In this inaugural episode, we introduce the ED GovCast team and share our mission.

To make the content of Emergency Department Governance meetings accessible, understandable, and useful to all staff.

• Governance is at the heart of how we continually learn and improve to provide the highest standard of patient care.
• We are committed to continuous learning and improvement to deliver excellent patient care.
• By reviewing and reflecting on Datix incident reports, we take proactive steps, implement changes, and communicate effectively.
• Our goal is to empower all staff to be actively involved in driving positive change across the department.

• Presentation:

• Bilateral facial nerve palsy and erythema migrans (target lesion)

• Management: 

1. Start antibiotics if clinical suspicion is high, especially if rash is present.
2. If no rash, request ELISA test for confirmation.

• Symptoms: 

• Chest pain, abnormal ECG with T wave inversions (pathological for age).

• Differential diagnoses included: 

○ Myocarditis ○ Endocarditis ○ Wellen’s Syndrome. 

• Key investigations: 

• Echocardiogram, Cardiac MRI and a cardiology referral. 

• Hypertrophic Obstructive Cardiomyopathy (HOCM).

○ Exposure to potential allergen.

○ Sudden, rapid-onset progressive symptoms.

○ Compromise of airway, breathing, or circulation, ± skin/mucosal or GI symptoms.

○ First-line treatment is IM Adrenaline, per Resus Council guidelines.

○ Steroids and antihistamines are not substitutes for adrenaline.

○ Manage in Resus; escalate early to senior staff.

○ Watch for Refractory Anaphylaxis: Defined as no improvement after 2 doses of IM adrenaline → Consider adrenaline infusion.