A 30 year old bricklayer has fallen 3m off scaffolding onto the hard ground below and has been unable to mobilise since the incident. The patient presents complaining of back pain with associated altered motor function and sensation to his lower limbs. He is GCS 15 and his vital signs read a BP 80/40 mmHg, Heart Rate 47bpm, Oxygen Saturations of 100% on room air and his temperature is 37 degrees Celsius. He has warm hands and feet. On examination you notice that power of his lower limbs is 0/5 in all myotomes and he cannot appreciate sensation below the dermatome level of T4.
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It’s 4:20am on a night shift, and you’ve finally caught up with the waiting patient list. Just as you’re thinking about where you could source some caffeine, you see a 26 year old male come up on the screen. The triage note reads: “2/7 epigastric pain, can’t sleep tonight”. You barely get a chance to chart the pink lady when a nurse places a venous gas result in front of you.
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Unlock the secrets the ACEM Exams
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Imagine you’re on for resus in the middle of a night shift and you receive an alert for a shocked diabetic male with respiratory sepsis and DKA who has been intubated and will be arriving soon. Your initial reaction to this news probably wouldn’t worry you too much (aside from how severe the DKA must be to lead to a tube) knowing that the hard work has been done pre-hospital until the paramedic ends the call with a very casual, “Oh by the way the patient is 280kg.”
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We will review 3 papers today, covering topics of effectiveness of three antiepileptic drugs in treating toxin-related status epilepticus, use of Kelly clamps vs fine artery forceps in decompressing traumatic pneumothorax and haemothorax, as well as implicit gender bias during procedural competency assessments of emergency medicine trainees.
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Welcome to our Unlocking the ACEM Exams blog posts where we unlock the key study habits, resources and top tips from recent successful exam candidates. This week we go to to sit down with Dr Holly Bannon-Murphy who recently completed a successful sitting of the ACEM fellowship written exam (2022.1). Holly outlines some of her key tips to success in this post.
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A 72-year-old man presents to the emergency department with persistent hiccups for 4 days. As you walk over to his cubicle, you think back to all the different ways you’ve tried to cure your own hiccups. What does holding your breath, drinking water upside down and getting frightened have in common anyway?
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A young footballer has injured their knee playing football? Do they need an X-ray and can you interpret the key findings?
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While recent cases of Japanese Encephalitis have caught headlines, I recently stumbled across a disease I was embarrassed to say I had never heard of…
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The Journal Club Podcast for June 2022. Listen to the podcast and have a read of our summary below, courtesy of our senior registrar for research, Dr Bertha Wu.
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A 22-year-old female medical student attends the emergency department. She is unable to close her mouth after yawning in one of her biochemistry lectures. She is in some distress and is struggling to speak clearly.
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