In the January 2024 episode, they discuss diagnosing acute aortic syndrome, RCEM Guidelines for invasive procedures, and non-invasive airway management for poisoned patients. They highlight challenges in diagnosis, the importance of informed consent, and safety practices in medical centers. The episode also covers a study on safety practices, exploring aortic dissection and blood donation awareness.
Diagnosis of acute aortic syndrome poses challenges in the ED due to varied presentations and ineffective clinical decision rules.
Guidelines stress obtaining consent and following safety protocols for high-risk ED procedures to ensure patient safety and team communication.
Empowering nursing staff to challenge clinicians and implementing mental induction programs are essential for maintaining safety and competence in high-risk ED procedures.
Deep dives
Observational cohort study explores diagnosis of acute aortic syndrome in the emergency department
A study investigated acute aortic syndrome diagnosis in the ED, highlighting challenges due to varied presentations. The study considered multiple clinical decision rules but found them ineffective when applied. Prospective and retrospective data collection from 27 UK ED's revealed challenges in diagnosing and managing acute aortic syndrome.
Importance of Consent and Verification of Procedure Site in High-Risk Procedures
The guidelines stress the importance of verbal or written consent for high-risk ED procedures ensuring patient awareness and safety. Verification of the procedure site and team briefing are key steps highlighted for high-risk procedures, reinforcing the need for clear communication and shared understanding within the medical team.
Checklist and Safety Procedures for Emergency Department Practices
The guidelines recommend following a comprehensive checklist for ED high-risk procedures, including steps like sign-in, time-out, reconciliation of items, and debriefing to ensure safety and minimize risks. Documenting reasons for non-compliance with steps is advised in cases where all checklist components cannot be fulfilled.
Training Programs and Empowerment of Nursing Staff in High-Risk Procedures
The guidelines emphasize the importance of mental induction programs for specific procedural training in high-risk procedures, allowing clinicians to practice and demonstrate competence. Additionally, empowering nursing staff to challenge clinicians not adhering to safety checks in high-risk procedures is highlighted to create a culture of safety and accountability in the ED setting.
Study on Non-Invasive Airway Management
The podcast episode discusses a study on non-invasive airway management of comatose patients with acute poisoning. The study challenges the belief that all patients with a low Glasgow Coma Scale (GCS) need intubation, highlighting that some intoxicated patients with benign agents like alcohol or benzodiazepines may recover without intubation. The multicenter randomized controlled trial in 20 emergency departments in France compared outcomes of patients with a GCS less than nine who were either intubated based on clinician judgment or had intubation withheld unless specific indications arose. Results showed that patients with withheld intubation had lower rates of ICU admission and shorter hospital stays, supporting the safety of managing select intoxicated patients without immediate intubation.
Blood Transfusion Safety and Awareness
The episode also touches on the importance of blood donation and blood transfusion safety. The discussion emphasizes donating blood as an act of goodwill and highlights the complexities and risks associated with blood transfusions. The blogs provide insights into the challenges and safety measures involved in administering blood transfusions, shedding light on the intricacies of blood transfusion practices and the importance of avoiding errors in the process. Additionally, the episode promotes awareness of blood transfusion safety protocols to ensure optimal patient outcomes and prevent adverse events.
Happy New Year! This month for the January 2024 episode of the RCEM Learning Podcast Rob and Liz have got a New in EM segment looking at the DAShED study examining the diagnosis and investigation of suspected acute aortic section. Becky and Chris then go over the RCEM Guidelines for Invasive Procedures in the ED. We then go to Andy and Dave again looking at non-invasive airway management of the comatose toxicological patient. We then end with New Online. If you'd like to email us, please feel free to do so here.
(02:58) New in EM - Diagnosis of Acute Aortic Syndrome in the Emergency Department
