For those of you working hard on the shop-floor a quick summary of whats going on in Glasgow @ #Eusem2018
3 interesting talks from dual Emergency Med and Infectious disease specialists, from Denmark and Germany, which highlighted that we are all in the same boat, and again doing the basics right is what maters.
Antibiotic Stewardship (What we do in ED, dictates inpatient care)
- Viral v.s. Septic – clinical differentiation is not reliable, and POCT for flu may be useful in the high prevalence of an outbreak but performs poorly the rest of the time.
- Choosing well – we can reduce the use of broad-spectrum antibiotic usage dramatically by using our site specific antibiotics [68-85% of the time we can correctly establish site clinically i.e. without tests – if it sounds like a chest infection it is]
- Blood cultures – really important for guiding the care of our inpatient colleges, esp. to help deescalation, [2 sets are better than 1]
Antibiotics within an hour
- 33% mortality reduction – more and more studies demonstrate the benefits of early antibiotic treatment
- Delay of 2nd dose kills – with longer boarding times in ED waiting for wards we need to remember that second dose it matters.
Is TCI (Target-Controlled Infusion) the way forward? Basically using an anaesthetic pump to smooth sedation instead of bolusing. Its already be used by non-anaesthetics in several areas and demonstrates lower complication rate than the RCEM sedation audit 0.05% vs approx 4%, when you look across studies.
PROTEDs group are currently doing a feasibility study into its application into the ED, early results show set up is quick, but the sedation time is slow. However, they admit that so far they have been very cautious with their dosing and are looking for optimal dosing regime.
Doing the basics well
There were a few pearls to take away.
- ECG moment artefact – if you get the patient to hold their arms out forward until they are too tired to move the artefact goes away!!
- Radiology in pregnancy
- Doses under 50mSV are not harmful to baby
- CXR is 0.1mSV (10 days background radiation)
- CT abdo pelvis 20mSV
- Once again doing the best for Mum is best for the baby
- Use Ultrasound/MRI where we can but if X-Ray/CT is warranted use it
- However, when multiple test are required (i.e. trauma) we need to actively monitor how that dose is increasing.