Norwich PEM go to DFTB19: Day 2

Day two of DFTB19 continued in much the same vein as the previous day. With an inspiring line up of some of my personal #FOAMed heroes speaking, the toughest part was working out which one of the breakout sessions I would attend. After my rather bloated, rambling post yesterday, and in the spirit of the conference, I decided to pare down my thoughts today to one single take home from the presentations today. So, without further ado, here is what I learned from DFTB19 Day 2.

Morning keynote:

Mary Freer on Conversations that change medicine

• Take home: Patients are on average only allowed to speak for 11 seconds before interruption. We are all taught to ask open question, but are we really listening to the answer if all we are allowing them is a fraction of a minute to tell you why they are there?

Stuart Dalziel on Non-trivial pursuit (PERN Update)

• Take home: Global research networks are an immensely powerful weapon in the ongoing fight for an evidenced based approach.

• Bonus take: pARC is a simple appendix score that we can use to clinically risk stratify patients with ?appendicitis. Would this save potentially unnecessary long transfers to paediatric surgical centres from DGHs?

Meredith Borland on Playing scrabble (PREDICT Update)

• Take home: Delayed presentations of head injuries >24 hours to A&E are tricky, as all of our clinical prediction scores are based on data for kids presenting under 24 hours. However, if there is no signs of a skull fracture, and no non-frontal haematoma, the likelihood of a clinically significant TBI is effectively zero

Damian Roland on PERUKI: the long and short game

• Take home: We don’t appreciate evidence well enough at a clinical level. Why do we allow ourselves to dismiss statistics as boring and hard, when it is a vital part of understanding what we should, or more often should not be doing every day in clinical practice?

Morning Breakout:

Suzie Piper on the top five general paediatric papers

• Take home: Two good quality studies looking at the impact of rudeness on performance unequivocally prove that there is a serious decrease in our ability to perform at our best in a hostile environment. Civility matters, and the standard that you walk past is the standard you accept

Craig McBride on the top five paediatric surgical papers

• Take home: People are entitled to their own opinions, but not their own facts. Everyone, from the media, to journalists, to healthcare professionals have a unique position to both know, understand and communicate those facts to the wider community.

Edward Snelson on the top five PEM papers:

• Take home: Identify your own biases before reading a paper. It’s easy to follow the crowd, and listen to what the “experts” are telling you the paper says, but take your time to evaluate and understand the evidence, and how it relates to your practice first.

Afternoon breakout:

Constantinos Karanis on Preparing for Transport

• Take home: Be very mindful of children presenting in status epilepticus with a mixed respiratory and metabolic acidosis, as there is often an underlying pathology causing the status

Ariane Annicq on Regional ECMO

• Take home: Patients who required intensive support, who were referred earlier that the traditional ECMO threshold did significantly better simply by being transported to the ECMO centre, regardless of whether they ended up on ECMO or not. If you have a deteriorating patient that you think might need ECMO, phoning earlier than the “ECMO limit” may save your patients life

Justin Hensley on Wilderness Medicine Mythbusting

• Take home: Never leave the UK, drink your own urine or attempt to suck venom out of a wound. Basically, stay indoors unless strictly necessary.

Afternoon keynote:

Taj Hassan on A future dystopian emergency medicine

• Take home: Speak truth to power. Make it cogent, coherent and constructive, but do not back down just because you are in a position of weakness. And foster an environment that encourages your juniors to be able to speak truth to you, when you are in power.

Helan Bevan on Culture Cataclysm

• Take home: Senior leaders are less influential than you might think. Top down change requires four times the number of people to gain the same influence as going through your organisational “influencers”. Identify who they are and tap into their potential for change.

Gayle Hann and Amani Simpson on Different halves of the same page

• Take home: Stop referring to patients caught up in knife crimes as in “gangs” or “gang members”. These are children, and we need to call them such. More often than not these are children who have been caught up in the wrong situation, putting on a mask to fit in, and depersonalising them as “gang members” doesn’t appreciate that these are children in desperate need of help.

That’s all I’ve got from today, back tomorrow for the final day of this year’s conference!