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Lightning Strike Injury

Learning about lightning injuries
A 47-year-old man presents to the ED after being thrown off his horse.
During Summer storms, lightning strikes can cause fatalities …but what happens to the survivors?
An 18-year-old female is brought into the ED following a head-on collision with another car with a combined speed of approximately 100mph.
You are assigned to perform an echo in life support on a 45-year-old patient with a witnessed out-of-hospital cardiac arrest.
This session concentrates on patients with actual or impending cardiopulmonary arrest.
A 4-year-old girl fell whilst playing in the playground on a metal slide and sustained a 3cm open wound to her left cheek and upper lip.
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.
The infant who nearly died in her parent’s arms.
A 4-year-old girl presents to the Emergency Department with a four-day history of fever and sore throat.
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.
An unusual presentation of chest pain to the emergency department following substance abuse at a party.
Angioedema and Urticaria (hives) are part of a spectrum of allergic symptoms and occasionally have a non-allergic aetiology.
This blog looks at RSI from the eyes of the “assistant” - this might be the resus nurse, the ED FY2, or a non-airway trained ED registrar. Please send your thoughts, feedback and comments.
A 35-year-old woman is brought to the ED after being involved in a road traffic collision.
Ultrasound in shocked patients. This competency is specifically for Higher Specialty Trainees. It is also useful for interested Core Trainees.
You receive a pre-alert for a 30-year-old female who had chest pain earlier that morning.
A 66-year-old man falls 6 feet from a step ladder on to concrete. On scene he is haemodynamically stable, his GCS is 15 and he is moving all 4 limbs.
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,
An 85-year-old lady is brought in after an unwitnessed fall in a care home complaining of right wrist pain. She has obvious facial bruising.
This month we discuss the SQUID protocol for DKA, Concussion Guidelines, The Physiologically Difficult Airway and New Online.
A 43-year-old cyclist arrives after being struck by a car. He arrives with spinal immobilisation on a scoop stretcher with evidence of bruising to the right chest, abdomen, and pelvis.
For each life-threatening thoracic injury this session includes: a definition and context, Clinical assessment , treatment and Key learning points.
This session is the second one in the series dealing with thoracic injuries.
This module is part one of two dealing with thoracic injuries. It is pitched at FRCEM examination standard and you are expected to be competent at leading a trauma response.
A Middle-aged man presents to the ED with Epigastric discomfort associated with multiple episodes of vomiting.
We’ve talked a lot in RCEMLearning blogs about how to recognise death in ED and how to break bad news, but we haven’t really focused on how to legally “declare” someone as dead, and complete the relevant paperwork. It is through researching updates to my trust’s policy, together with making sure our international medical graduates were aware of the UK rules, that this blog post was born.
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.
32-year-old presents to Resus with multiple stab wounds and breathlessness.
Tracheostomy emergencies are a relatively common and often alarming occurrence – do you know how to manage a patient presenting with a tracheostomy emergency?
This month we have: TXA in trauma revisited - the PATCH Trauma trial, Head injury, HALO procedures with Joseph Mathew and New Online.
This session covers the assessment, treatment and management of patients presenting to the ED with primary blast injuries.
This module covers the assessment, treatment and management of patients presenting to the ED with primary blast injuries.
EM/PHEM resuscitation during an observer shift
A patient having a large laceration sutured suddenly goes into cardiac arrest.
A 77-year-old man presents with haemoptysis and shortness of breath.
This month we discuss Bystander cardiopulmonary resuscitation and cardiac rhythm change over time in patients with out-of-hospital cardiac arrest, Spiking and Blunt chest wall trauma.
A 78-year-old gentleman is wondering if he needs antibiotics for his worsening shortness of breath. His only past medical history is a maxillofacial tumour that was surgically resected a year ago. Is this a simple chest infection?
Adult Trauma Call: Management of a 28-year-old male with a knife wound to the chest.
Management of Hypothermic Cardiac Arrest
A 71-year-old man with a history of chronic obstructive pulmonary disease, obesity, angina and ankylosing spondylitis presents to the ED acutely short of breath.
Management of Cardiac arrest in advanced pregnancy.
A 4-year-old child is brought into your resuscitation room with difficulty breathing.
A 52-year-old male complains of a mass at the base of his neck following a fall from his mountain bike.
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.
A 9-week-old female infant presents to Paediatric A&E at 2200 hrs with a history of coughing, difficulty in breathing, lethargy and reduced feeding.
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 patient presents with suspected aspiration but turns out to have something even more concerning.
An 8-month infant is brought into the ED following a collapsing episode as witnessed by his distress mother. What do you do next?
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.
Another pain in the back SBA
A 2-year-old boy is brought to the ED at 2 am with noisy breathing and a barking cough.
A woman presents with 10/10 eye pain. Consider what could be going on, rule out the red flags and address her urgent concerns!
The physiological effects of hypothermia mean that the management of cardiac arrest requires an altered approach.
The physiological effects of hypothermia mean that the management of cardiac arrest requires an altered approach.
This session is an overview of Sudden Unexpected Death in Infancy and Childhood (SUDIC); the risk factors associated with SUDIC, our role in the ED and the investigative process thereafter.
This session is an overview of Sudden Unexpected Death in Infancy and Childhood (SUDIC); the risk factors associated with SUDIC, our role in the ED and the investigative process thereafter.
RCEM, Advanced Life Support, ALS, shockable rhythm, non- shockable rhythm, cardiac arrest, resuscitation, resus.
30 questions. 30 minutes. Test yourself against your colleagues!
A 45-year-old female attends with grossly swollen lips. She has some important information about her symptoms, can you understand it? моє обличчя опухло! If not, it’s time to use some clinical acumen!
A 16-day-old baby, who has had an uneventful antenatal period, presents with coryza, with some blood streaking in this. His symptoms progress over the coming days to uncover another more subtle diagnosis that may not be considered without a thorough and detailed assessment.
A 72-year-old gentleman, who has not seen a doctor in decades, presents with dyspnoea and acidosis with increased work of breathing.
A patient with a bee sting complains of chest pain and has ECG changes, what are you thinking?
A 14-year-old boy has been brought to the ED with a headache that has been ongoing for the last few days.
A stinging tale of paediatric anaphylaxis, with the added buzzzz of pre-hospital emergency care.
This session is about the assessment and complex management of patients with pelvic injury in the emergency department.
This session is about the assessment and complex management of patients with pelvic injury in the ED.
A 14-year-old girl is haemodynamically unstable following an RTC.
This session covers how to diagnose, assess and manage a patient with chronic obstructive pulmonary disease (COPD).
This module covers how to diagnose, assess and manage a patient with chronic obstructive pulmonary disease (COPD).
A 35-year-old previously healthy male presents to the ED complaining of chest pain and breathlessness following an unknown bite.
This month we discuss IV Paracetamol, Sedation, Highlights from the Thames Valley Cardiac Arrest Symposium & New online material from RCEMLearning.
An 18-month old boy is brought in to the ED by his grandmother with a cough, mild constitutional upset and increasing stridor for approximately 12 hours. He is previously well and immunised up to date
A 21-year-old man presents with a chainsaw injury to his neck on the left side.
A 52-year-old male electrician presents in the ED with a complaint of abdominal pain.
A 54-year-old driver of a pick-up truck is involved in a head on collision with a stationary vehicle at approximately 30mph.
Preparing for exams and trying to find an SBA on organ donation? The law around organ donation has changed; refresh your knowledge with this SBA.
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)
You are met with a patient who you believe is suffering an anaphylactic reaction, however the adrenaline is not having the desired effect. Why might this be and what would you do next?
A 5-year-old girl presents with acute shortness of breath and wheeze.
A 68-year-old man attends the ED one evening with a painful right knee.
In United Kingdom, approximately 76,000 patients sustain Cardiac Arrest following a non-traumatic cause in an inpatients and out-of-hospital settings
The medical professionals have a great responsibility of ensuring the survivals of Cardiac Arrest have an excellent quality of life.
Palpitations in a young woman for the last week. Her GP says probably a panic attack. Can you stream her to the in-house GP?
Struggling to negotiate CT imaging requests for your paediatric patients? Let the guiding principles of ALARA come to your rescue!
You are asked to see a 51-year-old lady who has been taken to the resus room. The ambulance crew tell you she has taken an overdose 5 hours previously.
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.
A set of 10 Multiple choice questions to help you revise. The Questions have been selected at random covering the curriculum.
A 55-year-old woman, who is usually fit and well, is brought in on a spinal board having fallen off her bicycle whilst going downhill at high speed.
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.
Trauma Pre-alert for a 35-year-old gentleman who sustained injury to head and back after diving into the shallow end of a swimming pool.
Could this be a BRUE? A Brief, Resolved, Unexplained Event
Trauma Pre-alert for a 35-year-old gentleman who sustained injury to head and back after diving into the shallow end of a swimming pool.
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?
Life-threatening asthma and a difficult airway in a previously well patient.
There’s a lot to know about PEM. Can you answer our questions on some of the more common PEM?
Hypoxia is common in patients presenting to the ED and can be life-threatening. The differentials are wide and include cardiac, respiratory and haematological causes
Methaemoglobinaemia is a life-threatening cause of hypoxia and death but is reversible with early recognition and treatment.
A 6-month-old boy brought in because he can’t breathe.
This is the case about clinical diagnosis of Anaphylaxis and life threatening and non-life threatening mimics of Anaphylaxis
Penetrating neck wounds – how do you manage the stable patient?
This month we have New in EM - IV lines in axillary node clearance, Guidelines for EM - Headaches, New in EM - The RePHILL trial
Children present commonly to the Emergency Department with stridor. Stridor is a sign of upper airway obstruction. The ED physician must be able to diagnose, initiate treatment, appropriately investigate, anticipate and manage complications
Don’t trip yourself up in patients with trauma and neurological symptoms.
Before bedtime, 3 children were playing with matchsticks in their upstairs bedroom. They had made a tent earlier that evening using their bed linen and were inside, surrounded by their cuddly toys
An anxious 45-year-old male presents to your Emergency Department with acute neck swelling.
This session focuses on the way ultrasound works and how to manipulate the ultrasound machine to obtain optimal images.
This session explores how to use point-of-care ultrasound (POCUS) to assess patients presenting with shock to the ED .
Whilst waiting in the ED relative's room, a 59-year-old woman complains of chest pain.
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.
This session will explain what is meant by the term Human Factors and describe how Human Factors affect Patient Safety.
This session will explain what is meant by the term Human Factors and describe how Human Factors affect Patient Safety.
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
An 83-year-old female presents with worsening shortness of breath over the past three days which suddenly got worse tonight.
A 6-month-old girl was brought to your emergency department by her parents with five days of gradually increasing respiratory distress.
This month we have part B of our recordings from the Annual Scientific Conference. We discuss End of life and escalation with Dr Calvin Lightbody, Organ donation in EM with Dr Katja Empson and TBI in ED with Dr Virginia Newcombe
Understanding the use of Echo in Life Support (ELS)
Managing the paediatric c-spine
At TERN Education we are keen to help you learn how to critically evaluate the evidence base behind your practice. In order to do this, we are producing monthly virtual journal club modules on RCEMLearning.
A 60-year-old man with a tracheostomy is brought into the emergency department with acute shortness of breath
You are working on a rapid response vehicle (RRV) as a part of a PHEM-rotation and attend a ‘red’ call: “3-year-old cardiac arrest. Unsupervised child fallen into outdoor pond. Not breathing. Not responsive”.
TERN Top Papers for November 2021. This month’s topic is Training and Wellbeing
The biggest cause of spinal injuries in children is road traffic collisions, particularly those with high speed, a rollover or an ejection from the vehicle, with second place going to falls in younger children and sporting injuries in older children.
This SBA will test your knowledge about bronchiolitis – are you ready?
Acute Asthma, Describing the patho-physiology of asthma, categorise the severity of an asthma attack and more
FAST involves assessment of the peritoneal cavity, pleural cavity and pericardial space. Learning that free fluid is present facilitates the most appropriate management plan
TERN Top Papers for September 2021. This month’s topic is cardiac arrest
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction characterised by rapidly developing life threatening airway, breathing and/or circulation problems usually associated with skin and mucosal changes
A case of a 3-year-old child brought in to the ED by their mum, blue and breathless.
DNA CPR confuses many but is a very important area to get right.
Your receive a pre-alert call from the air ambulance team who are bringing a 32-year-old male who has sustained a single stab wound to the epigastrium whilst outside a pub
The aim of TERN Top Papers is to highlight the top emergency care related papers for emergency physicians, keeping them abreast of the latest practice-changing studies. This month’s topic is diagnostic imaging.
A 70-year-old male is brought to the Emergency Department by ambulance complaining of dizziness and generalised weakness following a fall.
This session will cover the principal modalities used in pre-hospital communication.
This session will cover the principal modalities used in pre-hospital communication
Intubation forms an integral role in the treatment of the critically ill or injured patients presenting to the ED with a failed or at-risk airway.
Intubation forms an integral role in the treatment of the critically ill or injured patients presenting to the ED with a failed or at-risk airway.
This session is about the evaluation of arterial blood gases in the emergency department.
The aim of TERN Top Papers is to highlight the top emergency care related papers for emergency physicians, keeping them abreast of the latest practice-changing studies. This month’s Top Papers comes from the beautiful hills of Snowdonia, with the team from Bangor Emergency Department bringing you this month’s summary of important articles for your attention.
1 in 300 people will experience anaphylaxis at some point in their lives. The 2021 anaphylaxis guidelines provide an updated consensus for the recognition and management of anaphylaxis in all age groups.
A third of deaths from food anaphylaxis occur despite appropriate early management. Consequently, the RCUK have recognised a need for standardised algorithms for ongoing resuscitation in cases of refractory anaphylaxis.
A 2-year-old boy is brought to the Emergency Department with a barking cough and noisy breathing. Can you diagnose and treat him before he deteriorates?
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.
A 21-year-old woman, 27-weeks pregnant, presents with a rare but important cause of chest pain during pregnancy.
This month we discuss the Usability of EHRs
This session describes the most common childhood exanthems that present to emergency departments
A 24-year-old woman presents to the Emergency Department with increasing lip swelling over the past hour.
This month we discuss Self performed high vaginal swabs, Anaphylaxis, Canadian TIA Score, Peads Acute Severe Asthma
Anyone who has ever worked in an ED on a Friday night knows that facial injuries are a common presentation
Andrew and Graham discuss Projected paediatric cervical spine imaging rates with application of NEXUS, Canadian C-spine and PECARN clinical decision rules in a prospective Australian cohort
DNA CPR or “do not attempt resuscitation” decisions are confusing to many. If discussed sensitively and correctly, they make a huge huge huge immeasurable difference to the hospital stay of the patient, and their relatives.
Eighty percent of children presenting with an acute onset of stridor and a cough have croup
This session provides an introduction to Brief Unexplained Resolved Events (BRUEs). It covers the definition, differential diagnoses, how to stratify patients into low or high risk and the subsequent management.
This month we discuss Killer rashes-not to miss, Traumatic Eye Injury, how to distinguish Severe Drug Reactions in the ED, REBOA: What have we learnt?
While the theory contained in this session provides useful knowledge about airway management, putting this knowledge into practice requires extensive supervised practical experience.
While the theory contained in this session provides useful knowledge about airway management, putting this knowledge into practice requires extensive supervised practical experience.
An 80-year-old gentleman is brought to the emergency department after falling at home.
A 40-year-old female is involved in a head on vehicle collision at 50 miles per hour into a tree.
Patients frequently attend the emergency department (ED) with episodes of cutaneous and mucosal swelling.
The aim of procedural sedation is to relieve a patient's anxiety towards and facilitate their cooperation for a potentially painful procedure
Welcome to the second of TERN’s Top Papers. Each month, a different region review a selection of papers on a different theme each month.
A patient arrives in resus following an out of hospital cardiac arrest. He had a background of obesity and type II diabetes.
A 67-year-old man is brought into the Emergency Department with a history of fainting on the way to the bathroom in the morning.
A 6-year-old boy is brought in by his mum after becoming wheezy and short of breath.
This document covers FAST, Assessment of the Abdominal Aorta and IVC, Vascular Access and Echocardiography in Life Support.
An 18-year-old male is brought into the ED by ambulance. He was performing a BMX stunt off a ramp approximately 6 feet in the air and lost his balance, and fell to the floor landing on his right hand side, and then rolling onto his front.
A 43-year-old cyclist arrives after being struck by a car. He arrives collared and blocked on a scoop stretcher with evidence of bruising to the right chest, abdomen, and pelvis.
56-year-old presents with a bleeding base of tongue tumour. You cannot intubate and you cannot ventilate. How do you proceed?
A 62-year-old man comes into the Emergency Department in the early hours of the morning following a fall