EDGovCast Episode 14
Can Patients Record Consultations? + Pancreatitis & Paediatric Cases
Adult Section
1. Information Governance – Recording Consultations
Discussion on legality and ethics of patients recording consultations in ED.
●Scenario: Patients using mobile phones to record interactions with clinicians.
●Key Points:
●Patients can legally record consultations (even without permission)
●Helpful for recalling complex or distressing information
● Limitations:
●❌ Cannot record other patients or shared areas
●❌ Must not breach confidentiality
● Clinical Practice:
●Maintain professionalism at all times
●Consider encouraging recordings for complex discussions
● Mobile Phone Use:
●✔️ Appropriate: clinical apps, guidelines
●✔️ Secure photography with consent
●❌ Inappropriate: personal storage or informal images
● Further Reading: BMA: Patients recording consultations
2. Handlebar Injuries in Children
RCEM Safety alert on serious internal injuries following handlebar trauma.
●Clinical Issue: Blunt abdominal trauma in children from bicycle handlebars.
● Clinical Evaluation:
○Risk of occult intra-abdominal injury
○CT may initially be normal
● Action Taken:
○Serial examinations
○Low threshold for admission
○Consider repeat imaging
● Outcome:
○Early recognition prevents delayed complications
● Further Reading:Safety Flash: Handlebar Injuries in Children - RCEM
3. Death Certification & Medical Examiner System
Update on UK death certification reforms.
●Background: Prompted by failures including Harold Shipman
● Key Chanes:
○Mandatory Medical Examiner review
○Expanded death certificate (1A–1D causes)
○Pregnancy status included
○Cremation forms removed
● Clinical Practice:
○ED clinicians should understand local processes
○Expect discussion with Medical Examiner
● Outcome:
○Improved scrutiny and family support
4. Sustainability in ED (Green ED Project)
Improving environmental sustainability in emergency departments.
● Key Points:
○Clinical waste significantly more expensive than recycling
○Small changes can have large impact
● Action Taken:
○Better bin placement
○Staff awareness
● Outcome:
○Reduced costs and environmental footprint
● Further Reading: RCEM Green ED
5. Case Study – Severe Pancreatitis with Respiratory Failure
A complex diagnostic case highlighting systemic effects of pancreatitis.
●Case:
○Elderly patient with abdominal pain and severe hypoxia.
○Broad differential (PE, perforation, sepsis)
○Raised amylase
○CT: early pancreatitis, no PE
● Pathophysiology:
○Inflammatory cytokines + enzymes → lung injury (ARDS-like)
● Action Taken:
○Full body imaging
○ICU escalation
○Supportive care
● Outcome:
○Patient deteriorated despite appropriate management
● Key Learning:
○Pancreatitis can cause severe respiratory compromise
○Imaging may be subtle early
○Escalation appropriate even in complex patients
6. Quality Improvement – Defining the Aim (QualityQuest)
Introduction to QI principles by Dr Sarah Noble.
●Concept: Start with: “What are we trying to achieve for the patient?”
● Example:
○❌ Solution: “Add ECG station”
○✅ Aim: “ECG within 15 minutes for chest pain”
● Tools:
○Fishbone diagram
○Pathway mapping
● Key Learning:
○Avoid jumping to solutions
○Use SMART aims but keep them patient-focused
Paediatric Section
7. Medication Error – Magnesium Sulfate Overdose
Illustrates risks of dosing errors in paediatric emergencies.
●Case: Child received 20g magnesium sulfate instead of correct dose.
● Clinical Evaluation:
○Flushing observed
○Error recognised early
● Action Taken:
○Supportive management
● Outcome: Full recovery
● Key Learning:
○Double-check doses
○Be cautious with prescribing errors
○High-risk drugs need vigilance
8. Paediatric Burns & Transfer Issues
Challenges in managing severe burns and appropriate transfer.
●Case:
○Child with circumferential burns and systemic illness.
○Acidotic and deteriorating
● Action Taken:○Early fluids
○Transfer attempted
○Diversion required due to lack of PICU
● Outcome: Delayed but appropriate transfer
● Key Learning:
○Ensure burns centre has PICU capability
○Plan transfers carefully
9. Septic Child – Escalation & Airway Management
Management of critically unwell child with sepsis.
●Case:
○Severely unwell child (likely Strep A).
○Rapid deterioration
● Action Taken:
○Early escalation
○PICU involvement
○Consideration of intubation
● Outcome:
○Appropriate management and escalation
● Key Learning:
○Intubation may be part of treatment
○Use PICU support early
○Training and simulation are essential
10. Seasonal Paediatric Reminder
Increase in winter respiratory illnesses.
● Key Points:
○Rising cases of:
■Bronchiolitis (RSV)
■Viral-induced wheeze
● Action:
○Review local pathways
○Know admission criteria
