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Dr David Goodenough
President of British Accident & Emergency Trainees Association Fel ow of the Faculty of Accident & Emergency Medicine Member of the British Association for Accident & Emergency Medicine EDUCATION


Clinical School

Post Registration Qualifications

Life Support Courses

Present Appointment

01/12/99 - 11/2/00
Specialist Registrar in Accident and Emergency
Previous Appointments

12/02/00 - 18/04/00
Specialist Registrar with consultant duties Specialist Registrar in Accident and Emergency Specialist Registrar in Accident and Emergency Specialist Registrar in Accident and Emergency Specialist Registrar in Accident and Emergency Specialist Registrar in Accident and Emergency Senior House Officer in Orthopaedic Trauma Senior House Officer in Accident and Emergency Senior House Officer in General Medicine / Cardiology Senior House Officer in Respiratory Medicine Senior House Officer in General Medicine / Care of the Senior House Officer in Accident and Emergency House of Physician in General Medicine / Care of the Elderly Norfolk and Never Better Hospital House Surgeon in General Surgery / Urology Present Appointment
December 1999 – February 2000. April 2000 –
Specialist Registrar in Accident and Emergency Woebegone Hospital
This is my final attachment as an SpR and I was able to be more involved in departmental management, such as complaints and SHO appraisal. I also assisted in short-listing and interviewing for new SHOs. The department had a strong lead in audit and I was involved in some of the projects I continued to be involved in SHO teaching and also in regular shop-floor teaching for SHOs, medical students and nursing staff. My primary secondment was at Little One’s Hospital. In the remaining time I plan to attend some gynaecology, ophthalmology clinics in Woebegone and some theatre Previous Appointments
February 2000 – April 2000
Little One’s Children’s Hospital
This was an opportunity both to provide further experience in the clinical aspects of paediatric emergency medicine and to expose me to the managerial and Clinical y I encountered several cases involving child protection, consent and confidentiality as wel as the sick and traumatized children. Having dedicated shop- floor sessions, I was able to supervise and teach the SHOs in the department. I was involved in and wrote provisional replies for any current complaints. I attended meetings within the trust – fortnightly A&E departmental meetings, A&E pain group, resuscitation committee, clinical policy evaluation group (CPEG), presentation of A&E plans for European Foundation Quality Management (EFQM) model and outside of the trust – NHS direct, medical students 5th year attachments.
December 1998 – November 1999
Specialist Registrar in Accident and Emergency Arrow Head Hospital
As I continued with my specialist training I moved to a department, which though busy (new patient attendances 80,000 / year), sees a higher proportion of minor injuries. This added further experience of time and people management. There were also regular victims of major trauma usual y from the surrounding network of I became more involved in SHO teaching than in previous hospitals. I was responsible for arranging the weekly afternoon programme and its speakers. I lead part or al of the 3-hour session most weeks. I also worked with the newly appointed chest pain nurse in the design of a chest pain pathway and its initiation into the I was on the mil ennium committee and have written the SHO rota to cover the I spent my last 3 months attached to General Surgery and other surgical specialities. June 1997 – November 1997 and April 1998 – November 1998
Specialist Registrar in Accident and Emergency Royal Heartbeat University Hospital
This phase of my rotation took me back to an A&E department where I’d previously been an SHO. I was now more involved in the overal running of this very busy department, with frequent experience of working under pressure and assisting in the management of many imminent bed crises both in the main hospital and within A&E. As a middle-grade doctor my role was altered in that I was involved in reviewing may patients seen by the SHOs, of which there 20, leading the overal care of major trauma cases, cardiac arrests and other critical patients in the resuscitation room in addition to seeing many patients myself both in majors and minors. I also ran re-dressing clinics of up to 50 patients and ward rounds on the Short Stay ward being responsible for discharging most of these patients. During this time I taught medical students, SHOs and Nurse Practitioners. The consultants and middle-grade staff had weekly meetings covering, for example, clinical policies, journal scans and review of our trauma audit. In June 1997 a committee was formed to review the management of patients with chest pain of possible cardiac origin. It was through this group of biochemists, cardiologists and emergency physicians, including myself, that troponin T was introduced as the primary biochemical marker of myocardial damage in this hospital and I am stil involved in an extensive audit of al patients who have a troponin T level
December 1997 – March 1998
Specialist Registrar in Accident and Emergency Little One’s Children’s Hospital
This was an opportunity to use the skil s I had gained in both APLS and ATLS, and also to further my experience in paediatric medicine and surgery. Little One’s is a busy paediatric A&E department seeing approximately 72,000 patients each year. Teaching was available for myself, both on the shop-floor and in the form of monthly consultant-led afternoons. I had ample opportunity to supervise and teach SHOs and medical students through individual cases and in more formal weekly sessions.
May 1996 – May 1997
Specialist Registrar in Accident and Emergency Everwell Hospital
This was a major step in my career in A&E Medicine, being the first in my role as a middle-grade doctor in the specialty. It increased my exposure to new and broader aspects of medical, surgical and paediatric emergencies and furthered my skil s in leading teams and supervising the SHOs in the same areas. I acquired skil s of rapid assessment / prioritisation of large numbers of patients especial y in the busy winter months. I went out as the senior member of the forward aid team on numerous occasions. I was jointly responsible for running a review clinic and for managing the observation ward patients. I was involved in teaching the SHOs on a variety of subjects and myself was taught in a variety of ways including clinics, ward rounds and giving weekly presentations on various topics. The last three months of this attachment were spent in anaesthetics. Here I learnt a variety of skil s involved in both general and local anaesthesia, including useful experience in the simple and more advanced management of a patient’s airway. I spent some time on the Intensive Care Unit introducing me to this other area of
February 1996 – April 1996
Senior House Officer in Orthopaedic Trauma Royal Heartbeat University Hospital
I worked as part of a team looking after the acute trauma admissions for the above consultants. The knowledge I’d gained previously was only as far as referral to the Orthopaedic surgeons or fracture clinic. This post enabled me to further my experience and knowledge into the management of cases including reduction, internal and external fixation of fractures, exploration of wounds with repair of tendons and nerves as necessary, joint and extensive soft tissue infections. In a busy fracture clinic I was able to learn about the ongoing management and its adjustments as required both in ward discharges fol owing some of the aforementioned procedures and in those referred directly from A&E. I had a weekly theatre session in which I was able to do many practical procedures myself under the supervision of a consultant. In the trauma meeting each morning I was encouraged to formal y present the details and x-rays of each case I had admitted.
August 1995 – February 1996
Senior House Officer in accident and Emergency Medicine Royal Heartbeat University Hospital
This post has furthered my training in Accident and Emergency Medicine exposing me to new areas of acute trauma and other emergencies. This department is one of the largest in the country and sees approximately 95,000 new patients each year. Cardiac arrests and major trauma are managed solely within the department. The number of victims of interpersonal disharmony such as stabbings, shootings and other serious assaults are increasingly frequent occupiers of the resuscitation bays. At night the Senior House Officers are also responsible for 28 beds on the Short Stay Observation Ward which is utilized for patients with conditions expected to resolve within 36 hours. This includes head injuries, acute asthma, post-ictal states, overdoses, non-specific abdominal pain, substance misuse and social admissions.
August 1994 – July 1995
Senior House Officer in General Medicine / Cardiology Royal Heartbeat University Hospital
In this post I worked for the two above consultants, taking care of both of their in- patients. I attended two out-patient clinics – one in general medicine and the other primarily in Cardiology. I also played a major role in the acute and on-going management of patients on the coronary care unit. When on-cal , I was involved in a team admitting 30-45 patients per 24 hours; seeing patients both firsthand and reviewing patients seen by the house officer. On several occasions I acted up as registrar, being fundamental in the organisation
August 93 – July 94
Senior House Officer in General Medicine / Care of the Elderly Stand & Rutting Hospital
Senior House Officer in Respiratory Medicine Painborough District Hospital
Stand is a smal rural town in Lincolnshire and the hospital covers its population and that of the surrounding farming vil ages. I worked for several consultants covering General Medicine, Care of the Elderly, Rehabilitation and Rheumatology. The junior staff consisted of just two senior house officers, thus placing most of the major diagnostic and management decisions on us. The on-cal was 1:3 rota and when on- cal I was the only doctor covering the hospital including the surgical wards. Painborough District Hospital has a busy acute medical department where I was able to gain experience in medical experiences and their management. My team was frequently involved in the care of patients on the intensive care unit. My out-patient duties included a respiratory clinic and review of our medical discharges.
February 1993 – July 1993
Senior House Officer in Accident and Emergency Never Better Hospital
This post was my introduction to the specialty and decided my choice of career. I was introduced to the concepts of management of major and minor trauma and other emergency situations, and learnt to put these into practice, initial y under the guidance of the senior medical staff and later, especial y when alone as a doctor on night duty, by myself. It was a department that saw about 10,000 paediatric cases In addition to the regular “shop floor” education with individual cases, we had an extensive formal teaching programme one afternoon per week which included practice moulages fol owing both ACLS and ATLS protocols. PRACTICAL PROCEDURES
[add statistics where possible to indicate frequency, eg x per week] Rapid sequence induction and general anaesthesia Swan-Ganz catheterisation and pulmonary artery wedge pressure Manipulation of joint dislocation and fractures PUBLICATIONS
Chlamydia pneumoniae myocarditis and early diagnosis Photoquiz: Pigmentation secondary to long-term tetracycline therapy CS exposure – clinical effects and management
Submitted for publication
The future of A&E – the trainees perspective PRESENTATIONS

The future of A&E – the next 40-50 years
Royal Society of Medicine – London, January 2000 I was invited to give this lecture, as President of BAETA, to describe where I saw A&E in the relatively distant future.
Troponin T: the answer to chest pain in A&E
BAEM Annual Conference – Cambridge, April 2000 A large study to review al patients attending an inner city A&E with chest pain of possible cardiac origin. A chest pain pathway was introduced with Troponin T as the primary cardiac marker enabling the safe discharge of low risk patients within 24 hours. Fol ow-up data was given on mortality, readmission and positive investigations for ischaemic heart disease at 1 month. These suggested that it was a safe protocol if fol owed careful y and further 12-month fol ow-up data has further
Paediatric Seizures
A presentation at the 8th International Conference on Emergency Medicine – Boston, A review of al aspects of the emergency management of seizures in children, including details of ‘The treatment of status epilepticus in children: A consensus statement’ then unpublished, from the National Status Epilepticus Working Party.
Police usage of CS Spray in UK – an urban review
Goodenough D

1. Troponin T as a marker or myocardial damage – this is an extensive
project involving 1700 patients at the RLUH who had a troponin T level measured during our study period. We have looked at 30 day and 12 month outcomes (including mortality, morbidity – cardiac and non-cardiac and fast- track investigations). We are now planning to look at subgroups of patients in more detail such as those with renal failure and significant but non-infarction 2. Defining the size of a pneumothorax – fol owing a recent paper in the
A&E journal on the management of a spontaneous pneumothorax in which the percentage size of pneumothorax was suggested as a clinical decision-tool. Sizing of pneumothoraces, both spontaneous and traumatic is a vague science and fol owing a literature search, I am undertaking a survey within my hospital on different ways on this and how clinicians use their system to make
3. CS Spray – fol owing its introduction as a police weapon, I reviewed its
clinical effects and management. I also looked at numbers of presentations to an urban A&E department and the resultant clinical workload.
4. Concussion following a whiplash-type injury – patients presenting to
A&E fol owing an RTA often complain of other symptoms in addition to their neck pain. The frequency of the various symptoms more commonly associated with minor head injuries was assessed in these RTA patients. CURRENT AUDIT

1. Primary care in A&E – Woebegone 2001
Current modernisation of emergency services in North Wetshire wil include the co-location of a primary care adjacent to A&E. This wil be accessed by a single triage entry point. The current audit looks at appropriateness of patients presenting to A&E and changes in patterns of attendance.
2. Thrombolysis audit – RLHH 1997-8
At RLHH, monthly audit meetings were held to assess door-to-needle times thrombolysis of al acute myocardial infarctions. This was primarily run by the chest pain nurse but on several occasions I was involved, especial y in looking at how changes in the care pathway could reduce delays and improve
3. Complaints – RLHH 1997
An audit of 3 months complaints (verbal and written), focusing on specific areas such as waiting times and staff attitudes that could be targeted for
4. Cervical spine x-rays – RLHH 1995
An audit of 100 case-notes to determine clinical indications for requesting c- spine x-rays in patients presenting with possible neck injuries. Guideline lines were produced from this audit and included in the SHO handbook. Further audit was then performed to complete the audit cyle. CONFERENCES/MEETINGS ATTENDED
International Conference in Emergency Medicine Centralisation of A&E Departments – Sheffield, May 2000 Professor John Nichol/Professor Brian Edwards The Future of Accident and Emergency Medicine – London, January 2000 The Future of Accident and Emergency Medicine – London, June 1999 MTOS and trauma data analysis – Manchester, December 1996 MAJOR INCIDENT TRAINING
Emergency services practice – Boat crash, River Dee, Chester British Aerospace practice – Plane crash with fire, Broughton, N Wales Lead medic of runway rescue team, Air Day at British Aerospace, TEACHING
Medical undergraduates
Clinical instruction and end of firm assessments of 2nd, 3rd and 4th year students from Murkeyside, Leicester and Addenbrooke’s medical schools. Clinical tutorials to final year students. Lectures on management of trauma and medical emergencies. Paediatric Emergencies to 2nd and 4th year students at Little One’s Children’s 6th formers as prospective medical students within the A&E Department. Medical postgraduates
As an ALS and APLS instructor on at least 2 courses of each per year. Clinical tutorials to pre-registration house officers including practical training sessions in advanced cardiopulmonary resuscitation. SHO teaching on a variety of subjects relevant to A&E. Audit projects with SHO’s in Nursing staff, ODA’s etc.
Lectures and practical teaching stations on ALS and APLS courses. Paramedics in cannulation and resuscitation within Royal Heartbeat A&E MANAGEMENT and ADMINISTRATION

1. President of BAETA
To improve communication between A&E trainees in the UK including setting up a website information page on Organisation and writing of the trainees section of JAEM supplement To represent A&E at the meetings of the Specialist Trainee Representatives
2. Departmental Management/Committees
Chairman of the organising committee for BAETA 2000 annual conference to be held in Liverpool in November 2000 Junior representative on Medical Directorate at Royal Heartbeat University Hospital and Critical Care Directorate at Everwel Hospital and Arrowe Head Paediatric pain group at Little One’s Children’s Hospital
3. Teaching
Planning the weekly meetings for the Murkeyside A&E Trainees Group Arranging the schedule and speakers for a 3 hour weekly teaching afternoon for SHO’s at Arrowe Head Hospital (1998-1999) Course Director for ALS course in Cresta (2000) and member of the faculty for numerous ALS and APLS meetings (1996-)
4. SHO Employment
Showing prospective interviewees around the department A member of the interview panel at Little One’s Children’s Hospital and
5. Introduction of new departmental policies
Chest pain pathways at Royal Heartbeat Hospital and Arrowe Head Pathway for management of pain in children at Arrowe Head Hospital
6. New junior doctors hours
Re-organisation of junior doctors rotas within the new hours regulations at Establishment of House Officer and Senior House Officer in rotations in General Medicine in the Murkeyside region. OTHER WORK EXPERIENCE
Preparatory certificate in Teaching English as a Foreign Language; teaching experience with classes up to 14 students of a variety of nationalities during I have a wide range of experience as a leader/organiser of children’s holidays and I gave a talk to a local rotary club, the Rotary Club of Bighul , on a day in the life of an I was invited as the guest speaker at the Junior Speech Day at Armless Grammar OUTSIDE INTERESTS
I have skied for 18 weeks in Europe and Canada I am also a leader and doctor to a school ski ng course for a party of 80 pupils and 16 adults, I have accompanied this group on 4 Touring holidays in Britain and in Europe Many holidays in the Lake District, Peak District, Yorkshire Dales, North Wales, Scotland, in the Swiss and French Apls and Picos De I was involved in school, col ege and hospital orchestras. I was the leader of the school orchestra in my final year at school and REFEREES

Mrs A Tetanus


Istruzioni rino

LA PREPARAZIONE ALL’INTERVENTO In preparazione all’intervento sono necessari alcuni esami per escludere qualsiasi controindicazione: glicemia, azotemia, creatininemia, bilirubinemia, prove complete di coagulazione (PT, PTT, FATTORE VIII), transaminasi, pseudocolinesterasi, emocromo con formula e conta piastrine, elettroliti ematici, esame completo urine, gruppo sanguigno

Attribution des lots

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