Search

Procedural Sedation in the Emergency Department – Guideline

Best practice standards for safe procedural sedation. Includes choice of pharmacological agents and suggested doses. Sets out recommended staffing, competencies, monitoring, location, and discharge criteria.
This month we are discussing paed nail bed repair, Sickle Cell Disease, James Lind Alliance Priority Setting Partnership for Major Trauma and New Online.
This session provides training in chest drain insertion. It looks at the indications for carrying out this procedure, as well as how to prepare for it, and shows a chest drain being inserted. Post-procedure management and complex cases are also covered
This module provides training in chest drain insertion. It looks at the indications for carrying out this procedure, as well as how to prepare for it, and shows a chest drain being inserted. Post-procedure management and complex cases are also covered.
This session describes the processes around Information Sharing to Tackle Community Violence. It also describes some of the responsibilities of emergency clinicians around confidentiality when looking after victims of violence.
This module describes the processes around Information Sharing to Tackle Community Violence. It also describes some of the responsibilities of emergency clinicians around confidentiality when looking after victims of violence.
In the past, paediatric lacerations requiring sutures often required admission and a general anaesthetic for wound closure. This blog looks at how we can provide timely, cost effective and acceptable management in the ED that avoids this paradigm.
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.
A man in his 20s attends the ED after injuring his foot while playing football.
A 23-year-old male was playing rugby 4 days ago. He was touching down in his in-goal area for a 5-metre scrum when he was kneed in the back towards his left side.
This 18-year-old patient was allegedly punched by a stranger during a night out.
This session will cover the practical aspects of safe insertion of chest drains.
This session covers the practical aspects of safe insertion of chest drains using videos to provide guidance. It covers both the Seldinger technique and the open approach to chest drain insertion.
This month we have Ketamine and Ondansetron, Hyperemesis Gravidarum, an interview with Vicky Price (SAM), Antibiotics for brain injury and New Online
Abdominal wall bruising in a 9-year-old girl following a car vs car road traffic accident.
Principles of consent in view of recent case law
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
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.
Patients with head injuries are the most common type of trauma seen in the Emergency Department and can represent up to 10% of all presentations.
This mont we have POCUS for paediatric wrist fractures, NICE Guidelines on TLOC, Interview with GP Steve Taylor, Removing Penicillin Allergy labels & New Online
A 60-year-old female patient presents to the ED with gradual-onset right-sided thigh and hip pain.
Walk into any Emergency Department in the country and you are bound to find at least one child waiting to be seen with a head injury.
Walk into any Emergency Department in the country and you are bound to find at least one child waiting to be seen with a head injury - it's one of the commonest presenting complaints to EDs in the UK
A 53-year-old lady with MS presents with left hip and pelvic pain after a fall.
A man in his 40s arrives in the Emergency Department with a deformed foot and ankle after falling off a motorised skateboard.
A 27-year-old male cyclist presents with an isolated fractured left femur, having been hit by a car.
A 51-year old man presents at 3am to the Emergency Department with severe pain in his left arm.
A 5-year-old boy presents with a central boggy swelling to his forehead without history of trauma, what’s the differential?
A 35-year-old woman is brought to the ED after being involved in a road traffic collision.
This month we have INTERACT 3, British Thoracic Society - Pneumothorax, PERUKI Update, UK-Med Experiences in Ukraine with Dave Clarke, New Online.
Another faller presents to your ED Confused and smelling of alcohol. What will you do? How can you avoid missing the common pitfalls?
A 14-year-old footballer is brought in with a shooting pain in his hip developed whilst shooting at goal.
This is the second blog in our public health series. Keep your eyes peeled for more public health goodness to follow in future blogs.
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.
An 80-year-old woman presented to the ED at 2am with acute chest pain and shortness of breath.
This session presents a logical approach to the assessment, diagnosis and management of soft-tissue hand injuries in the ED, including suggested indications for early hand specialist referrals.
This module presents a logical approach to the assessment, diagnosis and management of soft-tissue hand injuries in the ED, including suggested indications for early hand specialist referrals.
A 23-year-old man presents to the ED following a rugby tackle with left rib pain.
A 37-year-old male maintenance worker presents following a 440 volt electric shock with entry in the left hand.
You are asked to see a 21-year-old student who cycled into a lamp post whilst intoxicated last night.
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.
Susie and Raj discuss the evaluation of microMend wound closure device in repairing skin lacerations.
A 20-year-old man is brought in by ambulance following a motorcycle accident.
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.
Understanding mechanism of injury is a crucial aspect of managing patients who have suffered traumatic injuries. This module aims to provide an overview on attaining this information and its translation into patient care.
Understanding mechanism of injury is a crucial aspect of managing patients who have suffered traumatic injuries. This session aims to provide an overview on attaining this information and its translation into patient care.
A low impact fall in a 64-year-old woman has caused her medial thigh pain. What injuries has she sustained?
A 9-year-old girl attends the ED with a three day history of left wrist pain.
Elbow injuries are a common presentation to the paediatric emergency department.
The emergency nurse practitioner shows you these x-rays. This injury happened today, the skin is intact
32-year-old presents to Resus with multiple stab wounds and breathlessness.
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.
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.
Adult Trauma Call: Management of a 28-year-old male with a knife wound to the chest.
This month we have: EM ETCO2 at triage, Nitrous Oxide Toxicity, Horizontal or vertical for LP, Practice Changing Papers in PEM and New Online
A handy reminder that not all carpal bone fractures involve the scaphoid bone.
A 15-year-old twists his ankle while skateboarding.
This month we’ve got two New in EM segments: which shoulder relocation technique is best & the use of TXA in haemoptysis. We also speak with Tessa Davis of Don't Forget The Bubbles fame and her top tips for delivering teaching online. We then speak to Evan Bayton about the RCEM Coat of Arms and what on earth it all means, and then end the podcast with New Online.
A delayed presentation after trauma with an increasing joint swelling, what gives?
A child presents following a fall from a slide.
This month Graham talks to our very own Rob Hirst about establishing the research priorities of emergency medicine trainees, patients and carers across the UK and Ireland: the TERN Delphi study. Then Susie Roy discusses Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis.
A 52-year-old male complains of a mass at the base of his neck following a fall from his mountain bike.
Nikki Abela and Liz Herrieven have treated themselves to the RCEM PEM Conference in Manchester on 21/3/2023 – World Down Syndrome Day. Put on your #LotsOfSocks for the day and have a read to see what they learned.
Harry is a 2-year-old boy who presents to the ED with a one day history of a limp.
30 questions. 30 minutes. Test yourself against your colleagues!
A child presents following a fall from monkey bars with a sore elbow.
The case of a patient presenting with neck pain, headache and weakness following a road traffic collision 3 weeks previously.
A 30-year-old patient presents having fallen on an outstretched hand.
A young lady presents with shoulder pain, for which there are multiple differential diagnoses. How do you differentiate between them in order to manage her effectively?
A 29-year-old male attends with left knee pain having been hit by a slow-moving car 2 days earlier.
A 56-year-old plumber attends with lower back pain and urinary incontinence.
The use of FI blocks in the emergency department has been shown to provide effective pain relief in the acute setting and to reduce the use of opiate analgesia.
The use of FI blocks in the emergency department has been shown to provide effective pain relief in the acute setting and to reduce the use of opiate analgesia.
Radiation can be subdivided into two categories - ionizing and non-ionizing, both of which have an effect on human tissue
A patient presents after falling backwards onto an outstretched right hand.
It is Saturday night and your next patient is a 28-year-old man who has been assaulted earlier that evening.
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.
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.
Learn the causes and management of a painful & swollen digit.
A 14-year-old girl is haemodynamically unstable following an RTC.
A hockey player attends having injured his ankle.
A 45-year-old man attends the ED 3 days after a motorbike accident.
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.
A 21-year-old man presents with a chainsaw injury to his neck on the left side.
This session covers the assessment and management of patients presenting to an emergency department with electrical injuries.
This session covers the assessment and management of patients presenting to ED with electrical injuries.
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.
Refresh your knowledge on this latest outbreak.
Test your knowledge on managing an animal bite!
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.
Local anaesthetics are amongst the most widely used drugs in any emergency department. It is, therefore, essential that emergency medicine clinicians can use these drugs safely and effectively.
Struggling to negotiate CT imaging requests for your paediatric patients? Let the guiding principles of ALARA come to your rescue!
This month we discuss Laryngospasm in paediatric sedation, Case Based Discussions, Use of Non-Sterile Gloves for Wound Closure, and new online material from RCEMLearning
This month Noel and Stephen discuss paediatric fractures.
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.
A 23-year-old male presents to the ED on a Friday night with a punch injury to the face.
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.
Ten SAQs on knee injuries. Each SAQ has a knee x-ray image to interpret and questions on ED management of the injury.
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.
This month we discuss Mid lines vs PICC, Scaphoid Fractures, The FORCE study, RCEM Induction, New online
This man presents to his GP after an alleged assault. His knee is examined by the GP and he is sent for an X-Ray.
Cervical spine immobilisation is the most commonly performed procedure in pre-hospital care
Patients with head injuries are the most common type of trauma seen in the Emergency Department and can represent up to 10% of all presentations.
This month we have CTCA for chest pain, HSIB in the Guidelines for EM, chest tube size in trauma and a review of new RCEMLearning material
A 40-year-old man is brought to the ED after being hit on his right hand side by a car travelling at approximately 20 mph.
A lady of 24 years presents to the ED with Flash burn.
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.
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 43-year-old male truck driver presents to the ED with pain on walking after jumping out of his truck.
A 27-year-old male has self-presented to your ED with acute onset of shortness of breath and severe pain to the right side of his chest.
A patient was pulled over from standing. He now has a painful swollen knee and is unable to weight-bear – what have they done and how can we help?
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 minor injury with a major complication: applying clinically orientated anatomy in the ED.
3-year-old with a head and arm injury following an accidental fall.
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
A 45-year-old male patient presents to the Emergency Department having fallen on his outstretched hand.
A 12-year-old boy attends the ED with left knee pain and swelling while playing at school.
Elbow injuries are common and acute elbow trauma accounts for 2-3% of all visits to the emergency department.
This session covers the assessment and management of acute elbow injuries commonly seen in the emergency department
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.
An 11-year-old girl presents to Paediatric A&E complaining of left knee and thigh pain.
A 32-year-old male presents to the ED following a fall on his outstretched left hand from a height of 1.5m.
It's safe to say you will likely see a few of these, as minor injuries are a very common occurrence in childhood with around 20-30% of all paediatric attendances to the Emergency Department involving minor injuries or trauma
This session covers the diagnosis and initial management of a patient with acute limb ischaemia.
This session covers the diagnosis and initial management of a patient with acute limb ischaemia.
Paediatric injuries can be very different from those sustained in adults in many respects. This session discusses why this is the case and outlines the general principles of treating paediatric injuries.
Paediatric injuries can be very different from those sustained in adults in many respects. This session discusses why this is the case and outlines the general principles of treating paediatric injuries.
Managing the paediatric c-spine
A 58-year-old right handed man bitten by a dog 7 weeks prior, presents to your ED for a 3rd time with the sensation of a foreign body in his finger
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 29-year-old farmer presents to your local ED with a bite mark over the upper left calf.
Serratus anterior plane block can be used as multimodal analgesia for anterior lateral rib fractures in the trauma patient. This module outlines the ultrasound guided technique.
Serratus anterior plane block can be used as multimodal analgesia for anterior lateral rib fractures in the trauma patient. This module outlines the ultrasound guided technique.
A 40-year-old female presents with bilateral lower limb weakness and sensory loss
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.
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.
A young man presents with superficial wounds on his forearm from a dog bite. You know what you have to do. Clean the wound, give a tetanus shot and prescribe antibiotics…. Right?
Cervical spine injuries are rare but potentially devastating. Immobilisation of the cervical spine on the slightest suspicion of injury is recommended by most resuscitation courses.
FAST involves assessment of the peritoneal cavity, pleural cavity and pericardial space. Learning that free fluid is present facilitates the most appropriate management plan
A 21-year old male has been stabbed outside of a night-club.
Buckle / Torus fractures in children
We perform fascia iliaca blocks with ease… but do you really remember the anatomy?
A 46-year-old female, seen with her daughter, presents to the Emergency Department with a tick embedded in right upper chest wall.
This learning session focuses on improving the practitioners' skills and knowledge of wound management in an emergency department setting
This learning session focuses on improving the practitioners' skills and knowledge of wound management in an emergency department setting
Imaging and management in paediatric trauma
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 miscellany of paediatric procedures
A 70-year-old male is brought to the Emergency Department by ambulance complaining of dizziness and generalised weakness following a fall.
This SBA addresses an important time-critical complication of wound infection where early diagnosis and management can save a patient’s limb.
A 92-year-old man attends the emergency department complaining that his right shoulder "looks a funny shape".
This session will describe calcium homeostasis. It will also examine therapeutic uses of calcium and discuss the disturbances of hypercalcaemia and hypocalcaemia.
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.
Most of us are convinced that fascia iliac blocks for pain relief are fabulous. Models to teach and practice on can be expensive. Inspired by one of the ED registrars I work with, Dr Grace O’Connell, I am going to show how to make a simple model for simulating going through the fascial layers at the hip.
This session describes the most common childhood exanthems that present to emergency departments
Explore the NICE guidance on wound management of dog bites (NICE CKS and NICE Guidance)
A 20-year-old man presents after injuring his knee in football. He describes a tackle and varus stress on the knee.
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.