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March 2024

This month we have Low vs High Dose Dexamethasone for Migraine, Thoracic aortic aneurysm, Transfusion thresholds in MI and New Online.
This session details the three main presentations of Congenital Heart Disease to the ED; shock, cyanosis and congestive heart failure.
This module details the three main presentations of Congenital Heart Disease to the ED; shock, cyanosis and congestive heart failure.
This learning session focuses on the understanding, recognition and management of acute RHF.
This Reference focuses on the understanding, recognition and management of acute RHF.
You are assigned to perform an echo in life support on a 45-year-old patient with a witnessed out-of-hospital cardiac arrest.
In the first podcast of 2024 we have Aortic Dissection in the ED, Invasive Procedures in the ED, Noninvasive airway management in comatose poisoned patients and New Online.
Chest and abdominal x-rays are commonly requested in the emergency department.
An elderly man presents with central chest pain and exertional dyspnea.
This session covers the diagnosis and initial management of a patient with acute aortic dissection.
This session covers the diagnosis and initial management of a patient with acute aortic dissection.
This month we have a brand new Co-host, Liz Farah. And the topics on discussion are Mortality in older patients boarding overnight in the ED, Hypertension in the ED and Cauda Equina Syndrome, Opioids for back pain & New Online
This module deals with the assessment and management of bradycardias in the ED.
A 48-year-old gentleman presents at 3am to the ED having woken at 2am with palpitations.
Ultrasound in shocked patients. This competency is specifically for Higher Specialty Trainees. It is also useful for interested Core Trainees.
This session covers the assessment and management of broad complex tachycardia.
This module covers the assessment and management of broad complex tachycardia.
A 50-year-old man was brought to the ED with ongoing dizziness, visual hallucinations and floaters in his eyes.
You are called to a pre-alerted 6-day-old baby who has arrived in paediatric resus with rapid breathing. How will you manage this infant?
This month we have INTERACT 3, British Thoracic Society - Pneumothorax, PERUKI Update, UK-Med Experiences in Ukraine with Dave Clarke, New Online.
You receive a pre-alert for a 30-year-old female who had chest pain earlier that morning.
This session looks at the aetiology, diagnosis and management of bifascicular block in the ED.
This module looks at the aetiology, diagnosis and management of bifascicular block in the ED.
The boy doesn't look sick but his heart beats fast.
ECG changes in an unconscious patient
The aim of this blog is to review management of adult medical cardiac arrests and look at interventions beyond the ALS algorithm.
This month we have: outine head to pelvis CT post arrest, an RCEM ASC Interview Megamix and New Online,
A 69-year-old man presents to the ED with a heart rate of 28bpm. He is hypotensive and clammy.
A 40-year-old man is brought in by ambulance at 2am. He looks visibly anxious and is clutching his chest. The paramedics think it’s ACS.
A 50-year-old male attends with chest pain that has now resolved. He wants to know if he can go home.
A hypertensive emergency is defined as the clinical situation in which there is a marked elevation of blood pressure (BP) associated with acute or progressive end organ damage, e.g. cardiovascular, renal or neurological dysfunction.
This session covers the pathophysiology, clinical presentation and management of hypertensive emergencies
30 questions. 30 minutes. Test yourself against your colleagues!
This session looks at disorders of potassium metabolism, in particular the presentation of hypokalaemia and hyperkalaemia in the ED. It also covers the investigation and management of these conditions.
This module looks at disorders of potassium metabolism, in particular the presentation of hypokalaemia and hyperkalaemia in the ED. It also covers the investigation and management of these conditions.
This month we look at a paper dealing with Performance of a prehospital HEART score in patients with possible myocardial infarction a prospective evaluation and also one on methocarbamol vs diazepam in management of acute lower back pain.
This session is about assessment and management of patients presenting with transient loss of consciousness to the ED.
A previously well and fit 70-year-old man presents with acute shortness of breath, pre-syncopal symptoms and a significantly reduced exercise tolerance.
Adult Trauma Call: Management of a 28-year-old male with a knife wound to the chest.
Unstable Angina and Non-STEMI: Risk Assessment and Management
This module covers the risk stratification and management of unstable angina and non-ST-segment elevation myocardial infarction.
A child presents following a collapse at a football game.
Cardiac causes of ST segment elevation unrelated to acute myocardial infarction (MI) and the non-cardiac causes which might present similarly to MI.
This module is largely concerned with the cardiac causes of ST segment elevation unrelated to acute myocardial infarction (AMI).
The aim of this session is to have a quick recap of Brugada syndrome, identify key ECG features for diagnosis and learn about managing patients with the condition.
The aim of this session is to have a quick recap of Brugada syndrome, identify key ECG features for diagnosis and learn about managing patients with the condition.
Elderly lady presenting with abdominal pain and fleeting left upper limb weakness.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
This session looks at the risk stratification and management of patients with acute pericarditis.
This module looks at the risk stratification and management of patients with acute pericarditis.
Supraventricular Tachycardias can be divided into three pathophysiologicaly distinct conditions.
This module is designed to help you understand the principles, basic physiology, and clinical features of supraventricular tachycardias. It is written from a clinical standpoint, with testing based on scenarios, and the main text based on ECG interpretation.
Cardiogenic Pulmonary Oedema
This session covers management of tachycardias in the Resuscitation Room. It builds on the Resuscitation Council UK ALS Guidelines (2021) using selected evidence.
Management of tachycardias in the Resuscitation Room.
RCEM, Advanced Life Support, ALS, shockable rhythm, non- shockable rhythm, cardiac arrest, resuscitation, resus.
This session explores how to use point-of-care ultrasound (POCUS) to assess patients presenting with shock to the Emergency Department.
A young woman presents with breathlessness. She is profoundly tachycardic. How will you manage this?
Is this another ‘Normal Sinus Rhythm (NSR) or could the T-waves be telling us more about a not-so-rare syndrome in this 69-year-old patient with chest pain?
A 25-year-old obese female, who is 1-week post-partum, presents with worsening shortness of breath on minimal exertion, orthopnoea, pedal oedema and a dry cough.
A 25-year-old male presents to your ED with central sharp chest pain, shortness of breath and palpitations.
An elderly male with a shocking diagnosis.
A patient with a bee sting complains of chest pain and has ECG changes, what are you thinking?
A session describing the pathophysiology, diagnosis and management of endocarditis.
This month we discuss Midazolam vs. morphine in heart failure, Sedation (Part 2), TREDTalk, EMTA Survey, New Online.
Management of Cardiac Transplant Patients in the ED.
Management of Cardiac Transplant Patients in the ED.
A 56-year-old man presents to the ED with chest pain.
A 67-year-old man is brought into the emergency department with collapse associated with chest pain
Recap of the ASC 2022 conference
A 27-year-old man presents to the ED with a history of collapse whilst on a treadmill at his local gym. He was witnessed to have been briefly unresponsive but there was no seizure activity.
You think this is a regular day at the office and a very straight forward case, but is it?
This month we discuss IV Paracetamol, Sedation, Highlights from the Thames Valley Cardiac Arrest Symposium & New online material from RCEMLearning.
A conducted energy device (CED) ‘taser’ was discharged into a patient’s shoulder. Before this patient is taken into police custody, you’ve been asked to assess them in your ED.
The Police have brought a patient to your ED that has had a controlled energy device discharged into their upper back. You are called to assess this patient.
This month we discuss Fluids in RSI, Learning Disabilities, New Online material and we have highlights from the Thames Valley Cardiac Arrest Symposium (Part 1)
Predictors of hospital prenotification for STEMI and association of prenotification with outcomes
This session addresses the management of STEMI and its complications.
A 68-year-old man attends the ED one evening with a painful right knee.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
The aim of TERN Top Papers is to highlight the top emergency care related papers for emergency physicians. This month’s topic is critical care.
Your patient’s x-ray shows his heart is almost the whole size of his chest. What’s going on? And what are you going to do about it?
A 75-year-old man presents to the ED claiming he ‘just doesn’t feel right’. You are called urgently to assess him.
This session describes the pathophysiology, diagnosis and management of endocarditis.
This month’s edition of VJC is brought to you by ITERN, who are discussing the early CTCA in suspected ACS RCT.
A 30-year-old male presents with worsening shortness of breath.
This session aims to increase the awareness of Kawasaki disease with a focus on recognising the principal clinical features, in line with recent updates to the NICE guidelines
This learning session aims to increase the awareness of Kawasaki disease with a focus on recognising the principal clinical features, in line with recent updates to the NICE guidelines.
A 51-year-old female presents with sudden onset epigastric pain and FAST +ve symptoms.
Imagine it's 2am and the Red Phone rings…. “A 26-year-old male, fallen off motorcycle, in traumatic cardiac arrest”. Your heart races, you’re excited, but you feel way out of your depth. You know there’s loads to prepare and often there isn’t much notice. What do you do?
A 69-year-old gentleman presented to the emergency department with odd periods of vacancy. His wife reported that on the previous day, he had 2 episodes in which he would become suddenly pale and confused for 20 to 30 seconds.
A mother has rushed into the ED very concerned that her baby is blue. This case covers the importance of understanding cyanosis, with consideration for the potential causes and management in a 3 week old.
A 47-year-old female attends the ED due to chest pain that occurs on exertion and settles with rest.
A 36-year-old gentleman presents with intermittent flank pain and has microscopic haematuria. His BP is 220/110 and he is now pain free. What would you do next?
A patient is bradycardic. They might need pacing. They might not.
Thyroid storm is a rare but life-threatening endocrine condition that should be considered, recognised and treated quickly
This month we have Guidelines for EM on Heart Failure with Chris & Becky & Clinical Cases with Mark & Michelle
A 38-year-old gentleman has just finished a course of antibiotics for pneumonia, but his symptoms aren’t resolving
Radiation of pain to the arms or shoulders, and association with exertion, diaphoresis, nausea or vomiting are useful for ruling in the diagnosis of AMI.
This session addresses the clinical assessment and management of patients with low risk chest pain, specifically the identification of patients with acute coronary syndrome
This session explores how to use point-of-care ultrasound (POCUS) to assess patients presenting with shock to the ED .
Our curriculum mentions pacing, and we all think that we know all about that as we’ve got ALS… right? Some of our brief discussions on twitter highlighted that pacing can be more complicated than ALS implies, and actually isn’t very common in ED.
A middle-aged man presents to the emergency department with chest pain and syncope
This month’s edition of TERN’s top papers series comes from a small team of higher EM trainees in the North West. It looks like we will all experience some rainy days this winter, so we hope you enjoy these summaries of articles that caught our eye
EM physicians need to be decision makers, quick thinkers and risk balancers. This is what we are good at. In fact, many will tell you that the purpose of the PEM rotation is to learn to spot the sick child
This reference explores how to use point-of-care ultrasound (POCUS) to assess patients presenting with shock to the Emergency Department.
A 20-year-old male presents with a 6-month history of intermittent chest pain.
A 25-year-old male with no significant past medical history attends A&E with chest pain
Identifying aortic dissection is difficult, but the management doesn’t stop there.
An elderly man presents to the emergency department with dizziness associated with movement of his left arm.
At TERN Education we are keen to help you learn how to critically evaluate the evidence base behind your practice
A neonate is brought to your Emergency Department in a shocked state
There are two cardiac valves on the left side (aortic and mitral) and two on the right side (pulmonary and tricuspid)
An 84-year-old presents with shortness of breath, chest pain, and appears peri-arrest.
This session is about assessment and management of patients presenting with transient loss of consciousness to the ED.
A recently widowed 36-year-old female presents with chest pain and shortness of breath. Her ECG features diffuse ST elevation.
This session is about the pathophysiology of acute coronary syndromes, defining acute myocardial infarction and recognising the various presentations and clinical features associated with acute coronary syndromes.
This session is about the pathophysiology of acute coronary syndromes, and recognising the various presentations and clinical features associated with them.
As I write this, it’s aortic dissection awareness day. Not another blog on AAD I hear you cry…But we thought you might all like an update and a consolidation on what is happening in the world of this black swan diagnosis.
An 83-year-old gentleman is brought to the emergency department by ambulance with acute dyspnoea at rest.
A 21-year old male has been stabbed outside of a night-club.
The spontaneous presentation of phaeochromocytoma is normally between the age of 40 and 50 years, however the hereditary forms often present in younger individuals, including children.
Describing the key features relevant to the history of phaeochromocytoma
An 87-year-old female presents with episodes of transient loss of consciousness, pallor and seizure-like activity.
Patients with known pulmonary hypertension may present to the emergency department with a variety of acute problems related to this disease such as pulmonary embolism
Pulmonary hypertension (PH) is an elevation in pulmonary vascular pressure that can be caused by an isolated increase in pulmonary arterial pressure.
You are in charge of a congested department. Multiple ambulances have just arrived and you need to triage them to your clinical areas
For hypercalcaemia to develop, the normal calcium regulation system must be overwhelmed by an excess of PTH, calcitriol, some other serum factor that can mimic these hormones, or a huge calcium load.
Evaluate various patient entry methods.
This learning module covers the basics of what an LVAD is, the common complications an emergency medical team may have to deal with, and the management of a collapsed LVAD patient.
This learning module covers the basics of what an LVAD is, the common complications an emergency medical team may have to deal with, and the management of a collapsed LVAD patient.
Presentation to the ED with new onset heart palpitations
Cardiac rhythm management devices (pacemakers and implantable cardioverter-defibrillators, or ICDs) are a constantly evolving and improving field
Implantable devices in Cardiology is a term covering a variety of diagnostic and therapeutic modalities.
A patient arrives in resus following an out of hospital cardiac arrest. He had a background of obesity and type II diabetes.
This document covers FAST, Assessment of the Abdominal Aorta and IVC, Vascular Access and Echocardiography in Life Support.
Blood pressure is a fickle beast and one that I’m not sure many of us really understand. We’re fabulous at treating it if it’s too low… but when it’s too high, our practice is a bit more varied. 
A 94-year-old female with dementia was referred to the ED from her residential home. She had a 2 day history of anorexia, lethargy and loose stools 3 times a day.
Myocarditis is an uncommon disease but it has a significant morbidity and mortality
Myocarditis is an acute infectious or immunologically mediated syndrome causing inflammation of the heart muscle.
A 10-year-old boy is brought into hospital by his mother after he had a fainting episode at school.
An 84-year-old gentleman attends ED with a 48 hour history of tight central chest pain on exertion.
Dyspnoea is an overall term used to describe an unpleasant awareness of increased respiratory effort and will be used synonymously with "breathlessness" in this session.
This session is about the assessment and management of patients presenting with breathlessness to the emergency department
A 65-year-old male presents to the emergency department (ED) by ambulance with an episode of collapse.
A 5-week term baby is brought in by his parents with a 24-hour history of poor feeding. No fever or infective features.
This session focusses on the emergency department care of patients post-cardiac arrest i.e. after the return of spontaneous circulation
This session focusses on the emergency department care of patients post-cardiac arrest i.e. after the return of spontaneous circulation.
A 79-year-old female attends ED by ambulance after having 12 hours of central, pleuritic chest pain which radiated to the back across her shoulders.
A 57-year-old female with Chest pain, dyspnoea, abdominal Pain and syncopal episodes.
This month we discuss Undoing Skin Glue Mishaps | PoCUS for skin abscess | AAA | Paeds DKA
A 45-year-old man presents to the emergency department with sudden onset central chest pain
This month we have 2 sections. Part 1 we discuss Timing of endoscopy, New in EM Haloperidol for migraine, New in EM Drugs v DCC in A Fib. Part 2 we discuss the RCEM guideline on suspected internal drug traffickers
A rarer cause of pleural effusion
This month is in 2 parts. Part 1 has LoDED Study, Trauma Top 5 Papers, Neurosurgical Emergencies. Part 2 has New in EM - Peripheral pressors, VTE Guidelines, New in EM - Thirst guided IV fluid
An elderly lady presents to the emergency department from a nursing home having been found on the floor in her room
A patient books in stating that his “heart is beating fast”. Your receptionist thinks he ‘doesn’t look right’ and brings him through to you in the main department.
The January 2020 podcast is hosted by Chris Connolly and features New in EM currency in EM intubation, ASC 2019: Govind Oliver - Clinical Gestalt vs TMAC scoring, New in EM early antibiotic in sepsis, ASC 2019: Gordon Fuller AHEAD-2
An 80-year-old woman presents to your ED with shortness of breath on minimal exertion. She flew back from Singapore two days ago.
Octobers podcast is a special from the RCEM ASC with an interview with the new president Dr Katherine Henderson, Prof Simon Carley on his top 10 papers for EM, and an interview with Rod Little prize winner Dr Gordon Fuller
A 62-year-old woman presents with chest pain, fever, and systolic murmur.
ECGs can be challenging, right?  And so can children. Add the two together and……..arrghh - Paediatric ECGs!!
This month we have Aromatherapy for Nauseated ED Patients | Rob Rogers at EMEC - Medutopia, Legacies and Inspiration | Hugo Dowd - Syncope at Belfast CPD | Iain Beardsell - Diagnostics at Belfast CPD | Cardioversion for A Fib
A 30-year-old previously healthy male presents to your Emergency Department with syncope while on a treadmill.
About 1 year ago, Pam, a 62-year-old, recently retired teacher, fit, well & active, suffered sudden onset of severe ‘ripping’ pain in her chest & upper abdomen
Thyroid storm is a rare but life-threatening endocrine condition that should be considered, recognised and treated quickly
AF is an atrial tachydysrhythmia characterised by predominantly uncoordinated atrial activation
December 2018 Podcast
This session deals with the important presentations of valvular heart disease in adults and the early management in the emergency department
We all work in the Emergency Department because we think there’s going to be lots of “emergencies”
This podcast was initiated by the survivors and relatives of aortic dissection in the group Aortic Dissection Awareness UK
The latest podcast from the RCEMLearning team

SOB

It’s 5am, the pre-alert phone rings. The ambulance service are bringing in a patient with acute difficulty in breathing
Chest pain is one of the most common reasons adults come to an ED
It's a phrase you'll come to know well. Especially, you'll find, if you're sitting at a certain desk or in a certain area
January 2018
Managing Parkinson’s in the ED, Flaoting in the Face of Danger, MaxFax injuries in the E, and Paediatric Heart Murmurs & what to do with them