Edd Carlton
@EddCarlton
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Prof for RCEM and Associate Editor Emergency Medicine Journal. NIHR Emergency Care Incubator Co-Lead. Trials in trauma, chest injury and chest pain
Joined June 2012
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My dear friend died this week. 8 months into a 9 month GMC suspension for probity issues. This was a symptom of underlying life issues and was the tip of an iceberg. Cast out to “reflect.” A talented guy, brilliant doctor and truly the life and soul. I’m sorry, Jo, and gutted
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If you make a 90 year old who has fallen over wait 12 hrs for an ambulance, then lie them on a trolley outside A&E for 6 hours, then keep them for 72 hrs in a brightly lit understaffed A&E…their risk of death will increase exponentially. We don’t need data to prove this
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Any idea whether free tests will continue for NHS staff? Or are we just relying on the apron and clinell wipes from now on?
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Saw many frail patients today with “incidental” covid. The problem is that although it isn’t causing respiratory problems it definitely isn’t incidental. COVID is causing falls, collapse?cause, social admissions, delirium and more in our older patients. This is the new pandemic
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This time last year my best friend had a GMC suspension for putting his name on a conference poster that he had little input into. A probity issue. He died a few months later. This pales into insignificance compared to what the anti vaccine cardiologist is doing tight now
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This was one of the most fantastic things to do when times are tough for teamwork, morale and something a little different. Introducing the
@NorthBristolNHS
Southmead Hospital emergency department choir…(we all did this in our free time)
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The North Bristol Protocol has been discussed a lot on the bird app. Some explanations and truths (from someone who works there) a 🧵
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Very proud to have accepted the first tenured academic post in Emergency Medicine at the University of Bristol today. I haven’t followed a traditional academic pathway but am lucky to have had some fantastic mentors
@DefProfEM
@_AJG66
@richardbody
@BristolARU
to name a few!
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Can I get a “go well” from the cricket community for this little chap who is opening the batting for
@SomersetCCC
U10s tomorrow. He’s been inspired along the way by
@jackleach1991
@JacobLunn11
@BBCSport
@benstokes38
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20 year Med School reunion coming up. Advances in medicine have been amazing in that time.
Things I saw everyday in ED 20 yrs ago that have almost disappeared:
Ruptured AAA-screening
Perforated Gastric Ulcer-H pylori
End Stage Rheumatoid-Monoclonal antibodies
What are yours?
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Whoop! 20/100 patients recruited to our RCT of lidocaine plasters in older patients with rib fractures (RELIEF). Fascinating population to recruit with a median age of around 90 all recruited in busy emergency departments.
@ALBrooks2015
@NIHRresearch
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Niche tweet. Research bureaucracy is bonkers sometimes. I need to complete an expression of interest form, that I wrote, for a national trial I am running, in order for my site to be selected as a site…by me
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Emergency clinicians. What’s the last bastion of professional disrespect/archaic practice in your place? I’ll go first…I’m not permitted to call the endoscopist out of hours as an ED consultant, has to go via medical registrar first….
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He isn’t on Twitter but massive congratulations to Prof Jonathan Benger for his CBE. A privilege to have him as a mentor, guide and friend. An outstanding leader in Emergency Care delivery, research and all things NHS digital
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This is Rob
Rob gave his life working in the Emergency Department
@NBTNursing
during the pandemic
#COVID19
He was an outstanding member of the acute research team recruiting to
@crnwestengland
trials.
Rob made everyone smile.
Rob sadly died last week
Be more like Rob
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We finished recruitment 2 months early! 100 older patients with rib fractures in busy EDs. We can definitely say recruitment is feasible, now for some number crunching. Amazing work
@MissKerryLSmith
@stgEDresearch
@emerge_research
@frazdenny
@DefProfEM
@jamesgagg
@AAppelboam
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Conservative management of traumatic pneumothorax. Challenging dogma. 150 patients randomised to the
@CoMiTEDTrial
as of Sunday evening! The largest RCT in traumatic pneumothorax ever. With 70% out of hours recruitment the clinical buy in is amazing. Thanks to all teams involved
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BIG Congratulations to
@DrTomRoberts
for passing his PhD viva today with minor corrections. Thanks especially to Sue Mason from
@SCHARRSheffield
for being external examiner. Great to see another Emergency Medicine PhD awarded (still a rarity for our specialty)!
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Very proud to be taking over as RCEM Professor from the amazing Dan Horner
@RCEMprof
who has done so much to develop TERN. Great to see so much TERN work at the
#RCEMasc
. Just don’t tell
@RCEMPolicyVP
,
@DefProfEM
or
@RCEMpresident
I failed the critical appraisal exam in 2015…
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The amount of emails today applying the retrospectoscope from the “wise”. Across the NHS we spend an inordinate amount of time “learning” from rare cases. Things we can never predict. We should focus our time and efforts on getting things right for the mundane. More will benefit
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Twitter has become too -ve so signing off as I head into what will be a horrendous couple of weeks at work. Just FYI
1. COVID is out of control
2. Hospitals are rammed
3. People spreading misinformation are causing deaths
@MichaelYeadon3
4. Vaccines are safe and effective
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What does an Emergency Medicine prof do after a hard late shift whilst in lockdown....
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Comfort zones in medicine are fascinating. Up all night managing catastrophic facial injuries and torn aortas only to bat an eyelid. To be faced with my own child with life threatening asthma at home got adrenaline pumping. Familiarity, equipment, teams important. Emotions key
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Crash surgical airway and reflections on a recent case, a thread:
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Think of the model as a couple of Senna, rather than a phosphate enema or picolax in ED crowding constipation
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By sustaining an ankle fracture, I have learnt more about these injuries in the last 5 days than I have done in nearly 20 years practicing emergency medicine and 5 years in trauma research. This is why we must involve the patient perspective in clinical research
@NIHRtakepart
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I’m an emergency specialist in a UK Major Trauma centre. In 2020 I visited a US emergency department. I saw more gun shot injuries in 4 days than I have done in 8 years in the UK. 5 vs 0. It was terrifying in how it was “normality.” That surely has to stop
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Very proud to be shortlisted for an
@NIHRSW
award for my work in patient involvement in research. This is me boxing in one of the most deprived areas of Bristol trying to understand how we can engage victims of gang violence in research in a roundabout way!
@ResearchNBT
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The best guidelines that influence my practice as an Emergency Clinician always go over 170 pages, don’t involve my specialty in their writing and tell me to call “senior help.” Good thing I rarely manage hyperkalaemia…
The UK has the best hyperkalaemia guidelines in the world, and they’ve just been updated.
No one can cover all 171 pages, but here are 3 quick important bits in a thread👇
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Dear Medical Journal, yes I am aware that the review I promised is due on the 27th December. How about we let academia pause for this unpaid voluntary contribution so I can at least say hello to my family on Christmas Day
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Well this is rather fabulous. Our HTA trial of Conservative Management of Traumatic Pneumothoraces CoMiT-ED launches in October.
@UoBrisBRTC
@BristolARU
@TARNaudit
@UWEEmergency
looking forward to introducing this at the
#ASC
@RCEMevents
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Bumped into
@ceribattle
on the bus from the airport to
#RCEMasc
and we planned more in chest injuries research 20 mins face to face than we have done in the last 3 years online. This is what conferences are about. Collaboration
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The beginnings of our
@NBTWellbeing
@NorthBristolNHS
Emergency Department Christmas Choir today. What a brilliantly refreshing way to let off steam
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How exciting, our RELIEF RCT of lidocaine plasters in elderly rib # is well underway with 3 patients recruited in 2 weeks
@ResearchNBT
and two more sites open
@jamesgagg
@robrien100
.
#NIHR
. Thanks to our excellent TM
@ALBrooks2015
@UoBrisBRTC
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Today was a good day, big grant submitted, big paper accepted and 250 up for the
@CoMiTEDTrial
. Best moment…watching my 10 year old step up to Under 13s cricket and get 3 wickets for 1 run 😁
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If live streamed across the world I would count this performance as an international presentation
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Had to do a year of internal medicine as an EM ST5 due to a quirk of training. In that year due to me being afforded time I fell into research and an academic career I’ve not looked back on. Not a waste of time, changed my life. Guess it’s how you look at training opportunities
I’ve just finished a year as an anaesthetic/intensive care registrar working in internal medicine. Looking back on it, it was a waste of time. 12 months of time. Some thoughts. 🧵(/12)
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When I get a dog, it will definitely not be allowed on the sofa...
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@BBCHughPym
Prof Carlton thinks the numbers won’t be “manageable” with current pressures on emergency departments
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Wow the randomisations are coming through for our RCT in frail patients admitted with rib fractures. Two recruits today at the same time 470miles apart from
@emerge_research
@DefProfEM
! Also sterling work from
@stgEDresearch
in the last few days. Only 20 to go!!
@crnwestengland
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The kind of feedback I need after a Monday late shift in ED courtesy of my 8 year old. Not sure about A but there is always something to reflect on and develop in all feedback we receive
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You learn something new everyday. Elephants 🐘 are the only mammals with no pleural cavity rendering them ineligible for
@CoMiTEDTrial
@Consept_Trial
@PrinceTrial
3 big trials investigating traumatic, primary and secondary pneumothorax. Do we need protocol amendments??
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important non-COVID research does still get published
@richardbody
@kiwiskiNZ
@louiseacullen
@RCollEM
@thomasmarsha11
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A proud dad moment today when my 9 year old got picked out for a bit of individual spin coaching with latest England spin sensation Shoaib Bashir. It’s these moments that inspire future generations
@ECB_cricket
@SomersetCCC
thank you!
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In our first couple of weeks of successful recruitment to the
@CoMiTEDTrial
in traumatic pneumothoraces we have seen everything: statisticians complaining humans have 2 lungs, surgeons crying anathema and above all fantastic patient engagement. Look forward to other sites joining
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If you thought UK Cauda Equina pathways were bad, take a look at this from Ireland. Please don’t call the spinal surgeon unless you have made them a cup of tea acknowledging their preferences (after documenting them on the time stamped proforma)
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50 recruited to the RELIEF trial testing lidocaine patches on older patients with rib
#s
. May not seem many but these are frail patients in pain in busy EDs. Outstanding work across all sites and well done to team
@jamesgagg
for this week.
@emerge_research
@DefProfEM
@frazdenny
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Comforting “hand” from Bert the tortoise for the Labrador who has eaten something she shouldn’t have done yet again and feels sorry for herself. When do they learn?
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All doing well now thankfully. Not a sympathy post (although he was worryingly unwell). More a reflection on personal expectations and inability to intervene outside of my everyday practice, with the fantastic support that affords. He got to the right place and had amazing care
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A few years work and a project I am passionate about. Engaging older injured adults in randomised trials.
Older patients with rib fractures remain under served. Thanks to all patients who participated in the RELIEF trial. Results paper just out
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Clinical academics: I would always caution against press releases at the beginning of studies. The next big thing invariably will have a specificity of 60%. I’ve done several studies now on novel biomarkers/technologies and companies have gone bust when they don’t perform well
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@gushamilton
Yes many questions indeed. The MPTS/GMC case for my friend has been removed since his untimely death. He was a good doctor. It is a sad inditement of the whole process
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@drsarahedwards
@RCollEM
@RCEMLearning
@EMTAcommittee
I failed the FRCEM Critical Appraisal exam and I now RCEM Professor 😂
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We still need a social care system that is fit for purpose, better working conditions for all clinical staff, improved staffing numbers etc. The discussion around this model somewhat detracts from this. As my inpatient colleague who will remain anonymous suggests:
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Our ED is now truly dementia friendly with these cubicle designs. Thanks to
@freshartsruth
@NorthBristolNHS
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@trishgreenhalgh
One of the biggest scandals of the pandemic was the decision to direct NHS staff to wear simple masks when looking after COVID coughing patients. Many have died as a result. Coughing is the biggest aerosolising procedure we face by far
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Of huge importance is the Exec buy in
@sphams
. They have been brave and welcomed a change that has been risk assessed. Wards and inpatient teams have supported and although have reservations, recognised the need to try something different. Good leadership is key.
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Why? We modelled admissions. This number of patients always goes to beds eventually during a 24hr period. However, they wait and go usually between 0000hrs and 0400. This transfer of a large number of patients overnight has huge resource implications for both ED and wards.
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7. These are rare events, it’s what we train on mannequins for. Mannequins and sim can never truly prepare for the things above. Remember to debrief all your team and reflect. Good luck
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By spreading transfers throughout the day reduces overnight pressures but does mean some double occupancy and bedded patients in unsuitable ward areas. We have seen no increase in MET calls or complaints (crucially)
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Very noticeable that there is a very valuable increased presence of research delivery teams (research nurses/AHPs) at the
#rcemasc
this year. Something I’d like to offer my team. How are others funding this?
@KCoatesBristol
@MissKerryLSmith
@EmmaGendall_
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Just spent 50 quid on bog roll to be delivered to my home, because it’s made from bamboo and has a cool wrapper. This is as result of COVID brain fog
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I’m always struck by the number of St Christopher necklaces I need to remove prior to a trauma CT
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Impressive work from
@stgEDresearch
and
@godalmingjarman
randomising 2 frail older patients with rib fractures. Getting research done on a Sunday. Improving care for patients
@ALBrooks2015
@DrPhilipBraude
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There are some brilliant uncelebrated people in this world. These amazing mentors from
@EmpireFightingC
help us make our
@NIHRresearch
emergency research relevant to our younger vulnerable patients. Their impact across the NHS is huge. Thanks so much
@CourtMaan
@CoMiTEDTrial
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First patient recruited to the LoDED trial today. Shaping emergency assessment of chest pain for the future
@NorthBristolNHS
@richardbody
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A patient is brought to ED, they have head injury, GCS10, found in the street. You guess they are around 80 years old. You know nothing more about them but they are wearing a wristband like this. Would you honour the wristband and would it effect your decision making?
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ED clinicians…patient with confirmed saddle PE radiologically, BP hovering around 95, looks “a bit ropey” but wouldn’t be jumping for thrombolysis. How much fluid you giving? Assume treatment dose clexane given
1 litre stat
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1 litre 4 hrs
193
500mls stat
686
I’m just thrombolysing
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Well isn’t this just fantastic! The TERN network has achieved so much in the last 5 years but it feels like it is all just beginning! Congratulations to EVERYONE involved
@mattreed73
@ExRCEMprof
@ExDefProfEM
@RCEMpresident
@ternfellow
"This unique recruitment approach resulted in one of the quickest and most successful recruitment periods we have seen in Trauma and Emergency Care."
🏆Congratulations to
@ternfellow
, winners of our Embedding research in health and care category!
#CRNWEAwards
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I was today years old when I discovered Moderna was a portmanteau of Modified RNA
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After a hiatus due to COVID, great to be restarting non-pandemic research with 2 participants randomised to
@CRYOSTAT_2
today!
@EmmaGendall_
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I wish the health secretary well but he clearly didn’t follow the guidelines around lateral flow testing. He felt symptoms and the did the test, meant for asymptomatic testing only. Should he resign for not following the rules?
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I worry that hospital and ICU admissions are the current metric to gauge NHS pressure. ED attendances with COVID will be underestimated. The system discounts/doesn’t record these but IF omicron milder likely to become hugely problematic in the next few weeks
@ShaunLintern
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A lot of EM bashing of this satirical post. I can confirm
@PMccoubrie
is a superb colleague. The only radiologist I work with who ventures into the department to constructively discuss cases. He may even understand pretest probability better than me (on occasion)
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When I was 16 my dear mum took me up to London to see the Wellcome Collection to convince me that I should apply to do medicine (I wanted to be a vet). It was a pleasure to go back there today for an excellent meeting 25ish years later knowing that I made the right choice
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As an emergency clinician I feel privileged to undertake clinical trials. So many clinical questions still need answering in our specialty. If you have an idea for a trial go to our mentorship page and get in touch
@NIHRresearch
@RCEMLearning
#ICTD2021
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This is amazing 🤩. CoMITED has definitely had challenges but the engagement of all sites (and indeed our willing patients) means we have a great chance of reaching or target. Can’t quite believe we have reached the 200 mark!!
3 patients recruited in Bristol over the weekend, including the first at
@uhbwNHS
! A big thank you to our teams
@ResearchNBT
@NorthBristolNHS
@Emmasiancarver
@VOriolo
👏🏼 this took us over the 2️⃣0️⃣0️⃣ milestone! 🙌🏼
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We have just had our record 24 hours for recruitment in the
@CoMiTEDTrial
with 5 from all around the country. That this happened in busy EDs over the weekend is a huge testament to our clinical teams embedding research into practice and improving patient care 🙌
Amazing work over the weekend from our CoMiTED site teams 🙌🏼🤩 what a run of randomisations!
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Ooh this is exciting, the first qualitative manuscript I have had a hand in-far more challenging than quantitative work. Great to see
@EmergencyMedBMJ
publish this open access and will be of interest to
@richardbody
@patricia_vdberg
@DrTomRoberts
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Ooo exciting…we are building a large team of Emergency Medicine academics in Bristol and are advertising for an Academic Clinical Fellow post. Details on Oriel. Do get in touch with me for q’s about the role and projects. Come and join
@REACHBristol
@DrTomRoberts
@ternfellow
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Who knew you could reference Tweets in high impact medical journals? 🤣
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After some discussions about the potential for geriatricians to be involved in pre-hospital decision making in trauma, I asked AI to generate an image and I wasn’t disappointed
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Wow, quoted in an
#rcemasc
keynote from the excellent RCEM Professor
@mattreed73
. I feel like Gandhi
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A very rewarding chat with one of our amazing
@CoMiTEDTrial
PIs today
@EmergencyHull
. From beginning the trial with almost no research capacity they are now looking at weekend research nurse provision in ED. Great to hear about improved capacity to deliver research in EDs
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How you all managing this? Isolated chest injury. GCS 15, Sats 96% in air, physiologically normal. Poll below
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The biggest risk is not inpatient safety. It is that this model of care has been a necessity at north Bristol to patch over the wider issues in the NHS.
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Slowly making friends. The young eager emergency physician versus the old and wise ologist tortoise (who has just woken up from the winter of discontent)
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A rare manuscript writing day with nothing else in the diary. Nearly 1100, dog walked, 3 coffees, washing hung out…the writing shed remains locked and not a word written
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First visit to London in 3 years (!) today to explore traumatic pneumothorax management
@CoMiTEDTrial
. Thanks for hosting
@BartsEDresearch
@Raine_A_C
@drbenbloom
. Thanks to
@karimbrohi
@rossdavenport
@martinpgriff
for listening to me rabbit on about challenging current practice
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Absolute scenes in the RELIEF trial as Glasgow take a 4-2 lead over Edinburgh! Recruiting amazingly in all sites!
@emerge_research
@djlmed
@mattreed73
@robrien100
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@coffeeheadaches
We were advised on survey that our velux window had been installed the wrong way round. Asked vendors to fix it and they said they did. Turns out they just turned the velux sticker around 🙃
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LoDED will be done by Christmas at this rate. Fantastic work by all sites
@DefProfEM
@NoPacStudy
@richardbody
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You learn many things examining PhD vivas that are slightly outside of your expertise. Who knew that the LUCAS device stood for Lund University Cardiopulmonary Assist System?
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