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‘Coronitis Pigmentosa’ – A blind diagnosis?

You receive a sepsis pre-alert for a 39 year old female who is brought in by ambulance vomiting. She has muscle aches and a fever for 5 days. She is triaged to Covid resus. Her blood gas isn’t pretty. What are we missing?
An 8-month-old boy is brought to A&E by his mother. He became unwell 2 days ago with vomiting and abdominal pain.
A 55-year-old man presents to you in the emergency department with a distended abdomen and a past history of Crohn's disease.
A 30-day-old ex-36/40 twin, male infant attends the ED with his mother due to concern regarding vomiting of 4 days duration
A young female footballer presents with a swollen, painful knee after being tackled. She cannot mobilise. Examination reveals a large effusion.
An 80-year-old woman presented to the ED at 2am with acute chest pain and shortness of breath.
A 25-year-old man with no significant past medical history presents to the Emergency Department with his wife complaining of a one day history of vomiting and diarrhoea.
A 14-year-old boy attends the Paediatric ED with a 2 day history of worsening colicky central abdominal pain.
A 75-year-old man presented to the ED of a District General hospital complaining of severe abdominal pain that followed an episode of vomiting earlier in the day. He also reported one episode of loose stool that morning.
This article covers the generic assessment and management of the pain with abdominal pain without shock.
This session covers the generic assessment and management of abdominal pain without shock.
A 56-year-old man presents to the ED 48 hours following an alcohol binge with chest pain and dyspnoea.
Another pain in the back SBA
Can you recognise acute kidney injury and prevent its deadly complications?
This session covers the assessment and management of patients with acute liver failure
Paracetamol overdose accounts for in excess of 70% of cases in the UK whereas worldwide viral hepatitis is the commonest cause.
A young woman is pre-alerted to the emergency department with increasing drowsiness and confusion.
Describing the pathophysiology of cystic fibrosis
An unusual presentation of leaking gas in the abdomen.
Alcohol abuse is undoubtedly a huge social problem in the UK. It is responsible for many unnecessary attendances to Emergency departments (ED) and is an enormous burden on the NHS, which must treat the complications of alcohol abuse
This session will deal with the assessment and management of alcoholic liver disease.
Nausea and vomiting affects approximately 80% of women during early pregnancy
The ED often plays a vital role in making the first diagnosis of cancer.
You are in charge of a congested department. Multiple ambulances have just arrived and you need to triage them to your clinical areas
This session covers the diagnosis, management and treatment of anorectal conditions that commonly present to the ED.
This session covers the diagnosis, management and treatment of anorectal conditions that commonly present to the ED.
A 65-year-old male presents to your busy ED with pain in lower abdomen and radiating to testicular area.
This session deals with the assessment and management of patients with appendicitis.
This module deals with the assessment and management of patients with appendicitis.
This month we have DVT guidelines | CRT vs Lactate Guided Fluid Resuscitation in Septic Shock | IAEM PoCUS 01 SHOC ED Study | DFTB18 Elliot Long | Stabbings in children | Non operative appendicitis management
This month we have Ketamine and Ondansetron, Hyperemesis Gravidarum, an interview with Vicky Price (SAM), Antibiotics for brain injury and New Online
At TERN Education we are keen to help you all learn how to critically evaluate the evidence based behind your practice. In order to do this, we are producing monthly ‘virtual’ journal club modules on RCEMLearning. It’s like a critical appraisal paper you can do in your own time!
This session is about the evaluation of arterial blood gases in the emergency department.
When I was asked to talk about assessment of (de)hydration in children, about 6 months ago now, I accepted without a second thought. "How hard could it be?", I guessed, "I do this every single day"
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 young lady presented with abdominal pain, lethargy, (Groin) bone pain, depression and headache.
A 57-year-old lady was brought into the Emergency Department by ambulance with a presentation of abdominal pain.
A 25-year-old male presents with a five day history of bilateral muscular leg pain.
Mr Ship is a 94-year-old Gentleman who presents to the ED as his brother feels his indigestion is getting worse, and he can no longer eat and drink.
How to recognise and manage Cannabinoid Hyperemesis Syndrome as a cause of vomiting and abdominal pain.
Not one, but two teeny tiny yellow wailing babies present to your Paediatric ED! Their worried parents ask you: "why have the twins turned yellow?"
A topic to muddy the FOAMed waters; constipation, a problem for many patients in which their care could be dramatically improved. Find out how in this podcast
A lady presents with decompensated liver disease and the CT reveals more than just ascites and cirrhosis.
Research in Emergency Medicine ranges in scale and complexity and covers a wide spectrum of subjects, all of which contribute to our overall knowledge base
TXA for haemoptysis, EMJ Podcast, Capacity, DFTB18 Domenic Cincotta, Premedication for ketamine sedation, C-spine in distracting injuries
A keen fisherman attends following a flu-like illness. He has a small head wound and is now jaundiced. One sign brings it all together, can you spot it?
FRCEM Primary Examination Single Best Answer
FRCEM Primary Examination Single Best Answer
FRCEM Primary Examination Single Best Answer
FRCEM Primary Examination Single Best Answer
FRCEM Primary Examination Single Best Answer
Gall Bladder, specifically gallstone, disease is the commonest abdominal complaint causing hospital admission in the developed world.
This session deals with the assessment and management of gall bladder and gall stone disease
A frail elderly female is brought to the emergency department following two episodes of “coffee-ground vomit”.
Describing the natural history and aetiology of paediatric gastroenteritis
Describing the natural history and aetiology of paediatric gastroenteritis
A 45-year-old man attends the department with a 48 hour history of nausea and vomiting. He also has a diffuse upper abdominal pain.
Patients frequently attend the emergency department (ED) with episodes of cutaneous and mucosal swelling.
This question is aimed at CT1 and above. This question focuses on decision making.
Is there a role for the Impedance Threshold Device in hypotensive, spontaneously breathing, trauma patients?
Small magnets in small people.
"Toni is a 35 year old lady who attends the emergency department regularly with chest pain. Nothing seems to make it better, and her troponin is always normal. You wonder if there is a potential cause. Read on to find out that there is more to IBS than abdominal pain."
A 65-year-old lady presents to the ED with a 4 day history of diarrhoea after being treated for a UTI by her GP.
A 76-year-old presents with abdominal pain. He is clinically shocked (hypotensive and tachycardic) with a known abdominal aortic aneurysm.
Jaundice is a physical finding, which emergency physicians see in patients who may present with jaundice alone or with other complaints and symptoms.
This session deals with the assessment and management of jaundice.
The July 2018 Podcast
This months podcast features Angio following cardiac arrest | Vertigo | Bag Mask Ventilation in RSI | LGIB | and IAEM PoCUS Erector Spinae Block
It's a common card to pick up in some paeds EDs - the yellow newborn. But whilst this can be an 'easy' one, such tiny babies can strike fear into the hearts of some!
This module will discuss the causes of lower gastrointestinal bleeding in children. It will consider how the causes can be differentiated by age, when to perform further investigations and basic management plans.
This module will discuss the causes of lower gastrointestinal bleeding in children. It will consider how the causes can be differentiated by age, when to perform further investigations and basic management plans.
This session covers the assessment and management of lower gastrointestinal (GI) haemorrhage.
This session covers the assessment and management of lower GI haemorrhage.
Prolonged jaundice is different from early jaundice as it is jaundice which persists for 14 days in a baby who was born at term (37 weeks or more gestation), or to 21 days in a pre-term baby born before 37 weeks gestation.
The March 2018 Podcast
This month we have: New in EM - Clonidine for pain, Guidelines for EM - NEXUS Chest CT Rule, an interview with Matt Reed, Coca cola for food boluses and New Online.
What will you do when your weekend shift in the Paediatric ED turns into seeing a stream of yellow babies?
A mother presented to the ED with her 4-week old baby that had been drowsy and was not feeding as usual.
A 5-week-old presents to the Emergency Department with a worsening, projectile, non-bilious vomiting.
An 8-month-old baby is brought to the ED due to changes in behaviour. The baby's mom says he looks limp and isn't as active as usual.
Management of a patient who reattends the Emergency Department with cyclical nausea and vomiting.
It's a common card to pick up in some paeds EDs - the yellow newborn. But whilst this can be an 'easy' one, such tiny babies can strike fear into the hearts of some!
A patient presents to the Emergency Department suspected of having illicit concealed drugs. This SAQ explores the clinical management, combined with the ethical and medicolegal aspects of their care.
The new podcast for October 2017
The October 2018 podcast
This month we discuss Guidelines in EM: Mental health | Ondansetron take home in paeds gastroenteritis | Diarrhea and rehydration
A 67-year-old alcoholic presents with anuria for one day and the next day is passing fluid.
Understanding paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS).
This SBA will test your knowledge on worrying presentations to ED, and when fevers come and go.
A 65-year-old gentleman attends with a 4 week history of increasing pain on swallowing - although he is still managing to eat and drink.
The pancreas is the largest gland in the body and is situated transversely across the posterior wall of the abdomen, at the back of the epigastric and left hypochondriac regions.
Elicit the features on history and examination that suggest a diagnosis of pancreatitis in a patient with abdominal pain
A pregnant female accidentally takes an excess of paracetamol. This SAQ explores the important considerations taken when managing acute paracetamol poisoning during pregnancy.
Parkinson's disease is a common neurodegenerative disease affecting adults. Symptoms and disability can arise as a result of the disease itself and the complications of medical therapy.
This is an up-to-date review of peptic ulcer disease pathophysiology, presentation, management and complications in the Emergency Department.
A 3-year-old child presents to your emergency department with a rash, fever and vomiting.
A young male has concerning symptoms with a background history of G6PD deficiency…
A 32-year-old man arrives in emergency department writhing in agony with flank and loin pain.
A patient presents following a viral illness with RUQ pain, vomiting and confusion.
Struggling to negotiate CT imaging requests for your paediatric patients? Let the guiding principles of ALARA come to your rescue!
iBook 3 including 'Looking like Maggie Simpson' , 'Pem and EX PREMS', and 'prolonged jaundice'
Link to ibook 4 and a PDF version available here
e're here to give you updates and some pearls that we've gleaned from the conference.
A 23-year-old man presents to the ED following a rugby tackle with left rib pain.
A 41-year-old gentleman presented to the ED with a three day history of vomiting blood and the passage of bright red blood rectally.
A 57-year-old female with Chest pain, dyspnoea, abdominal Pain and syncopal episodes.
The new podcast for September 2017
You receive a standby call for red-flag sepsis – Initial pattern recognition triggers the pathway. Shortly after arriving you experience ‘pattern interrupt’ and ponder new evidence in the treatment of this condition.
A healthy 25-year-old presents to the emergency department complaining she cannot text on her phone
A 22-year-old man presented to the ED following a collapse with abdominal pain and no history of trauma. He was profoundly shocked and investigation revealed intra-abdominal haemorrhage.
A 73-year-old woman presents with 2 episodes of passing dark red blood per rectum associated with LIF pain of 1 day duration.
A young lady presents to the ED with a history of pain on urination and defecation for two months.
This blog is an overview of how to approach an unwell infant. It covers diagnoses not to be missed, how to spot them and a few tips about management.
The neonatal period (<28 days of age) and young infancy (< 3months ) is the most common time for presentation of congenital conditions and the highest susceptibility for infection.
A 24-year-old gentleman attends ED due to vomiting, abdominal pain, constipation and a swollen neck.
Understanding paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS)
A 7-year-old girl presents with an acute, painful hot knee and a red-purple non-blanching rash.
A 13-year-old girl presents to the Paediatric ED with a 48 hour history of nausea, vomiting and abdominal pain.
A normally well man in his 50’s presented with severe chest pain following vomiting
A 12-month-old diabetic girl presents generally unwell and vomiting.
Patients who suffer from an acute upper gastrointestinal (GI) haemorrhage are a common reason for presentation to the ED in the UK
This session is about the assessment and management of an upper GI haemorrhage
Patient with Von Willebrand disease is brought to ED with per rectal bleeding.
A 12-year-old girl is brought to your ED with abdominal pain and a urine dip is done.
You are handed the ECG of a lady with known alcohol excess who has presented with at least 48 hours of vomiting. The ECG reveals one of her blood tests may be critical – but which one?
It is a busy winter evening in the Emergency Department. The next patient to be seen is a 37-year-old female presenting with a headache, nausea and general malaise.
A woman in her 50s presents with sudden onset nausea and vertigo.
A 27-year-old female has presented with recurrent headaches, worse in the morning.