New co-host Liz Farah joins the RCEM Learning Podcast to discuss topics such as overnight boarding of older patients in the ED, use of opioids for back pain, management of hypertension in the ED, and investigation of cauda equina syndrome. They also explore the impact of long waiting times on patient outcomes, guidelines for hypertensive crisis, and the introduction of an interactive pathway tool. The Opal Trial study reveals that there is no evidence to support the prescription of opioids for acute back pain. Additionally, they discuss the role of the RSI assistant in the ED and provide insights on Bifascicular Heart Block.
Extended wait times in emergency departments can lead to increased mortality rates, infections, and falls.
The British and Irish Hypertension Society provides guidelines for managing acute hypertension in the emergency department.
The Getting It Right First Time program offers an online tool for diagnosing and treating suspected Quadrachuina Syndrome (CS) to optimize patient care and reduce misdiagnosis and delayed treatment.
Deep dives
Overview of Opiate Animal Jeezer Study
The Opiate Animal Jeezer study, published in The Lancet, investigates the use of opiates for lower back and neck pain. The study focuses on the effects of opiate prescription, emphasizing the need to prove the adverse outcomes associated with long wait times in emergency departments. The study analyzes data from a large research network in France and highlights the increased mortality rates for patients who experience extended waits before their inpatient bed is available. The study also links longer wait times to higher rates of infections and falls. The findings underscore the need to address hospital overcrowding, and the associated negative impact on patient outcomes.
Guidelines for Managing Hypertension in the Emergency Department
A position document by the British and Irish Hypertension Society discusses the management of acute hypertension in the emergency department. The guidelines aim to streamline the understanding and definition of hypertensive emergencies, urgencies, and malignant hypertension. The document suggests oral therapy with a calcium channel blocker or beta-blocker for patients with eye changes indicating malignant hypertension. However, it lacks specific instructions for managing patients with other severe end organ damage. The guidelines recommend following the existing NICE guidelines for hypertension management in primary and community care and advise close monitoring of blood pressure until it reaches the target range.
Streamlining the Diagnosis of Quadrachuina Syndrome
The Getting It Right First Time (GIRFT) program has developed an online interactive decision tool to streamline the diagnosis and treatment of suspected Quadrachuina Syndrome (CS). Urgent MRI scans within four hours of request are recommended for patients presenting with specific symptoms, such as acute or worsening back or leg pain, urinary flow problems, severe motor loss, or other indications of CS. The tool also guides clinicians in interpreting post void residual measurements and ensures prompt surgical referral and treatment for confirmed CS cases. The GIRFT program aims to optimize patient care and reduce unwarranted variations across medical specialties, addressing the challenges posed by the misdiagnosis and delayed treatment of Quadrachuina Syndrome.
Opioid Use in Back Pain
This podcast episode discusses the use of opioids in the management of acute, nonspecific lower back and neck pain. The episode highlights a randomized controlled trial, the Opal trial, which compared the use of an opioid analgesic (targent) with placebo in this patient population. The trial found no significant difference in pain scores at six weeks between the two groups, indicating that short-term judicious use of opioids did not provide any benefits for pain relief. Additionally, the study showed a small but significant increase in the risk of opioid misuse in the long term for the opioid group. The authors concluded that there is no evidence to support the prescription of opioids for acute non-specific back pain or neck pain.
RSI in the Emergency Department
This podcast episode discusses the process of rapid sequence intubation (RSI) in the emergency department (ED). It highlights the role of the RSI assistant, who plays a vital role in ensuring the smooth execution of the procedure. The episode covers various aspects of RSI, including setup, optimizing for success, drug administration, surface anatomy, airway assessment, and safety considerations. It also provides valuable insights into potential complications and offers checklists to ensure a safe and effective RSI process. This resource is recommended for anyone involved in or interested in understanding RSI in the ED.
This month for the December 2023 episode of the RCEM Learning Podcast we welcome our new co-host Liz Farah. Merry Christmas!. We discuss two New in EM segments looking at overnight boarding of older patients in the ED and mortality and looking at the use of opioids in treating back pain. Rob and Liz discuss two guidelines looking at the management of hypertension in the ED and the investigation and management of cauda equina syndrome. We then end with New Online. If you'd like to email us, please feel free to do so here.
(03:10) New in EM - Overnight stays in the ED and mortality in older patients