Bangor ED Newsletter Jan Feb 2014 Hi Res Version

8/13/2019 Bangor ED Newsletter Jan Feb 2014 Hi Res Version

1/20

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Welcome to BEDLEM News!

Its been a while... its almost two years sincethe last issue of the Ysbyty Gwynedd EDnewsletter !where did the time go?!

Weve had a name change too: this newsletterused to be called Bangor EmergencyDepartment Local Education & Social Stu" !aka BEDLESS !but to eliminate the possibilitythat anyone couldpossiblyhave interpreted theprevious title as a political comment, we have re!named it BEDLEM instead. Just to be sure.

We apologise in advance if this issue is a bit doctor!

centric: we wanted to get the project resurrected asquickly as possible, so we had to use material we had tohand. Having decided to re!launch the newsletter ASAP,

we just didnt have time to canvas the nursing sta"forcontributions !just compiling it was a big enough job!

We are now appealing for contributions towards thenext one, because it really does need to be a team e"ort.If youd like to see something included, please write it forus! No contributions, no newsletter...

So please, do put pen to paper!

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2/20

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2013 was an eventfulyear for our EmergencyDepartment.

Probably the biggestsingle change since ourlastnewsletter is that, mostdays, we actually havepatient flow.

Sta"who have joined ussince May 2013 may notrealise just how much of animprovement there hasbeen, thanks to a return tosite!based operational

management, herculeane"orts by the entire medicalservice #and many otherspecialties$and, of course,the very, very hard work ofED sta"and bed managers.

The situation is fragile...one missing ward round at a

weekend, or a few extrapatients can quickly scupperthings... but what a

di"erence cf. 2012 and early2013.

Our senior doctor sta%nglevels have improved too: weappointed two new substantive

consultants in July 2013, and ourClinical Fellow scheme is

gathering pace again after acracking 2012/3 year.

We are also becoming ahighly desirable place formedical students to visit ontheir electives !weve got our2nd and 3rd Australian students

with us at present and much of2014 is booked up already.

We are still working in acramped and out!dated physicalspace, but our new build is dueto commence soon... and whilstIm sure we will be cursing itduring the phased buildingprocess #which will inevitably bedisruptive$we promise itll be

worth it!

So, rock on 2014... wereready for you!

Linda Dykes

7D>N @C8 "MF@>D:;B E>F5EHR

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News

Seeing in the New Year in a deserted waiting room !the sta"on duty for the

night when 2013 turned into 2014! Sadly, the waiting room didnt staydeserted for long a#er midnight. And no, the bubbly wasnt alcoholic!

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3/20

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Dont forget the PregnantPatient Pathway!

If you are seeing a pregnantpatient !or someone in the post!natal period who is within two

weeks of delivering !please dontforget to use the PregnantPatient Pathway.

Some high!risk conditionscan present apparentlyinnocuously in pregnant andpost!partum women, and if youdontspecifica$ythink about

possible complications ofpregnancy, you may well miss

them.

We recently sent home a lady

36/40 gestation with increasedleg swelling and proteinuria

without discussing her with amidwife, and saw a possible post!partum eclampsia present 2

weeks after the woman delivered#the record, apparently, is 23 dayspostpartum$so please !get thepathway out and follow it!

Metoclopramide

Contra!indicated in under 21sdue to the higher risk of adystonic reaction

Blood bottles

Dont forget that bloodbottles, particularly the yellowU&E bottle, should be gentlyinverted about 6 times aftertaking your blood sample

?ruptured tendo achilles

We have missed a couple ofTA ruptures in the past year. Ifyou think theres any possibilitythat there may be a TA injury,

youmust perform and documentanormal calf!squeeze test #forgetpositive or negativeSimmonds test... nobody knows

whether positive means itsnormal or it isnt!$

Its also wise to quickly checkfor any TA gap or tenderness

when examining an injured ankle!we are all so fixated on theOttawa areas that most peopleforget to check the TA and thehead of the fibula, which areboth part of ankle examination.

If you suspect apartialTArupture #normal calf squeeze but

very tender over the TA and ahistory to match$you mustensure it is protected pendinginvestigation by ultrasound. Ourfoot & ankle surgeon, MrMumtaz, advises a full equinusPOP whilst waiting. Manypatients wont be thrilled withthat inconvenience for an injurythat is only suspected, so if theydecline, you must persuade themto be completely non!weightbearing #and document you toldthem a POP would be better$.

Mr Mumtaz is happy to haveall ?partial TA injuries referred tohis fracture clinic on a Mondayafternoon in the event you cant

wangle an urgent ultrasound withDr Kraus or Dr Barwick first.

eGFR - two caveats

We now have eGFR quotedon our blood results. Just bear inmind that eGFR is not validatedfor use in acutely ill patients, andit may be falsely low in patients

who have significant muscle!wasting or who are vegan, asthese individuals will typicallyhave very low creatinine levels.

Secondary Surveys thatarent enough

If a trauma patient isadmitted to a specialty otherthan orthopaedics or EDOU, youshould specifically point out thelimitations of the secondarysurvey and that a tertiarysurvey is required.

A post!trauma patient wasadmitted to medicine after anepisode of collapse. Hedcomplained of ankle pain on thesecondary survey, it had been x!rayed, there was no bony injury.He was later discharged from the

ward without a full ankleexamination being conductedand a ruptured achilles tendon

was missed.

A quick squeeze on asecondary survey !even with an

x!ray as well !isnota fullexamination. Do explain this to

people who dont deal withtrauma on a daily basis!

$84D5F5E P>F5@G W D8NF5M8DG
mailto:[email protected]:[email protected]:[email protected]:[email protected]


4/20

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Tetanus boosters

Kids under 15 are regarded as

up to date with their tetanuscover, even though they havent

yet had 5!shots!in!their!lifetime,so long astheyve hadtheir full primary immunisationcourse of 3 doses as a baby.

They dont need additionalboosters in the ED, and theydont need immunoglobulin: beaware that regional experts dontall agree with the HPA advice

#which advocatesimmunoglobulin even in fullyimmunised patients if there isheavy contamination withmaterial likely to contain tetanusspores or extensive devilalisedtissue. http://www.hpa.org.uk/

webc/hpawebfile/hpaweb_c/1194947314087

We do occasionally seefarmyard crush injuries garnished

with cow pat, but theyre not thatcommon in kids!

Molluscum contagiosum

Now, youd think thatmolluscum #a highly contagiousbut usuallyharmless

viral skindisease$really

wouldnt besomethingto fret aboutin the ED.

We thought so, too.

So we got a bit of a shockwhen we learned that molluscumfrequently causes a dermatitisreaction in a"ected areas whichare dry, pink and itchy and makediagnosis more di%cult. %Mind

you !surely it sti$didnt need to cometo the ED ?!Ed&

Lisfranc injuries of the foot

Lisfranc injuries #TMT joint

disruption$are a classic easilymissed injury in the ED.

These midfoot injuries occureither due to crush injuries, or

when a rotational force has beenapplied to a plantar!flexed foot.

The problem is that standardfoot views on x!ray can becompletely normal even iftheres a Lisfranc injury present.

Our foot & ankle colleague

Mr Mumtaz o"ers the followingadvice:

Always think: could there be aLisfranc injury? andspecifically look for the x!raysigns

Look for bruising on theplantar surface of the foot !this is highly suggestive of amidfoot problem

Safety!net: instruct patients toreturn for re!evaluation if their

foot is not significantly betterafter a week, and considerweight!bearingx!rays views ifthey do return.

Although in EMpractice we are taughtthat dislocated joints arealways an emergency,Lisfranc injuries dontnecessarily have to bereduced immediately. Afew days delay in a

patient who isnt weightbearingdue to pain isnt going to domuch harm. However, patients

get very cross about delayeddiagnoses, so if you think thatclinically there may be aproblem, always warn patientsthat initial x!rays arent infallibleand a normal initial x!ray doesnt

always totally exclude asignificant injury.

Your hip isnt broken...

On a similar note, be careful in

how enthusiastically you reassurepatients whom you thought had afractured NOF, but then the X!rayseemed fine.

Some of these patients dohave occult fractures and, onceagain, patients and families getreally cross if a fracture is missedon their first visit.

Its important to be honestabout the limitations of x!rays :I

cant see any break on the x!ray,which is reassuring, butoccasionally you can get a crackthat doesnt show up on the first x!ray. Depending on whether thepatient mobilises or not, you needto make a judgement call whetherto refer to orthopaedics because

your suspicion of a fractured NOFis clinically so high, or whether tosafety!net with instructions to

return for possible repeat x!ray ifthe pain doesnt settle.

Arterial blood gasses

We have become great fans ofvenous blood gasses !much lesspainful for patients #although weshould use LA for radial arterypunctures$and many of our nurses

will do venous gasses, so they aregenerally less hassle.

But some patientsdo sti$needan ABG: notably, anyone with satsless than 93&and most majortrauma patients #even if theres nosuspicion of chest injury, you can

get weird stu"like fat embolism$.

We recently treated arespiratory failure patient with

very low sats who, embarrassingly,didnt get an ABG done in the EDat all. Worse still, we didnt notice

this till an independent reviewerpointed it out after a complaint.Red faces all round.

%>D8 L84D5F5E P>F5@G W D8NF5M8DGOOO
mailto:[email protected]:[email protected]://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1194947314087mailto:[email protected]:[email protected]


5/20

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/C8 %IG@ +84M 28K@F>5OOOWe dont like na!ing, honestly we dont, but theres some stu"that wejust cannot a"ord to get wrong, or forget to do.

Bangor ED sta": if you dont read anything else, read this page!
mailto:[email protected]:[email protected]://www.youtube.com/watch?v=R-KSb5tOJzwhttp://www.youtube.com/watch?v=R-KSb5tOJzwhttp://www.youtube.com/watch?v=69s6ezhwTWQhttp://www.youtube.com/watch?v=69s6ezhwTWQmailto:[email protected]:[email protected]


6/20

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Dercums Disease

Possibly the weirdest conditionwell mention this issue, but wepromised a patient wed educatesta"about it... which means wemust have seen at least onepatient with it!

According to the NationalOrganisation of Rare Diseases #of

whose reliability we know little,but we dont know much aboutDercums either$: Dercumsdisease is a rare disorder in whichthere are fatty deposits whichapply pressure to nerves,resulting in weakness and pain.Various areas of the body mayswell without apparent reason.

The swelling may disappearwithout treatment, leaving

hardened tissue and pendulousskin folds.

More worryingly for ED, it canalso apparently cause death frompulmonary complications.

If anyone can tell us more andsupply more reliably information

wed be happy to feature it nexttime.

Cephalosporins and

penicillin allergy

Still carrying around in your headthat someone told you theres across!reactivity risk of about10&for penicillin allergicpatients being givencephalosporins? Time to update!

Its way, way lower. Think nearer1&in patientsreportingallergiesto pencillin #and still only 2.55&in patients withprovenpenicillin

allergy$. Whats more, only 1stand 2nd generation

cephalosporins possess the R1side chain said to beresponsible for the allergiccross!reactivity. The 3rd and4th generation cephalosporinswed use in ED dont even havethe R1 side chain #thoughcefuroxime does !2nd

generation$.

Glucagon and

oesophageal obstruction

Doesnt work. Neither doesbuscopan. Fizzy drinks work inabout 70&of cases, butendoscopy works in 93!100and finds pathology in 55!90&of these cases$. We might wantrefer patients with oesophagealfood boluses to ENT sooner

than we typically do...

Tramadol lowers the

seizure threshold

Not recommended in patientswith epilepsy #and if you see apatient with epilepsy whoseseizure pattern has changed,ask about tramadol use !wefound one who was taking hismums tramadol for toothache$

Milk tooth knocked

out?

Dont try and replace it: youcan damage the permanenttooth developing beneath.

Drowning terminology

Struggling with near drowning, wetdrowning, dry drowning? Forget it.Its wrong anyway. The currento%cial definition of drowning is:The process of experiencingrespiratory impairment due tosubmersion,or immersion, in liquid.Outcomes are injury, no injury, or

death. Weve also got a new EDguideline for management of thedrowned patient who hasexperienced injury #dammit !neardrowning was a lot shorter to type!$!see next issue for more details.

Lactic acidosis in alcoholics

We often forget this one: chronicalcoholics may develop a type B2lactic acidosis, partly de to lack of

food and partly because alcoholinhibits gluconeogenesis, so glucoseisnt available as fuel and so ketonesare created instead. This is all made

worse by ACTH deficiency and liverdisease, which further impair

gluconeogenesis as glycogen storesbecome depleted.

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7/20

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1. Take care with modified release preparations ofhighly toxic drugs !eg diltiazem MR. Patients may

go o"suddenly after several hours of being

apparently well.

2. Be cautious with staggered paracetamoloverdoses !if worried at all, treat.

3. Use e"ective doses of insulin!dextrose incardiotoxic drug poisoning. Inthis situation the dose of insulin

needs to be appropriatelyadjusted. Hypoglycaemia isuncommon, and concerns aboutthis should not prevent use.

4. Observe opioid overdose

patients for at least 4 hours, andat least 8 hours following

overdose with methadone orsustained!release preparations.Observe for at least 6 hours afterthe last dose of naloxone: patients

discharged earlier may die oncethe e"ect of naloxone wears o".

5. Metabolic acidosis is often a challenging

di"erential diagnosis, and poisoning is one possible

cause. The Unknown poisoning link below thesearch box in TOXBASEmay be helpful.

6. Iron poisoning is deceptive, and it is often

di%cult to risk assess, especially in children.Remember that desferrioxamine will prevent properinterpretation of serum iron concentrations, andthat haemolysis is a complication of serious iron

poisoning.

7. Therapeutic excess with digoxin is often over!treated with FAB. Indications are clear on

TOXBASE. FAB should only be used for patientswith cardiovascular impairment secondary totoxicity, notjust a slightly high serum concentration.

8. Although major smoke inhalation could lead tocyanide toxicity, the frequency of this complication is

currently unknown. In conscious patients, antidotesare unnecessary. In unconscious patients, checking

lactate may help guide need for therapy.

9. Carbon monoxide poisoning is an importantproblem, but should not be a major issue in conscious

patients in whomnormobaric oxygen

therapy is su%cient.The role of hyperbaricoxygen remainsuncertain; in particular

clinical trial data is

unclear on long!termbenefit.

10. The patient whodoes not wanttreatment is di%cultfor the most

experienced clinician.In overdose this is a

most challenging issue, and TOXBASEo"ers someoutline guidance to assist front line sta".

11. Patients with a long QT are likely to be su"

eringfrom a toxic e"ect on cardiac potassium channels.Automated machines use inbuilt nomograms that are

likely to be unreliable in poisoning in correcting QTfor heart rate. TOXBASEcarries a nomogram thatuses heart rate and measured QT to assist riskprediction. The treatment of choice for this

abnormality is IV magnesium.

12. Patients with suspected poisoning are a diagnosticchallenge. TOXBASEnow carries a list of common

Toxidromes and possible causative agents. See the

Unknown poisoning link under the TOXBASE

search box.

In mid!2012, just prior to the changes in the UK Paracetamol Poisoning guidelines, we saw a case of severe liverfailure in a young man whom wed treated according to the "now defunct#normal!risk treatment line. NPIS

request that a$such cases are reported to them, and the doctor concerned ended up being de!briefed by Professor

Bateman%om NPIS. It was fantastic service and we were most impressed. We asked Professor Bateman if he

could kindly share with us the top tips%om NPIS for ED doctors. Here is his selection...

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mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


8/20

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We are sti$not doing bri$iantly we$onsensible use of the D!Dimer.. so heres an

article%om 2012. Again....

The D!dimer is a useful test that can be used to rule!out PE in low risk patients. But if the pre!testprobability is high, then the D!dimer result is irrelevantand the test should not be performed#because even anegative test would leave an unacceptably high risk ofPE$.

These are just three: there are others #get theMedcalc Pro app for your iPhone!$.

We dont actually mind which you use !butwed like you to use one of them. Some peopleloathe the awkwardness of the BTS Score !others find it by far the most straightforward.But both Wells & BTS require you to decide

whether you think its a PE or not, whichGeneva does not. On the other hand Geneva

requires you to be able to pick up bandatelectasis on CXR. Take your pick!

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9/20

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Weve always said we weregood at trauma, but were notsure anyone believed us... howcould a little unit 100 miles%om tertiary services, where penetratingtrauma is almost unheard of, possibly be good

at trauma?

We$, we can poke a thumb at our doubters,because the latest results in the UK national

major trauma audit, TARN "TraumaAudit Research Network#confirm that we

are doing rea$y very we$with5.4additional survivors!om thoseexpected!om every 100 patients.

TARN isnt perfect !we have done our fair share ofcriticising the methodology in the past, as so muchemphasis was placed upon the Injury Severity Score #ISS$derived from radiology #and, in deaths, PM$reports wherethe precision was sometimes insu%cient to generate anaccurate score.

However, the e"ort going into ensuring the ISS is accurateis now considerable, greatly assisted by the Major TraumaNetwork process, and it will be the same in every traumanetwork now reporting to TARN. So we think that

TARN is probably comparing apples to apples more thanin the past.

We must, of course, thank our Major Trauma Centre,University Hospital North Sta"s, who have been takingover our most seriously injured patients since October2012 !this success is their success too !and especiallyLeesa Parkinson and Sue Owen in our ED who have

worked so very hard to get our TARN participation backon the road after a significant hiatus!

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GOLDSTAR


10/20

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Above ! Dr Helen Salter

Right! Dr Leesa Parkinson

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!H9:VNE Linda.

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New challenges for Linda & RobWe are pleased to announce that the role of ED

Lead Clinician has rotated from Dr Linda Dykes to Dr

Rob Perry. Congratulations Rob (or should that be

commiserations?) - youre the new go-to person!

Linda, meanwhile, has started a one-day-per-week

secondment to work with Welsh Ambulance Service

Trust (WAST) as an Honorary Assistant Medical

Director. She will be scoping out areas where BCUHB

and WAST can work together to improve patient

care & reduce the demand on emergency services

including the ED.
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


11/20

!"# #%#&'#()* +#,! !#)"(-)./ 0,+.!# 12 .++#+ #3!&.4 !5 %.6# -! %5 -(!#!-('7 89:; ?@AB

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M+00%"N,&$0" 017)1& '"(-Some goodbyes

Our Clinical fellow

Scheme did very well in2012/3, we had 6wonderful middlegrade doctors #whichfell to five when Will

Sutcli"e left us to be lured back to the GasBoard!$. Two of the 2012/13 Clinical Fellowsloved it here so much they stayed on... Dr Rio

Talbot as an ST4 #Registrar$in EM, and Dr JenDinsdale for a second CF year with the additionof Medical Education to her portfolio for 3sessions a week.

Greg Cranston and Rich Gri%ths returnedto Higher Specialist Training in EM, and JakeHartford!Beynon went o"travelling #we are veryjealous of his Facebook updates!$and is due toreturn to training in February 2014.

New faces

Dr Kate Clayton joined us in August 2013 for a 12!month Clinical Fellow post, bringing with her a wealth of

EM experience from the uniqueperspective of someone who went into

medicine after being a very experiencedEM nursing sister in London.

We will soon be welcoming two newClinical fellows from early February 2014:Dafydd Williams & Jason Rigby.

Dafydd hails from North Wales #and will be only oursecond!ever Welsh!speaking Clinical Fellow$and we havehad reports from Ben Hall #our former registrar$thatJason has a penchant for outrageously colour!coordinatedscrub suits with matching trainers... watch this space!

On a sad note

We lost a colleague and friend last year:Dr Rimon Than, the RAF Valley GP

worked with us in the ED one day a week,but was tragically killed in an avalanche inthe Cairngorms on Valentines Day 2013.


12/20

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/C8 "# 5>@FK89>4DM

/C8 "# %>D9FMF@T W %>D@4LF@T N88@F5EIts not the most cheerful of titles for a meeting, but we are working hard to ensure

that all ED staff have access to regular updates on our performance when it comesto quality of care and patient safety.

Meetings take place each month in the ED Seminar Room #the last bay on the left on Beuno... itdoubles as a store room which isnt ideal, but its something !although we cant wait for the new build!$.

The provisional dates of the 2014 meetings #the team running them occasionally alter the date$are:

Date Lead senior doctor

Jan 15 #instead of 14$ Linda

Feb 11th Rio

March 11th Rob

April 8th RaviMay 13th Khalid

June 10th One of the new Clinical Fellows #i.e. Dafydd or Jason!$

July 8th Helen

Theres a "How To" document, stats presentation #and also the All Wales M&M toolkit containing anexample presentation and lots of tips on how to present cases$on the ED intranet website #i.e.not theuno%cial www.mountainmedicine.co.uk website!$. The M&M meeting stu"is accessed via the

Training tab: there is a link at the top of the Training page to the Monthly Meeting page containing allthe documents. We also need to be filling out the barcoded forms #which Lou has$for any casereviewed for potential inclusion in the meeting #they're the same format as the CPG M&M forms$

If you arent sure of anything to do with the M&M meeting, please ask Dr Leesa Parkinson.


13/20

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>*" IJ '1)+7"L1$&0

Our new consultant Dr HelenSalter is our Audit Lead: please go andsee her if you wish to volunteer for an

audit, have an idea youd like todiscuss, or are floundering with one

youve already started!

Have you seen thenewly revised jointED/T&O guidelines?

We hope this is auseful resource to a$ED and T&O sta".

Look out for a minorrevision !v2.02 !which wi$incorporate theJanuary 2014 changesto who takes chestinjuries.

Next step !ChineseFingers Traps...!
mailto:[email protected]:[email protected]:[email protected]


14/20

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1C4@ >ID M>KG E8@ IP @> S .4D@ *58

/84KCF5E

As well as our shop!floor teaching commitments with medicalstudents of various sorts passing through our ED, the e"ortsof the Clinical Fellow team deserves specific mention.

Most of the 2012/13 group thew themselves into paramediceducation with great enthusiasm, getting involved with theparamedic training of RAF rear!crew #a good excuse for themthen to go our flying with the Sea King, naturally!$as well assupporting the development of the local Welsh Ambulanceparamedics and technicians they work with on pre!hospitalshifts.This culminated in the Clinical Fellow team forming themain speaker body at the May 2013 WAST CPD Day that we

hosted in YG. The day was a huge success, totally sold out, andthe combination of lectures and lunchtime work!shops proveda hit. There are photos of the day at http://

www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlA paramediccrew from Monmouth were so inspired by the event they thenorganised a repeat event in South Wales, using our posters andlectures.

Dr Jen Dinsdale #pictured left$then tookher Medical Education interest to a wholenew level, by staying on for a second year

#with a 3!session/week MedEd commitment$teaching medical students, as well as startingup CPD sessions forlocal paramedics, the

first of which took place in January 2014at Caernarfon Ambulance Station and

was very well received. They willcontinue on the 3rd Wednesday of eachmonth.

Finally, the ultimate perk of the 2012/3Clinical Fellow posts went to Dr Rich

Gri%ths #right$whose name came out ofthe hat to go on a working holidayteaching RAF winchmen... in Cyprus!
mailto:[email protected]:[email protected]:[email protected]:[email protected]://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://www.mountainmedicine.co.uk/Mountain_Medicine_Bangor/Blog/Entries/2013/5/17_CPD_Day_photos.htmlhttp://lifeguardswithoutborders.org/http://lifeguardswithoutborders.org/http://lifeguardswithoutborders.org/http://lifeguardswithoutborders.org/mailto:[email protected]:[email protected]


15/20

!"# #%#&'#()* +#,! !#)"(-)./ 0,+.!# 12 .++#+ #3!&.4 !5 %.6# -! %5 -(!#!-('7 89:; ?@AB

!"#$%&'( *+ ,- .%/(0 ,+1'2 3 '#0%& &%/(04(+1'2560&'24/72481 C5/ DE (5 A ,.'# AD

BKJ N (*"&" )1 ,1 )1 %"$&' -)9==333Wales is hosting the 2014 College of Emergency Medicine Spring CPD EventinCardi"on 17!19 March at the Mercure Cardi"Holland House Hotel in the city centre. It

costs from (215 for one day, (345 for two or (455 for full event for CEM members to(250/(450/(550 for non!members.

Previous events have been superb and the programme looks very good.

Book via the CEM website: http://secure.collemergencymed.ac.uk/Development/Conferences&20and&20courses/Forthcoming&20Conferences/CPD&20Event&202014/Registration

Convenient for North Wales, the International Traumacare Conferencetakesplace in Telford, just o"the M54, from 23!28 March. The programme is arranged sothat most professional groups will fine one or two consecutive days of interest.

Always good value for a major conference, as well as the 15 free day passes suppliedto YG from the Major Trauma Network #see Rob to see if he has any left$the dailycost starts at (110 for Traumacare members #(180 for non members !the pricing isarranged so its always cheaper to join!$rising to (325 for all five days for members,(530 for non members. The First Aid and CFR programme on the Sunday are a realbargain at (30 if you know anyone who may be interested!

You can book at the Traumacare website: http://www.traumacare.org.uk/conference/register!to!attend

Sunday

23rd March

Monday

24th March

Tuesday

25th March

Wed

26th March

Thursday

27th March

Friday

28th March

First Aid Programme Paramedic/ AirAmbulanceProgramme

Paediatric Trauma Trauma ImagingProgramme

Trauma Critical CareProgramme

Chest traumaProgramme

Community FirstRespondersProgramme

Trauma in austere &wildernessenvironmentsProgramme

Trauma Nursing Major Trauma in theED

MusculoskeletalTrauma(orthopaedics)Programme

Rehabilitationfollowing majortrauma Programme

Fire service &extricationprogramme

TARNProgramme

Pre-HospitalEmergency MedicineProgramme

Wound CareProgramme

MusculoskeletalTrauma (Sportsinjuries and rehab)Programme

Hand TraumaProgramme

First Aiders, MRT Casualty Carers, CFRs

Paramedics

Emergency Physicians

Nurses

RadiologistsOrthopaedic Surgeons

Intensivists/anaesthetists

Physios, OTs, nurses

Trauma Networks

Paediatricians

Pre-hospital doctors
mailto:[email protected]:[email protected]://www.traumacare.org.uk/conference/register-to-attendhttp://www.traumacare.org.uk/conference/register-to-attendhttp://www.traumacare.org.uk/conference/register-to-attendhttp://www.traumacare.org.uk/conference/register-to-attendhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationhttp://secure.collemergencymed.ac.uk/Development/Conferences%20and%20courses/Forthcoming%20Conferences/CPD%20Event%202014/Registrationmailto:[email protected]:[email protected]


16/20

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18/20

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/C8 :;D "# K>5Q8D85K8 P>G@8DG

International Conference on Emergency Medicine, Dublin, June 2012

We love hosting medical students and wetry hard to support them get their first

publication: even a lowly conferenceposter can gain vital extra pointsamongst o&en!identikit applications atF1, F2 and CT/ST1 applications.

More to the point, however, the posters look great in the ED,although we ran out of wa$space within the ED some time ago

and have nearly fi$ed the corridor towards radiology as we$.Where next?!

A$posters designed by & copyright Dr Linda Dykes: please [email protected] a readable PDF copy 0f any of them.

UK Radiology Conference

2013 (and CEM 2012) 999 Research Forum, Cardiff, February 2013


19/20

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CEM National Conference, Twickenham, September 2013

...and conferencepresentationsWe well as the speakingengagements on page 14, we havehad multiple presentations atconferences during the past year.

Former SSC Medical Student LeilaBassirhad a Free Paperpresentation at the National 999Research Forum conference in

Cardiff, expanding upon her posterSicker from the Start (pic - right)

Our military registrar Dr Ben Hallpresented FromHelicopter Rescue to the Perfect F2 post at the All-Wales Medical Education conference in Swansea(this was later made into a poster for CEM, see topright) and in-the-midst-of-her-finalsAnnaWoodmanpresented a Free Paper on Medical

Students in EDs: which aspects are mostappreciated at the same event. (pic - top left)

Ben Hallpresented again in the moderated postersession at the CEM Conference (Spinal fractures inmountain casualties from Snowdonia) and consultantLinda Dykesfollowed on behalf of the Clinical Fellow

team with the ED@Home in the same session.


20/20

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mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.mountainmedicine.co.uk/http://www.mountainmedicine.co.uk/mailto:[email protected]

Documents

Bangor ED Newsletter Jan Feb 2014 Hi Res Version