Top tips for a teaching fellowship.

BACKGROUND: Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers. Within the seven hospital trusts that host students from the University of Bristol there are now 19 clinical teaching fellowship (CTF) posts. On starting a dedicated medical education post, the opportunities available can seem overwhelming, and on reflection many of the local 2012-13 CTFs would have changed their initial practice. The purpose of this article was to explore and collate the experiences of CTFs to produce a selection of practical 'top tips'. METHODS: A questionnaire was sent to all 19 CTFs via e-mail, asking them to state what they would do the same and what they would do differently if they had their time again. Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers RESULTS: Eight themes were drawn from the 13 (68%) returned questionnaires, with each theme mentioned between four and 11 times. The themes included: keeping a portfolio of evidence; personal development; undertaking educational research; developing as a clinical teacher; and administration. CONCLUSION: Our aim for this article was to generate practical top tips for those doctors considering, about to start or having just commenced a dedicated teaching role, helping individuals to get the most from their time. It also explains what these teaching fellowships can involve, and gives those thinking of undertaking a dedicated teaching role a better idea of what to expect.

Is lidocaine Bier's block safe?

OBJECTIVES: To assess the safety profile of lidocaine Bier's block when compared with that of prilocaine. METHOD: A retrospective audit of patients undergoing Bier's block using 0.5% lidocaine during a 27-month period (April 2008-June 2010) at the Royal United Hospital Bath emergency department. RESULTS: 416 patients with sufficient data were included in the study; 360 women and 56 men. The mean patient age was 65 years. Complications were reported in 39 cases; transient hypotension/vasovagal episodes and transient mild bradycardia were most frequent. No patients required any medical intervention. There was no occurrence of anaphylaxis, convulsion, hypotensive episodes requiring medical intervention, collapse or death. CONCLUSION: No clinically significant morbidity or mortality as a consequence of lidocaine Bier's block was demonstrated in this audit.

Emergency department-focused thrombolysis for acute ischaemic stroke.

Acute ischaemic stroke (AIS) is a leading cause of death and disability. Until the 1990s early intervention in AIS was limited to prevention of secondary brain injury. Early thrombolysis has now become standard practice in many areas of the world. Despite the evidence of benefit, the lack of good alternative acute treatments and the recent shift in political focus to stroke management, a thrombolytic strategy for AIS has been very slow to develop in the UK. In this paper, the successful introduction of thrombolysis for AIS through the development of an emergency department-focused process is reported. Obstacles to service development and ways to overcome these are discussed and this therapeutic process is demonstrated to be both possible and self-sustaining in most UK hospitals.

Anaesthesia for arterial puncture in the emergency department: a randomized trial of subcutaneous lidocaine, ethyl chloride or nothing.

OBJECTIVE: To determine whether the use of ethyl chloride and subcutaneous lidocaine are associated with a reduction in pain during arterial blood sampling compared with using no local anaesthesia. METHODS: Patients over the age of 16 years and who required arterial blood sampling as part of their on-going emergency department management were randomly allocated to one of three groups. Group A received routine skin preparation before arterial puncture (AP); group B received 0.5 ml of 2% lidocaine 2 min before AP; and group C received ethyl chloride immediately before AP. Pain was measured using 100-mm visual analogue scale. SETTING: Two urban emergency departments. RESULTS: Fifty-four patients were recruited. Those receiving lidocaine before AP had lower pain scores [10.2 mm, 95% confidence interval (CI): 4.8-16.3 mm] compared with the use of ethyl chloride (23.9 mm, 95% CI: 12.4-35.5 mm) and nothing (23.4 mm, 95% CI: 11.7-35.0 mm). Lidocaine was more painful to administer (22.0 mm, 95% CI: 10.9-33.7 mm) compared with ethyl chloride (12.9 mm, 95% CI: 5.5-20.3 mm). CONCLUSION: Ethyl chloride is not an effective local anaesthetic agent for AP. When the pain of local anaesthetic administration is taken into account the benefit of subcutaneous lidocaine for single AP is limited.