Dr Will Duffin

That feeling when you jump off the boat at !

A patient collapses in the doorway and has a seizure. Another comes to the front desk with central crushing chest pain. Then a concerned mother asks you to look at her drowsy newborn with a non-blanching rash…. 

With overstretched ED’s and ambulance services we are seeing a lot more urgent and emergency presentations at GP surgeries. 

What makes these ‘Waiting Room’ Emergencies so challenging? 

Well, we’re not really geared up for them….

🤷‍♂️ We’re using the emergency kitbag from the cupboard that few in the practice are familiar with. 
🧐 There is massive skill fade of acute skills, which are rarely deployed in day to day general practice
🤨 There’s generally a lack of dedicated processes and systems to treat these patients, we’re caught off-guard.
🤯 A ‘flash team’ of forms around the patient, who have not worked together in this context before. 
😳 The whole time you’re dealing with the situation, the routine work continues to build up, only adding to the pressure….

I put together a training session for the skilled and dedicated staff at Ide Lane Surgery. We worked through some of these HALO (High Acuity, Low Occurrence) presentations, reviewing up to date practical guidance followed by hands-on rehearsal through low-fidelity, in-situ simulation in the practice waiting room using the live emergency kit bag. It was great to see everyone get stuck in, particularly the vital role provided by non-clinical staff (practice receptionists and secretaries). 

If this is the kind of training your practice team would benefit from, please ping me a message

Thankyou for inviting me to upskill your paras on common skin conditions in primary and urgent care today. We had a blast!

Key take homes from today:

1. To the untrained eye all rashes (skin eruptions) look the same
2. Even to the trained eye they often still all look the same!
3. Nonetheless, dermatology is a fascinating and rewarding sub-specialty - the skin is truly a ‘window’ into the human body, rich with diagnostic clues.
4. It’s a massive skill gap for so many generalist clinicians, and a bit of knowledge can go a long way including
-The early recognition of skin cancer can be truly life saving in melanoma.
-Good quality, primary care level management of common inflammatory dermatoses like eczema and psoriasis is a lifeline for patients whilst there are long waits for secondary care.
-We should never under estimate the impact that chronic skin conditions can have on quality of life, mental health and overall wellbeing. Simple interventions (including topical emollients and steroids) done well can be transformative.

Last night I hosted the Annual Journal of Wound Care Awards at the Imperial War Museum in London: a celebration of the incredible and often hidden work being done by community nurses, tissue viability, podiatrists and industry innovators for patients with chronic wounds. Receiving one of these awards is a big deal, and it was humbling to greet these dedicated professionals on stage. To kick things off, I reflected on some of the wound care challenges I’ve had as a jobbing GP, caring for both NHS patients in the UK as well as reality TV show contestants overseas!

Shout out to mens tailoring for kitting me out with a banging velvet Tux!
For speaking/hosting enquiries please contact [email protected]

Here’s a still from some really fantastic simulation training with James, Steph and the team at Code Red Training in the Centre. I attended on behalf of

First responders on scene. Two casualties - we split into two teams. Here was the handover (on patient 1) when further help arrived:

32 y/ro female, 

Mechanism
cyclist vs car at pedestrian crossing - head on impact @ approx 40mph.

Injuries
-Presumed c-spine and head injury. 
-Blunt trauma to abdomen
-Open book pelvis #
-Open R femoral fracture. 

Signs/ symptoms. 
-No external haemorrhage
-Airway patient
-RR 24, Sats 96 on air, no visible chest wall trauma. 
-Clinically shocked, radial pulse 130, thready, pale and peripherally shut down.
-Pupils equal and reactive. Responding to Pain

Treatment given
-High flow oxygen running
-T-pod pelvic binder
-R Femoral traction splint and exposed bone ends covered. 
-Trauma naked skin-scoop plus blizard blanket. 

Some key learning points: 

Gain full 360 access early - move car back/pull out from car - ensure scene safety (handbrake/chocs under wheels etc). 

Expose to fully assess but also early use of blizzard blanket - trauma patients who get cold can’t clot properly, become acidotic and hypocalcaemia and have much worse outcomes (trauma diamond of death). This casualty got very cold! 

Management of bystanders - delegate wherever possible (i.e. calling ambulance), taking the c spine, crowd control etc. 

Maintain structured approach with clear roles in 2-operator response team - one operator making initial assessment using MARCH here rather than CABACDE but they’re broadly similar), whilst the other exposing the patient, applying oxygen, monitoring, gaining access etc. 

Simulation is a such a valuable tool to drill skills under stress!! Practice doesn’t make perfect but it does (eventually) make perment!

Code Red Training are running a Trauma CPD day on 9th April in Bristol! Definitely worth checking out: https://www.coderedtraining.co.uk/

End of day 1 of the conference!! Bottling that energy elixir in selfie form
.m.grange .hannaford_adventurer

I was honoured to be invited back to Buckfast Abbey to deliver another two hour seminar on Self-Leadership and Careers that Break the Mould to the Next Gen GP Group of primary care leaders.

We explored the concept of developing your inner game of intention, self-awareness, self-confidence and self-efficacy that is the precursor to a strong outer game of influence and impact!

Filming on location today in the stunning with and . We had some fun out there! 🤵‍♂️😎☀️☀️☀️

We don’t inherit the earth from our ancestors, we borrow it from our children.

‘The future belongs to those who believe in the beauty of their dreams’ -Pierre Teilhard de Chardin

Make them believe it too.

Thanks for the pics

Selfie time! Not often you get to do a presentation with the massive biomes of The Eden Project as the backdrop! Urgent Care Course in Kernow!