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Management of Acute Presentations of Sickle Cell Disease in the Emergency Department

How to manage acute sickle cell disease. Focus on early analgesia, warmth, hydration, and oxygenation. Recognition and management of specific complications. Criteria for admission and discharge.
How to identify, investigate, and manage nitrous oxide toxicity.
Headaches are one of the most common presentations to the ED and may be primary or secondary. We want to help you differentiate between those benign ones that just require simple analgesia and reassurance, and those that require further investigation.
Sudden visual loss is a presentation one should expect and be prepared to see, as an emergency physician.
30 questions. 30 minutes. Test yourself against your colleagues!
This module identifies the clinical features of acute behavioural disturbance (ABD) and covers the initial assessment and management of patients with ABD in the Emergency Department.
This session identifies the clinical features of acute behavioural disturbance (ABD) and covers the initial assessment and management of patients with ABD in the ED.
Sudden visual loss is a presentation one should expect and be prepared to see, as an emergency physician.
This month we have Ketamine and Ondansetron, Hyperemesis Gravidarum, an interview with Vicky Price (SAM), Antibiotics for brain injury and New Online
The child with decreased consciousness is a common problem with many possible diagnoses and potentially high mortality and morbidity.
The child with decreased consciousness is a common problem with many possible diagnoses and potentially high mortality and morbidity
A man collapses in the bathroom. What was the cause? Is he safe to go home?
This month we have Low vs High Dose Dexamethasone for Migraine, Thoracic aortic aneurysm, Transfusion thresholds in MI and New Online.
Learning about lightning injuries
A 10-year-old girl presents with lethargy, vomiting, headaches and an unsteady gait. She collapsed at home a few hours prior to arrival at your ED.
During Summer storms, lightning strikes can cause fatalities …but what happens to the survivors?
A 27-year-old man is brought to the ED by ambulance after having two seizures. He has no known health problems.
This session reviews the clinical presentation and investigation of cervical artery dissection.
This session reviews the clinical presentation and investigation of cervical artery dissection.
A 35-year-old presents with right sided headache, photophobia and vomiting progressing to left homonymous hemianopia and left sided numbness.
A 53-year-old man presents to the ED with a 12-hour history of impaired sensation to the right side of his face, right arm and right upper torso.
Is it just another headache, or something more sinister?
Acute dystonia is a movement disorder in which there is a state of abnormal tone produced by slow and sustained contractions of opposing muscle groups.
Acute dystonia is a common presentation to the ED. Most cases occur as a result of recreational or prescribed drugs.
A 34-year-old woman presents with a worsening vision and pain on eye movement.
Ultrasound in shocked patients. This competency is specifically for Higher Specialty Trainees. It is also useful for interested Core Trainees.
You take handover for a patient in resus. They have presented with new onset of focal seizures. You start treatment but the convulsions are worsening. What will you do?
A 50-year-old man was brought to the ED with ongoing dizziness, visual hallucinations and floaters in his eyes.
This month we have INTERACT 3, British Thoracic Society - Pneumothorax, PERUKI Update, UK-Med Experiences in Ukraine with Dave Clarke, New Online.
A 57-year-old male patient presents with acute back pain and numbness in both legs.
A 69-year-old man presents to the Emergency Department after a minor road traffic accident.
A 70-year-old female presents to the ED with headache, jaw pain and visual disturbance.
A young girl collapses suddenly at school and presents to your ED with an altered level of consciousness – what could have happened?
A 77-year-old man presents with sudden onset of nausea, vomiting & difficulty walking.
A 38-year-old fit and well female, who is 29 weeks pregnant, attends with a sudden onset of worsening, retro-orbital headache.
A 55-year-old female presents to the ED with worsening diplopia for 2 days.
This month we discuss: The STANDING Protocol for Vertigo, Head Injury (Part 2 of 2), A History of A&E Performance with Steve Black, TTA Topical Anaesthetics for Corneal Abrasion and New Online.
A 76-year-old diabetic is referred with confusion and is being treated for a UTI. She is tachycardic and drowsy, is there more than sepsis?
Wounds abound in your ED, but who needs ‘a tetanus’?
A 30-year-old post-partum patient with post-natal depression is referred to the ED following a witnessed seizure and confusion.
A 35-year-old lady is brought to the ED by her husband after developing acute confusion, vomiting and unsteadiness on her feet.
This month we have: EM ETCO2 at triage, Nitrous Oxide Toxicity, Horizontal or vertical for LP, Practice Changing Papers in PEM and New Online
Young male with rash dizziness and facial weakness
It's 5am. A 26-year-old is blue lighted to ED with slurred speech and limb weakness.
A 40-year-old man is brought to the ED by his partner. He has had a gradually worsening headache for 10 days and intermittent vomiting for 3 days.
This session describes the management of presentations of non-traumatic subarachnoid haemorrhage in the ED.
This session describes the presentations, pathophysiology, management and treatment options for multiple sclerosis relevant to ED.
This module describes the presentations, pathophysiology, management and treatment options for multiple sclerosis relevant to ED.
Describing the initial management of tetanus in the ED.
Describing the initial management of tetanus in the ED.
An older patient with acute onset of vertigo. How do you decide if it’s peripheral or central vertigo?
The case of a patient presenting with neck pain, headache and weakness following a road traffic collision 3 weeks previously.
This module is largely concerned with the cardiac causes of ST segment elevation unrelated to acute myocardial infarction (AMI).
This month we discuss: Using lactate to diagnose seizures, Non-fatal strangulation, Impact of familiarity on performance and New Online.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
Elderly lady presenting with abdominal pain and fleeting left upper limb weakness.
This month Noel and Stephen discuss diagnostic performance of S100B as a rule-out test for intracranial pathology in head-injured patients presenting to the ED who meet NICE Head Injury Guideline criteria for CT-head scan, and Graham discusses Paediatric acute non traumatic limp.
A 55-year-old man is brought in with fatigue and headache.
A young lady presented with abdominal pain, lethargy, (Groin) bone pain, depression and headache.
A 3-year-old boy presents with a 6-day history of vomiting and “stillness”.
A 77-year-old gentleman presents to the ED five days after his endoscopic endonasal transsphenoid resection of his pituitary adenoma with a severe frontal headache, fever and multiple episodes of vomiting.
Another pain in the back SBA
It all started with a headache…
A woman presents with 10/10 eye pain. Consider what could be going on, rule out the red flags and address her urgent concerns!
A 59-year-old man presents to the ED at 11pm with acute onset severe (9/10) generalised headache and vomiting, which started at the dinner table at 5pm.
This month we have Neutrophil: lymphocyte ratio in septic arthritis, NICE SAH and New Online.
A woman presents with an unusual cause of ophthalmic symptoms.
The unspoken disease of inflicted, non-accidental injury in children.
A 14-year-old boy has been brought to the ED with a headache that has been ongoing for the last few days.
An elderly woman attends with a vague history of weakness and confusion but an unremarkable clinical examination. How will you proceed?
An elderly lady attends the ED unaccompanied in the middle of the night. She is very confused, agitated and becomes aggressive towards the staff.
A 29-year-old woman attends your ED for medical clearance before further treatment by her Mental Health team. She has a seizure before you review her.
A 12-year-old girl is brought by her parents with a 1-day history of fever and lethargy, associated with a rash that has rapidly developed over the last 3 hours.
A 73-year-old male presents to ED with sudden, painless vision loss in left eye.
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.
A 9-year old boy with known sickle cell disease who suddenly cannot move his right arm and leg.
A woman with diplopia needs your help. Can you identify the cause and include or exclude any red flags?
Vertigo is a common problem which affects 5% of adults in any one year. Consequently, it is a frequent presenting problem to the ED
Vertigo is a false perception, experienced by the patient, of rotation or movement of the external world or of the individual in space.
An 8-year-old girl is brought into the ED with a head injury. She was out sledging with her family when she lost control and collided with a tree.
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.
A 40-year-old female is brought in by ambulance having collapsed. She has vomited several times.
A 21-year-old female presents to the ED with reduced level of consciousness. According to her family, she has been unwell for the last 3-days complaining mainly of headache. After having slept all day yesterday, her mother tried to wake her up this morning but she was unawakening from sleep.
A 75-year-old man presents to the ED claiming he ‘just doesn’t feel right’. You are called urgently to assess him.
A young man presents with fever, headache, photophobia and vomiting. Can you interpret the findings to diagnose and treat him appropriately before it’s too late?
Functional Seizures aren’t managed with benzodiazepines – but how do you tell functional seizures from epileptic ones?
Elderly male with chronic kidney disease presents to ED department with acute onset of confusion and twitching at the end of his dialysis.
A 72-year-old female presents to the ED with a four week history of worsening neck pain, lethargy, reduced sensation and difficulty with fine motor movements in her upper limbs.
A 51-year-old female presents with sudden onset epigastric pain and FAST +ve symptoms.
A 27-year-old single Caucasian male attends the ED after an episode of paralysis of his limbs at home.
Diving-related problems can present in many ways and their appropriate and timely management is essential for good outcomes and patient safety.
Diving-related problems can present in many ways and their appropriate and timely management is essential for good outcomes and patient safety.
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 27-year-old female has presented with recurrent headaches, worse in the morning.
A 20-year-old female was brought into the ED as a pre-alert call. She had been found unresponsive in her room at a psychiatric unit.
A woman in her 50s presents with sudden onset nausea and vertigo.
Nerve entrapment syndromes are a group of conditions in which peripheral nerves are damaged, through compression or repeated trauma.
Nerve entrapment syndromes are a group of conditions in which peripheral nerves are damaged, through compression or repeated trauma.
A 25-year-old male presents with a five day history of bilateral muscular leg pain.
This blog article aims to consolidate several resources and anecdotal practice around functional seizures.
A gentleman presents with loss of power and sensation to his left side, slow speech and facial droop; CT brain is normal.
This month we have New in EM - IV lines in axillary node clearance, Guidelines for EM - Headaches, New in EM - The RePHILL trial
Can you recognise acute kidney injury and prevent its deadly complications?
A 50-year-old female presents to the Emergency Department with non-traumatic neuropathic sounding upper limb pain.
An asylum seeker presents to the ED with a chronic headache prompting questions of finance, logistics and follow up from the staff.
A 57-year-old gentleman self-presents to the ED with a 1-hour history of headache and chest pain.
Magnetic resonance imaging (MRI) is rarely used in most EDs. However, the properties of such images can provide emergency physicians with critical information to support the optimal clinical care of many neurological disorders.
Acute, severe headache is a common symptom of patients presenting to the emergency department. In 90% of cases, the cause will be one of the primary headache syndromes.
Acute, severe headache is a common symptom of patients presenting to the emergency department. In 90% of cases, the cause will be one of the primary headache syndromes.
Recognising the clinical features of invasive meningococcal disease in children
Recognising the clinical features of invasive meningococcal disease in children
The seizing child is truly a scary thing to behold. If you work in the Paediatric ED, you will, at some stage, come across a child who has had a seizure, is recovering from a seizure, or is actively seizing
Abdominal pain is a reasonably common presentation in paediatrics-increasing as the child gets older
Transient Ischaemic Attacks
Transient Ischaemic Attacks
A 45-year-old male presents to the ED with a 3-day history of progressive weakness in his right upper and lower limbs. On examination there's observed ataxia and ocular involvement only had developed within the last 24 hours.
The paramedics arrive with a 3-year-old boy who has had two seizures today. He has known developmental delay but has no history of seizures previously
GBS is now thought to be a group of phenotypically similar disorders. Degeneration of the axon can occur as well as demyelination of the nerve sheath.
Describing the classical presentations of Guillain-Barre Syndrome (GBS)
An elderly man presents to the emergency department with dizziness associated with movement of his left arm.
This session looks at the assessment and management of acute facial palsy.
A 58-year-old man presents to the Emergency Department with progressive weakness and recurrent falls of unknown cause.
Myasthenia gravis does not present often to the Emergency Department. However, it can manifest as respiratory failure
Myasthenia gravis does not present often to the Emergency Department. However, it can manifest as respiratory failure
A 22-year-old healthy male attends ED with sudden onset of headache. He reports taking 100 mg Sildenafil before the headache started. On examination there is right arm weakness.
Outlining the epidemiology and pathophysiology of stroke
A 70-year-old male is brought to the Emergency Department by ambulance complaining of dizziness and generalised weakness following a fall.
This session aims to illustrate, through a series of clinical cases, the common presentations and complications of acute kidney injury (AKI).
A 35-year-old presents with paraesthesia and weakness in both lower limbs.
Peripheral neuropathy is a pathological process affecting a peripheral nerve or nerves (includes cranial nerves).
This session describes the most common childhood exanthems that present to emergency departments
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!
Status epilepticus, a state of prolonged, uncontrolled seizures, is a common emergency department presentation that is potentially life-threatening. Clinicians need an awareness of the existence, and presentations, of the different forms
Status epilepticus (SE), a state of prolonged, uncontrolled seizures, is a common emergency department (ED) presentation that is potentially life-threatening.
We at TERN Education are keen to help you all learn how to critically appraise a paper. In order to do this we will be producing monthly 'virtual' journal club modules on RCEM Learning. It’s basically a critical appraisal paper that you can do in your own time during the month! It gives you the opportunity to practice and learn critical appraisal in a relaxed environment and you get a certificate for the old portfolio!
Back pain is common: it is estimated that 60-80% of the population have back pain at some time during their life.
While working in the minors area of a busy teaching hospital's ED, a somewhat flustered junior doctor approaches you to confess her actions.
Cranial nerve injuries are important clinical signs, which alert the examiner to intracranial pathology. This session will look at the more common traumatic and medical causes of cranial nerve injury
A 69-year-old lady presents with a 3-week history of right sided headache and jaw claudication, associated with significant reduction in vision of the right eye for 2 days.
A healthy 25-year-old presents to the emergency department complaining she cannot text on her phone
A 49-year-old man is brought to the ED by ambulance after waking this morning with severe vertigo.
This session will focus on secondary causes of acute severe headaches that are likely to present to an emergency department.
Bell's palsy is a relatively uncommon condition presenting to primary care. Despite a benign course for most children with Bell's palsy, there are a number of serious causes of facial paralysis which can be easily missed
Bell's palsy is a relatively uncommon condition presenting to primary care. Despite a benign course for most children with Bell's palsy, there are a number of serious causes of facial paralysis which can be easily missed.
A 46-year-old female patient presents as she keeps falling over and is no longer able to feed herself
A 34-year-old female presented to the emergency department with a 3-day history of left ear pain, without discharge or tinnitus.
A 65-year-old male presents to the emergency department (ED) by ambulance with an episode of collapse.
A 42-year-old man presents to the Emergency Department at 4am with a severe headache. He is pacing up and down and says that he has been woken up by a similar headache every night for the last 4 nights.
A case of Ataxia and weakness of limbs in a teenage male
A 31-year-old female presented to the emergency department complaining of a dilated left pupil that had been noticed by a colleague at work.
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 patient starts seizing in your ED, standard management is commenced but the cause and management may not be so straightforward.
Cranial nerve injuries are important clinical signs, which alert the examiner to intracranial pathology. This session will look at the more common traumatic and medical causes of cranial nerve injury to cranial nerves
A 30-year-old lady presents to the ED feeling "numb from the waist down".
21-year-old female with headache and visual disturbances
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
CNS infections are relatively rare, but form a very important differential diagnosis in the unwell patient presenting to the ED.
Intracranial infections (also called central nervous system infections or CNS infections) are relatively rare, but form a very important differential diagnosis in the unwell patient
A 40-year-old man had a seizure which was witnessed by his wife; she reported that he was unresponsive and all limbs were shaking
This session will deal with the assessment and management of alcoholic liver disease.
4am and a trauma call for an intoxicated 45-year-old man who has tripped and fallen into a lamppost, hitting his head.
This month we have BET 2: Is keeping the eyes shut while fitting predictive of a psychogenic cause for seizures? And initial focused assessment with sonography in trauma versus initial CT for patients with haemodynamically stable torso trauma
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?
A 60-year-old man presented to the emergency department with a 1 week history of increasing lethargy, intermittent tingling in both arms and palpitations
This iBook (in conjunction with a series of associated clinical cases) is another manifestation of the heterogenous learning communities which constitute EM.
This month we have Guideline CVA part 2 | Paper 1 - New in EM cervical artery dissection | Belfast CPD 2019 Acute Ophthalmology | New in EM: NACSTOP trial - early cessation of NAC in paracetamol OD | EMEC Anu Mitra
What went wrong for a child who picked up Lymes’ instead of limes?
This months podcast has Belfast 2019 CPD - Leadership | Belfast CPD 2019 End of life care | New in EM: Rethinking IV Size & Location for CTPA | EMEC Jon Carter | Belfast CPD 2019 Top Paeds Papers | Guideline NICE CVA and TIA (part one TIA)
A previously healthy 28-year-old male accountant presents to the ED with pain in his left eye.
A 4-year-old boy is brought to your ED by his parents. Two hours previously he had been on the back of a horse being led from the field to the tack room before going out for a ride.
I remember the excitement in the room at the European Society of Emergency Medicine (EuSEM) conference in September 2018 as the room waited to hear the results of the EcLiPSE trial
This months podcast features Angio following cardiac arrest | Vertigo | Bag Mask Ventilation in RSI | LGIB | and IAEM PoCUS Erector Spinae Block
FRCEM Primary Examination Single Best Answer
March 2019 Podcast
FRCEM Primary Examination Single Best Answer
Alcohol withdrawal is a common presentation to UK EDs and patients can present significant management challenges to clinicians.
This module describes the management of presentations of non-traumatic subarachnoid haemorrhage in the ED.
This session looks at the assessment and management of acute facial palsy.
Alcohol use disorder (AUD) is defined by the World Health Organisation as consuming more than 40g/day of alcohol for males and 30mg/day of alcohol for females
Middle aged man with left sided headache and horners syndrome.