Do you know when a patient needs an emergent fasciotomy for a compartment syndome? Which compartments are most likely to be affected? What injuries are most likely to result in a compartment syndrome? How do you measure comparent pressures?
All your questions are answered in this lovely review article from Sigamoney et al.
The 2015 AHA and ERC guidelines have been released. The Australian Resuscitation Council has released a statement indicating their final guidelines will be released in December. In the interim, the AHA Highlights document, albeit long, does give a good update on the changes that have occured since the 2010 guidelines with simple explanations for these reasons behind these changes.
Isbister et al have published a summary with 2 case reports on funnel web spider envenomation. It’s an excellent refresher on the features of funnel web envenomation and a good update on the treatment modalities that can used in this life-threatening presentation.
A fit and well 70 year old man comes to your ED with a couple of weeks of exertional breathlessness. Last night he had some brief heartburn. He feels fine currently.
This is his ECG:
What is the significance of this ECG?
A woman in her 60s is referred to your ED with altered colour vision, nausea, and bradycardia.
Her ECG is as follows:
What could be the cause of these symptoms and ECG changes?
What would be your approach to the management of the patient?
A 50 year old male presents to your ED by ambulance with a 3 hour history of progressively severe central pain which is pleuritic and radiating through to his back. He has had a history of a provoked PE over 2 years ago. He is brought to your resus area after the nurse-in-charge has noted that “he doesn’t look good”.
His vitals are normal however he is diaphoretic and clearly in pain. His cardiac, respiratory, and gastrointestinal exams are normal.
His initial ECG is:
Repeat ECGs over the next 20 minutes remain unchanged from the above. CXR is also normal.
What is your differential at this juncture and what are your next steps?
His story continues here.
Bedside ultrasound is commonplace in the ED having started with the FAST scan (first used in the 70s in Europe) and now encompassing a range clinical conditions that can be assessed at the bedside with the ultrasound machine becoming an extension of the physical exam.
This post from Academic Life in Emergency Medicine highlights the utility of occular ultrasound in the ED. Like fundoscopy it is an acquired skill that needs practice, however compared to fundoscopy it can help us arrive at a diagnosis more quickly and confidently.