Polytrauma patients with penetrating trunk injuries alongside a TBI would be treated by the Ambulance Service anywhere in the UK and that crew would follow clinical treatment guidance published by the Association of Ambulance Chief Executives and Joint Royal Colleges Ambulance Liaison Committee (JRCALC). In this scenario JRCALC would suggest maintaining permissive hypotension despite all of the evidence maintaining that one drop in systolic blood pressure below 90mmHg in a TBI patient leads to as much as a 100% increase in mortality.
30 year old male has been involved in a road traffic collision and sustained penetrating injuries to the chest. You arrive on scene and the patient loses his pulse and goes into traumatic cardiac arrest. You wonder whether a prehospital resuscitative thoracotomy (PHRT) would improve his chances of survival?
A 40 year old male presents to the emergency department in septic shock. He is given fluid and vasopressor therapy. Can serial serum lactate measurements be used as a predictor of mortality?
Effective pain relief from fascia iliaca block using levobupivacaine in femoral neck fractures
ED Presentations- 78 years old female, 87 years old male, 64 years old male, 53 years old female, all had falls and confirmed fracture neck of femur. All had received IV Morphine for pain by the ambulance crew. They received fascia iliaca block (FIB) with 0.25% levobupivacaine adjusted to their estimated weight by the emergency physicians. Their pain scale varied between moderate to severe. We were expecting drastic improvement in pain within the first 30-60 minutes after instilling the blocks. Instead all had no pain relief even after 1-2 hours and required additional analgesics to reduce the pain in the emergency department.
A 45 year old male came to A&E with sever upper abdominal pain, and upon examination there is signs pf peritonism and elevated serum amylase more than 4 folds in addition to elevated CRP, WBC and fever.Within two days, he developed signs of acute severe necrotisig pancreatitis with Cullin and Turner signs and AKI for that we kept him on conservative treatment for more than 10 days
A 55 year old man is admitted to the vascular ward following a fasciotomy and bilateral lower limb embolectomy. He presents with reduced ROM and strength of his ankle and is struggling to weight bear due to pain. Does physiotherapy and exercise improve functional recovery?
A 20-Year-old female front seat passenger with the seat belt on sustained a neck injury from a frontal collision car Accident that left her with a fronto-parietal scalp laceration; presented to the Emergency Room with cervical spine precautions. Primary survey demonstrated a non-disabling local neck pain and tenderness. The neurologic examination was normal with no disabilities, and no cranial nerve involvement. Glasgow coma scale was 15/15. Past medical history is unremarkable with no previous incident. An X-Ray, Computed Tomography (CT) scan and MRI of the neck revealed only a Jefferson fracture with a 12 mm widening of the lateral mass of C1. The Anterior Atlanto-Dens Interval (ADI) was normal (2mm) and the Space Available for the Cord was 17mm.
Is cross sectional imaging of the hip necessary in isolated greater trochanter fracture?
In patients who have isolated fracture of the greater trochanter seen on plain film, does further cross sectional imaging (CT or MRI) help diagnose occult unstable extension of the fracture
Deliberate self-harm in children subject to a child protection plan
A 13 year old female presents with self-inflicted lacerations on her wrists. It is revealed she has a history of physical and emotional abuse, and a child protection plan is in place. You wonder if deliberate self-harm is a predictor for being subject to a child protection plan?
Abra Podagra: Is Colchicine the Magic Treatment for COVID-19?
You are the EM Specialist Trainee covering the resus room for respiratory patients. The 'red phone' rings to pre-alert the department about a 52 year old woman who tested positive for COVID-19 3 days ago. She is breathless with oxygen saturations of 74% on room air and will arrive in 5 minutes. During a recent conversation with a rheumatologist about a different patient, colchicine was mentioned as being currently under investigation for treatment of COVID-19 due to its well-known anti-inflammatory properties. You wonder if there is any evidence to suggest this potential treatment would be beneficial for your impending arrival...
A 4 year old boy attended the paediatric emergency department following a circumcision for religious reasons earlier that day. He had ongoing bleeding from the surgical site. Is there any evidence behind the use of topical adrenaline in the management of these patients.