12/04/17

1. Echo in the ED - EF
Lots of good tips and reminders on how to do echo.
Give your links here - http://adultemergencymedicine.blogspot.co.uk/search/label/echo

2. Critical Appraisal of the AHEAD study
The AHEAD study was written before the new NICE head injury guidelines, looking at when they all needed scanning or not.
It has also been appraised here: http://theresusroom.co.uk/the-ahead-study

Our points
- Why was it in BMJ Open
- Who was on the NICE guideline committee?
- This is only one study.
- Do we feel comfortable discussing risk with patients? Should or could they self discharge. If we give patients the information, do we trust their decisions?
- Does this mean we just need to observe people for longer so that we are happy? Bed doesn't do that.
- Their follow up was not sufficient.
- There are a lot of coufounders. including advice to attend hospital is given to warfarin patients, and it is more older patients on warfarin.
- The whole GCS being low thing wasn't very clinically useful as we know we are going to scan a low GCS irregardless of whether they are on warfarin.
- There was quite a lot of missing data which does mean we need to err on the side of caution, but makes the results difficult to interpret. 1/3 of the data was made up.
- Discussion about what is appropriate risk?

Take Homes
- INR is not important or relevant
- Warfarin does increase the risk of head injuries - asymptomatic had 2.7% risk of adverse outcome.
- Some of the symptoms are user dependent - what is amnesia, or LOC?
- We can use this information to prioritise our scans


Curriculum:
CAP 18, HMP 4
HAP 22, HAP 35