• Meetings, greetings, and your people

    Induction is much the same everywhere. There is the stuff you need to know which is some things, and they stuff they must tell you, which is a lot of things. Acceptance is a powerful thing. I accept now this is the way of the world. As it is when it comes to meeting the various great and good of a hospital. It is good to be always polite and good practice to remember everyone’s name, but it does someone become a blur of names and titles as I do my best to scribble them down in my notebook as we go. I was surprised that my little project led…

  • This week I learnt- 5

    Controlling fever doesn’t seem to have any effect on serious outcomes or death. Controlling fever could be harmful but of course can be provided for comfort. It is probably safe to skip thrombolysis and go straight to thrombectomy. Beware winter’s morphology as STEMI mimic In kids with buckle fracture unlikely matters much what type of immobilisation is offered. That saying “quiet” in an emergency department does not make it busier (but leads to perception it is!)    

  • TWIL-4

    That the biggest decrease in a patient’s angina symptoms come form telling them the lesion they have isn’t going to cause a problem. Explored more; apparently about a third had symptoms completely improved. Clinical prediction tools are much better validated to “rule out” than “rule in” the need for intervention. The “weekend effect” is more likely due to lack of community services than inadequate hospital services. In low-resources environments (in this case South Africa) a (Free) emergency department visit could cost them about a third of their monthly income.    

  • TWIL-3

    This week I learnt The SNOOP mnemonic is useful to rule out serious cause of acute headache Pain scores at triage are not associated with admission or mortality In rotator cuff shoulder pain a one of session of physio is equally effective than a long course (but no placebo control). Ebola has made (another) resurgence in the democratic republic of Congo. Unfortunately; there is no good evidence for unconditional cash transfers to treat poverty. NSTEMI treated later rather than in first few hours do very similarly to those who get to the cath lab a couple of days later.  

  • TWIL-2

    This week I learnt A 6 hour CT is the key to ruling out Subarachnoid haemorrhage (if reported by a neuro-radiologist) It might be time to reframe “sepsis” as a part of the dying process in a significant proportion of patients. Statically broad-complex tachycardia is going to be VT. Cerebral oedema in DKA doesn’t seem to related to sodium.