Today was the worst shift I've ever had in the ambulance service.

The entire system has collapsed. We're no longer practicing emergency medicine. We're just desperately trying to put out fires & triage the sickest patients but it's just not enough. There are literally hundreds and hundreds of emergency calls in the stack with no resources to send.

This is true up and down the country. People are dying waiting for ambulances as we queue outside ED's, themselves in crisis & experiencing critical incidents.

To clarify my stance on this issue, I do not believe public information campaigns designed to dissuade the public from calling 999 work. As far as I'm aware there is no evidence to support them & I would go so far as to say they're dangerous. The general public are not medically trained, and so what constitutes an emergency for them will be incredibly subjective, much like with pain scores.

You wouldn't tell the public to only call for help if their pain score is over 6 as this is too subjective.

Short tweetorial on Narrow Complex Tachycardias for any students or NQP's who may follow me.

I suppose I would define a narrow complex tachycardia as any presenting rhythm where the rate is above 100 bpm and the QRS complex duration is <120ms. Some of the most important questions I like to ask when presented with a narrow complex tachycardia is:

Is the patient symptomatic of this tachy arrhythmia?

and/or

Is the patient decompensating in any way?

Going to do a small thread on some of the memorable take home messages from #ACPconference for those that were unable to make it.

Apologies in advance if I've missed out anything. From @C6uthrie lecture on pain.

Pain is a multi-factorial experience, not always related to tissue injury, which will improve once healed.

Incorporate ICE into your history taking.

I - Impression

C - Concern

E - Expectations

Reassure & manage!