A 3 month old term male infant of Somali background presented with a history of recurrent left axillary abscess, 1.5 cm in diameter, following BCG vaccination at birth. Swelling of the left axillae was noted at age 1 month along with keloid scarring of the injection site and this was diagnosed as BCG lymphadenitis at 2 months of age, supported by ultrasound scanning. The patient remained afebrile and otherwise fit and well, and there was no family history of Tuberculosis (TB) infection or recent travel and both parents had received the BCG immunisation. At 3 months of age the patient was admitted via the emergency department due to worsening of symptoms; this resulted in incision and drainage of the abscess alongside a short course of oral Co-Amoxiclav. Histopathology showed acid fast bacilli, though swab cultures were negative on Ziehl Nielson staining. A fortnight later the patient re-presented with increased exudate and erythema of the surgical site, alongside presumed viral gastroenteritis. He received a further short course of intravenous Co-Amoxiclav and was discharged with advice on conservative management.
Ketamine versus Propofol for adult procedural sedation in the Emergency Department
A 34 years old man presents to your emergency department with a dislocated shoulder. You want to use procedural sedation for the reduction of his shoulder. You have used ketamine successfully for sedation in children before and you wonder if it would be as effective as propofol in an adult population requiring procedural sedation.
In children with simple finger lacerations does LAT gel provide safe local anaesthesia?
You’ve just seen a 6yr old little girl with a gaping laceration to the palmar aspect of her index finger. You feel it requires sutures but are unsure if LAT gel is safe to use in digits.
A 30 year old man presents having been involved in a front end collision while driving a car at 40mph. He is found to have sternal tenderness and an x-ray reveals a fracture. There are no other significant injuries.