ICU registrar refuses to assess patient for intubation for CT

• 23yo brought in by ambulance with unknown ingestion of drugs + alcohol - now obtunded, snoring, vomiting - want to intubate for CT scan
• ED SHO was very vague about what exactly happened
• ICU reg thought should give naloxone first, not an intubation service
• Apologises and clarifies details of patient + indication for intubation

Orthopaedic registrar refuses to assess patient with back pain

• 65yo with back pain, lost feeling of rectal fullness and post void bladder scan 300ml
• why can't ED manage MSK back pain? sciatica can also produce some focal neurology in lower limb. doesn't consider 300ml to be really 'retention'
• wants ED to do PR examination first
• point is to emphasise not just focal neurology but risk factors for CES; reduced anal tone while part of ASIA score is a late sign and not part of the GIRFT guidelines
• seeks compromise by helping to arrange MRI?

Gynae registrar refusing to see young female patient with abdo pain

• 25yo with sudden onset LIF pain, normal bloods, urine dip normal, pregnancy test negative, has had oramorph/para/PR diclofenac - still in pain
• wants surgeons to see first
• LIF sudden onset pain referred as ?torsion - severe pain - says otherwise stable, if surgeons are happy, GP can refer to gynae OPD
• insists that ED has not given enough analgesia
• Gynae reg stressed - lots going on in maternity and inexperienced SHO
• emphasise that torsion like testicular torsion is time-sensitive and poorly picked up on imaging