Category Archives: Emergency Medicine

Exit block

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The Royal College of Emergency Medicine has produced some excellent videos on Exit Block.

A new condition called ‘Exit Block’ is harming patients: they are put at risk when ‘Exit Block’ occurs. This happens where you can’t get patients from A&E into a hospital inpatient bed. Over 500,000 patients a year are affected. The Royal College of Emergency Medicine says that this is unacceptable. The Royal College of Emergency Medicine is currently campaigning to eradicate Exit Block from Emergency Departments.


This video highlights the work underway in Leicester Hospitals to tackle Exit Block.

Can patients with recent-onset atrial fibrillation be discharged from the Emergency Department after successful cardioversion?

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Congratulations to my colleague Dr Adeel Chaudhary for publishing a BestBET on this topic in this month’s EMJ.

Thee-Part Question

In (adults with recent-onset atrial fibrillation who are stable after successful cardioversion) is (immediate discharge) as safe as (admission for a period of further observation)?

Clinical Bottom Line

Stable patients with recent onset of atrial fibrillation after cardioversion and stroke risk stratification can be discharged home with adequate follow-up after a period of observation. Level 2 evidence, grade B recommendation.

Full article: (i) Can patients with recent-onset atrial fibrillation be discharged from the Emergency Department after successful cardioversion? Emerg Med J 2013;30:81-83, and (ii) on the BestBETs website.

Tips for Life Support OSCEs in the MCEM & FCEM

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I give my trainees sitting the MCEM Part C (OSCE) exam the following tips for the life support OSCE stations:

  1. Keep every member of the team busy.
  2. Treat the manikin like a real person.
  3. Look at the monitor or examine the patient yourself.
  4. Do to the manikin what you say you would do.

Download this PDF for an illustration of each of these 4 points.

(This advice is equally applicable for the FCEM OSCE stations.)

OSCE Day of Central FCEM Course of Autumn 2012

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Central FCEM Couse OSCE Day - 22 September 2012

The OSCE Day of the Central FCEM Course took place at Rotherham Hospital on Saturday 22nd September 2012.

The day involved 20 ST6+ senior trainees in Emergency Medicine, 17 actors & helpers, 15 faculty members and 1 corporate sponsor. We covered 37 FCEM OSCE stations spread over 4 OSCE circuits. The OSCE Day is designed to give candidates for the FCEM OSCE exam a day of intense exam practice and preparation. A big thanks to all the actors, helpers, faculty and candidates who participated!

The Viva Day of the Course will be held on Saturday 3rd November in Rotherham Hospital.

NSTEMI Pathway Wins “We Are Passionate & Creative In Our Work” Award

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At University Hospitals of Leicester NHS Trust‘s annual "Caring at its Best" Award ceremony on 12 September 2012, my colleague Dr Martin Wiese was chosen as the overall winner in the "We Are Passionate & Creative In Our Work" category for his pioneering work in developing our Emergency Department’s Non-ST Elevation Myocardial Infarction (NSTEMI) / Chest Pain Pathway.

Martin had already won the Quarter 3 award for this work back in June 2012. At the awards ceremony last night Martin fought off stiff competition from other quarterly award winners to win the overall award for this category.

Over 500 staff, volunteers and supporters of Leicester’s Hospitals gathered at The Athena for the glittering & high-profile awards ceremony. Martin was presented with a plaque and certificate by Simon Cole, the Chief Constable of Leicestershire Police.

Well done Martin!

Full press release: Staff recognised for offering patients Caring at its best
Photos and Videos from the event: "Caring at its Best" Award ceremony 2012

“Caring at its Best” Award for Dr Martin Wiese

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Caring at its Best Awards – June 2012 – We Are Passionate & Creative In Our Work from Leicester's Hospitals on Vimeo.

Congratulations to my colleague Dr Martin Wiese for winning an award in recognition of his work in establishing our Emergency Department’s new Chest Pain / NSTEMI pathway.

Martin has a passion for creating evidence-based protocols and pathways. His work is recognised at a national level, and he has worked with both the National Institute for Health and Clinical Excellence and the College of Emergency Medicine on a number of clinical guidelines.

Martin has helped keep our Emergency Department at the leading edge of Emergency Medicine by producing and implementing a Chest Pain / NSTEMI pathway that not only incorporates the latest ultra-high sensitive Troponin assays (allowing NSTEMI biochemical rule-out at 3 hours, which is great for both patients and the hospital), but also incorporating a whole package of investigations and treatments including GRACE scoring and the latest coronary artery calcium CT scoring techniques.

Please watch the video above, or read this press release for more information.

"Martin has substantially re-organised the way emergency patients with chest pain are managed, making sure they see the right people at the right time during their visit to the Emergency Department. This newly developed system is successful thanks to doctors, nurses and clinicians who have put in both time and dedication and work together to provide high quality patient care."

Emergency Medicine Operational Handbook

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Emergency Medicine Operational Handbook (The Way Ahead)

The College of Emergency Medicine (CEM) has published an updated version of the “The Way Ahead” policy document, dated 2 December 2011. It has been renamed the “Emergency Medicine Operational Handbook” and replaces the old “The Way Ahead 2008-2012”.

The full document is 83 pages long and gives a comprehensive analysis of the state of play in Emergency Medicine in the UK – current practices, service configurations, workforce considerations and key challenges.

It lays down the blueprint of what Emergency Medicine in the UK is, and the direction of travel over the foreseeable future. It is an impressive policy document which is essential reading for anyone with an interest in UK Emergency Medicine.

"This guidance is for clinicians, managers and commissioners involved in the delivery of Emergency Medicine in the UK and the Republic of Ireland. The public may also find the document of interest. It replaces the previous guidance we issued known as ‘The Way Ahead’ in December 2008."

* A useful 4-page executive summary, called the “Operational Handbook Highlights” is also available from the CEM website.

For a historical perspective, “Way Ahead 2005” (written jointly by the British Association for Emergency Medicine and The Faculty of Accident and Emergency Medicine) and “The Way Ahead 2008-12” (written by the then newly formed College of Emergency Medicine) are also available.