I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
There is guidance from NICE 2010 on this. RCEM has a brief summary
What does not NICE consider as red flag on the ECG?
- conduction abnormality
- they include RBBB and LBBB in this
- long or short QT
- any ST segment or T wave abnormalities
Who should we refer for urgent CV assessment?
- (this can be within 24 hrs but I suspect this means for most of us – admit)
- ECG abnormality
- heart failure (by history or signs)
- FHx sudden cardiac death <40
- New/unexplained breathlessness
- They also add anyone over 65 without clear prodrome
Describe some ECG causes of syncope
When should we do a tilt test?
- suspected vasovagal that is recurrent and adversely affecting quality of life
- tilt test is only to assess for a severe cardioinhibitory response (asystole)
What do we do with syncope during exercise?
- offer EST within 7 days unless you suspect something more significant (AS or HOCM which would both be a bad idea to stress!)