Dr. Damian Roland (@damian_roland) - #FOAMed supporter

EM isn’t child’s play when it’s Emergency Maths

In FOAMed, Medical Education on August 27, 2014 at 6:10 pm

New starters to paediatric wards, emergency departments and general practices around the country are faced with a huge array of formulas and equations to navigate. Most are relatively simple and require only a basic revision of multiplication tables. However some calculations are required in a time critical manner and anyone experienced in treating children knows how easy it is to make mistakes. In resucitation situations there may be many drug doses to calculate using some medications which may not be frequently used by the person prescribing them.

Given paediatric pharmacy is a very ‘mass’ based subject prompt calculation of weight is an essential first step. The traditional approach taken is that advised by APLS courses:

Weight 0 -1 = (Age/2)+4

Weight 1 -5 = (Age x2)+8

Weight 6 -12 = (Age x3)+7

There is a great blog from Simon Carley on the introduction of three equations rather than just one and the problems this may cause. The key point being does having three forumula increase complexity, and therefore risk of error, especially given we aren’t really sure what amount of difference in weight is clinically significant?  Other mechanisms of calcuating weight do exist, the broselow tape for example, but I especially like this one via Dilshad Marikar

(2010 APLS weight estimation) – Talking to the hand from Paediatric Tools on Vimeo.

The Leicester Hospitals Emergency Department have been working for sometime on a drug calculator for use in Emergency Situations. I’m very grateful to Dr. Mike Pearce, Dr. Mark Williams and Dr. Steve Corry for their hard work on bringing this to fruition. In the spirit of ‘FOAM’ we are sharing our efforts, not because we think it is any better than other systems out there, but because we are sure improvements can be made.

Drug Calculator

It can be downloaded by clicking LRI Paeds Drug Calculator v1.4. It’s been extensively tested and has the approval of our senior paediatric pharmacist. As with all such calculators we can not accept responsibility for its accuracy or ensure its currency.

Please let us know what you think via comments, @damian_roland or @em3foamed

What I learnt this week: #Everybodycounts – really everybody does! #WILTW

In #WILTW on August 22, 2014 at 5:52 pm

This is the fourteenth #WILTW

The story is told of how President John Kennedy once visited NASA. He came across a cleaner and asked him what his job was. The cleaner replied: ‘My job is to help to put a man on the moon.’

This is an oft quoted story which may not be based in truth. It does emphasise an important point, however cheesy, that knowing your value to an organisation is very important. The Emergency Care pathway involves patients from the moments they become unwell, onto health seeking behaviour, to urgent or emergency care settings, into hospital and then back into the community. Although ‘Emergency’ makes people instantly think of  the Emergency Departments role; we are only one part of the puzzle.

Everybody Counts

Leicester Hospitals have just launched #everybodycounts. A campaign to energise staff to improve and celebrate the care we provide for patients who receive emergency care wherever they are on the pathway. A few videos have been released demonstrating the little things that can be done to improve the quality of care provided (I apologise to Kate Granger for mistaking Leeds to be in the “North-West”).  It’s deliberate we have a nurse, junior doctor, and play specialist all contributing – they are all part of the process. In fact in some respects they are far more important  than the consultants and matrons who set strategy.  It is the hands on, patient facing, staff who will be the arbitrators of patient experience, quality of care and delivery of standards.


I have written previously about how anyone can make simple mistakes on obvious tasks that demonstrate compassionate care. And it is the same simple things, performed by any member of staff, that can brighten up a patients otherwise miserable day.

#everybodycounts – all the time, every time.

What did you learn this week ? #WILTW

What I learnt this week: Organisation is more than files and folders #WILTW

In #WILTW on August 15, 2014 at 10:36 pm

This is the thirteenth #WILTW

Effective time and administrative management is vital in any leadership position but when part of your job role takes you away from the ‘office’ for potentially significant parts of the working week it becomes even more important. In clinical medicine managing your time away from the shop floor is therefore a vital skill. Although this is becoming increasingly recognised in training programmes, it is still the case that very little time is spent on training health care professionals how to be more efficient and effective in administrative tasks. The Academic Life in Emergency Medicine series: How I work smarter provides some brilliant tips and techniques in this regard. Since writing some of my own thoughts on this subject I have been mulling over how efficient I actually am.

One of the things I have always aimed to keep on top of is my file and folder system, both on my work desktop and home laptop.

Desktop Crowding


That is not a picture of my desktop…. But I do start to get nervous when files start to pile up. One of the light bulb moments I had this week was how much time I was potentially wasting trying to be organised. 

One of the very worst uses of time is to do something very well that need not to be done at all.”- Brian Tracey

Just a small reminder of the ongoing learning that being a new consultant has brought with it. 



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