Foundation Course

Updated: 10th April 2018

This course is mandatory for junior/foundation-level doctors to complete during their time in our department, however in the spirit of #FOAMed we have opened it up for everyone.

It follows the Emergency Department teaching curriculum that is delivered over one year. Each teaching session is split into a module. Within this module there are various tasks to complete, from reading a passage of text and watching a video to completing an eLearning module. By completing our course you will have accessed a variety of resources that can be linked to your curriculum as evidence for your ARCP.

The modules can be accessed by clicking on the relevant boxes below. Any questions? Please email the course administrator (teaching@em3.org.uk).

 
 

CARDIOVASCULAR

Updated: 5th Jan 2017

Acute chest pain is a common presenting complaint in patients attending general practice, Emergency Departments (EDs) and Medical Assessment Units (MAUs). It accounts for 6% of all new attendances at EDs in the UK (Goodacre et al, 2004). 

Ischaemic heart disease is responsible for 38% of all adult deaths in the UK (Allender et al, 2008). It is estimated that there are 96,000 new cases of angina and 146,000 new cases of myocardial infarction each year in the UK (Allender et al, 2008). Early management of ischaemic heart disease in the UK has been revolutionised by evidence based guidelines. Acute chest pain may be the only clue of a life-threatening condition and all such patients should be urgently assessed.

Patients presenting with acute chest pain are at risk of being inappropriately discharged home following inadequate assessment, with potentially catastrophic consequences: 6% of patients presenting with acute chest pain are discharged from EDs with missed prognostically important myocardial damage (Collinson et al, 2000). A careful history and examination will often suggest the cause in non-cardiac chest pain. Many causes of non-cardiac chest pain require immediate treatment to avoid serious sequelae. 

A medium-sized district general hospital can expect to see 50 cases of pulmonary embolism (PE) each year. PE is easily missed and is the leading cause of maternal death in the UK (The Confidential Enquiry into Maternal and Child Health (CEMACH), 2007). Chest pain may be caused by gastrointestinal disorders, but acute chest pain should not be assumed to be due to gastrointestinal disease until serious cardiac syndromes have been properly ruled out, especially in older adults.

Top 5 differential diagnoses:

  1. Acute Coronary Syndrome
  2. Pulmonary Embolism
  3. Aortic dissection
  4. Pneumothorax
  5. Pneumonia

Complete the tasks to learn more about Chest pain and some other Cardiac presentations. Remember to always consider and actively exclude the top five differential diagnoses.

Finally if you have any doubts you should seek senior advice, and RCEM state all adults (>17yrs) with non-traumatic chest pain require review by an ED senior prior to discharge.

Tasks:

NICE Guidance:

BMJ Learning:

Resus Council (UK):

  • The ALS manual is a good source of information. This becomes available when you do an ALS course or can be found on the Resus Council (UK) website.


RESPIRATORY

Tasks:

  1. Shortness of breath – this really good video has been produced by the team at Southampton for their junior doctors.

  2. Breathlessness – this learning module encompasses all the main differentials into  systematic approach to the patient with SOB in the ED. It is from the RCEMLearning website, which replaced enlighten. All modules are linked to the RCEM curriculum and bet of all they are free! (Membership is required if you want certificates though) If you haven't been to the website before it is worth spending a few minutes having a look at the other content.

  3. Arterial blood gas analysis – ABG interpretation can be challenging, but can also be crucial when formulating a management plan, once again the RCEMLearning website can provide assistance. This eLearning module provides the relevant information to apply on the shopfloor.

  4. Management of spontaneous pneumothorax – review this flowchart from the British Thoracic Society (BTS) on the management of spontaneous pneumothorax

  5. Chest drain insertion – those working at University Hospitals of Leicester can access the following eLearning Module on Chest Drain Insertion via eUHL. There is also a YouTube video on the technique available to all.

BTS Guidelines:

NICE Guidelines:

DNUK (requires membership):

RCEM Learning:


Course Feedback

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: