when not to stop resuscitation’. Roger talked about the difficulty of deciding when to stop resuscitation and the debatable injustice of this extraordinary care we give some patients when that money could be better spent on a greater number of patients for the greater good.



So here we are in Chicago with the biggest FOAM if not EM-Critical Care conference on the planet this year!! Here’s a whistle stop tour of some of the sessions from the first day at the conference, which followed the dramatic opening ceremony and I’ll just cover the major take home messages from each session……… IMG_7036

Cliff Reid’s opening lecture, ‘Advice to a young resuscitations’ not only gave advice on the placement of a whoopee cushion on ward rounds under your consultants behind but the journey through confidence, competence and the following key bits of advice;


Presyncope, what does it mean for our patients in ED?

What does presyncope mean to you?

If you ask this question to a handful of doctors you’ll get a multitude of different answers, you’ll also get a huge variety of opinion as to their understanding of it’s significance or associated morbidity and mortality. As with most areas of greyness in medicine this is contributed to significantly by a paucity of evidence on the topic.


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pH on the gas, should it influence you cardiac arrest prognostication??

It’s a common scenario in multiple ED’s every single day;

The pre hospital cardiac arrest has arrived in your resus. They’re undergoing ALS, the team has run through their 4H’s and 4T’s. So far they haven’t been able to achieve a ROSC and are at a tipping point. They’re wondering whether continuing with this resuscitation could be of benefit, or if it is likely to be futile.

‘I know’ says the team leader ‘lets just get a gas, if the pH is really low then we should stop.’


Urine testing; who gets the antibiotics??

Just to let you know, the patent in cubicle 7 has got a UTI, can you prescribe her some antibiotics?

Err, I guess so. How do you know?

Well she just went for a wee, it looks infected and and she’s got leucocytes on her dipstick…..

We’re often led by tests that we haven’t ordered and understanding the context and implications of those tests is a tricky skill to master. Bedside urine testing is probably one of the most frequently performed tests in the ED and a good understanding of it’s application is essential.