Episode 2: The Emergency Department: The Pitfalls

LibyaMedCast

http://www.archive.org/download/Ahmed_HusseinLibyamedcast002_0/Libyamedcast_002.mp3

Here we are, the second episode, where the fun begins! I dragged Hussein out on his rest day (thanks Hussein), and we put this together quickly, so excuse the relatively poor sound quality and some of the ad libbed content, which always sounds funny when you hear it again! One thing we learnt from this exercise is that it must take a lot of practice for people who do it so well on the radio and TV! I decided to post the recording despite the fact it may need some improvement. Although not perfect, we will not postpone until perfection, which will never be reached and if we keep postponing, the project will never start. We will try to improve inshala, esp. with your support and feedback. We pray that Allah gives us guidance.

Below I posted some related material and references related to the podcast. I hope you find it useful.

Ahmed (Email: Libyamedcast at gmail . com)

—————————————————————

In this podcast we talked about the Emergency department. Everyone may and will eventually need this vital service some day makes it essential that it should be run efficiently, scientifically and ethically in order for it to provide a life saving service. Any complacency here means lives. As an example of this, in a very small study of 29 deaths in an emergency department, it was found that 20 people would have survived and could have had a chance for long term survival if they received STANDARD care*. Failure in the care chain leads to deaths and permanent disability. We should focus in improving our skills on detecting the common and dangerous conditions, the biggest killers, the rest will follow with increased experience.

The main take home messages from Episode two are:

-Inappropriate Action Costs Lives.

-Classification of medical emergencies:

• Cardiac 29%
• Respiratory 26%
• Neurological 21%
• Gastro 13%

–Common reasons for admission:

• Myocardial Infarction.
• Stroke.
• Cardiac Failure.
• Acute exacerbation of asthma.
• Acute exacerbation of COPD.
• Deliberate Self harm.

-Common Mistakes:

• Failure to recognise and treat serious illness and infection.
• Error in investigating-acute headache, acute breathlessness, epilepsy.
• Misinterpreting of investigations.
• Inadequate assessment of Abdominal symptoms.

-Errors in patient assessment:

• Available clinical evidence incorrectly interpreted.
• Failure to identify and focus on very sick patients.
• Investigations misread or ignored.
• Radiological evidence missed.
• Standard procedures, guidelines/protocols not followed.
• Inadequate assessment or treatment.
• Discharge from hospital without proper assessment.
  

In the emergency department, doctors should always assess patients in a structured and a focused way. Its very important to seek a second opinion if doubt exists NO MATTER how senior some one is, EGO COSTS LIVES.

Key Principles:

• Do no (further) harm.
• Focused knowledge and basic skills are essential.
• A structured approach will identify problems and prioritise management.
• Prompt accurate assessment improves patient outcome.

References: *Acute Medical Emergencies: The practical approach.

Useful website for Evidence based care: Evidence-Based On-call.