If you’ve pressed this button the answer is almost certainly “YES”
Please note that after 5am the consultant on for the coming day should be contacted.
If you are unable to contact the on call consultant you should contact the consultant that is on call for the next day.
All FACEM’s are happy to be consulted about any patient/ aspect of management you are concerned about.
If you are ambivalent or feel like you should be able to do this on your own, keep this in mind: the ICU/HDU Trainee calls the Intensivist after every ED referral. If any patient needs to go to the Operating Theatre afterhours the Surgical and Anaesthetic trainees speak to their bosses (who attend the case in person).
If you have a patient that is a vexing case for an emergency medicine trainee or RMO at 3am or 3pm and you’re worried - speak to your consultant - like every other capable trainee does. Just get their advice if you feel like you need it, you won’t regret it. Its better that the FACEM knows there is an issue early, so that if the situation deteriorates you are both cognitively primed to deal with it.
Provided below are specific scenarios we recommend you discuss the case with the FACEM overnight.
1. Shocked patient that you are considering giving inotropes.
2. Airway threat or compromise.
3. Patients that you are considering intubating or have intubated.
4. Patients that you are considering contacting retrieval about or have already contacted the retrieval service about, including referrals from other centres that may need retrieval.
5. Patients with a persistently elevated lactate (greater than or equal to 4) that are requiring ongoing resuscitation in which the cause is unclear
6. Trauma patients with haemodynamic or respiratory instability.
7. STEMI that has not been accepted for primary PCI at JHH.
8. Any critically unwell patient without a definitive management plan or not improving.
9. Any paediatric patient that you have concerns about or with observations outside their age appropriate SAGO chart guide and that are not improving within 1-2 hours
10. Significant logistical issues that arise i.e. unable to make contact with speciality registrar/ services, unexpected management decisions made by teams you are referring to if the decision is not in line with what you believe is the most appropriate management for the patient. i.e. GIH not accepted for urgent transfer.
The staff specialist needs to be notified of any deaths occurring in the department after hours. It may be appropriate for this notification to happen in hours (e.g. expected death in patient being palliated).