Emergency Medicine

SAQs

Browse saqs for EM.

Cases

Browse cases for EM.

Vivas

Browse vivas for EM.

Live topics

Open a figure-rich spine

All topics

ABCDE approach

ABCDE approach to the deteriorating patient

A structured, prioritised approach to the recognition and resuscitation of the deteriorating emergency department patient — airway, breathing, circulation, disability, exposure — built on oxygen-delivery physiology, early-warning scoring, the pathophysiology of compensated shock, and time-critical sepsis care. ACEM-primary, globally tagged.

Abdominal aortic aneurysm

Abdominal aortic aneurysm (ruptured and intact)

The abdominal aortic aneurysm — the triad of sudden abdominal or back pain, hypotension and a pulsatile mass in a ruptured AAA, the permissive-hypotension resuscitation principle (do not disrupt the retroperitoneal tamponade), the clinical (not radiological) diagnosis of the unstable rupture, the immediate repair (open or endovascular), and the massive haemorrhage protocol. ACEM-primary, globally tagged.

Abdominal trauma

Abdominal trauma from blunt and penetrating mechanisms through FAST, CT and DPL; the solid organ (spleen, liver) and hollow viscus injuries; non-operative management with observation, angioembolisation and splenectomy; the damage-control laparotomy; the seat-belt injury with the Chance fracture and the mesenteric tear; and the anticoagulated trauma patient.

Acute abdominal pain (approach)

Acute abdominal pain — the emergency department approach

The acute abdominal pain approach — the structured emergency department framework that separates the surgical abdomen from the medical, the time-critical from the benign; the three clinical axes (the surgical vs the medical, the upper vs the lower, the colicky vs the constant); the demographic sieve by the age and the sex (the child — the appendicitis, the intussusception; the woman of the reproductive age — the ectopic, the PID, the ovarian; the elderly — the AAA, the mesenteric ischaemia, the SBO, the perforation, the biliary); the location-specific pain patterns (the epigastric, the RUQ, the RLQ, the LLQ, the diffuse); the investigation ladder (the bloods, the urine, the beta-hCG, the lipase, the lactate, the X-ray, the ultrasound, the CT); and the resuscitation with the named drug doses (the morphine 5 mg IV, the ondansetron 4 mg IV, the ceftriaxone 2 g IV, the metronidazole 500 mg IV, the 500 mL fluid bolus). ACEM-primary, globally tagged.

Behavioural and mental health emergencies

Acute agitation and rapid tranquillisation

Acute agitation in the emergency department — the behavioural emergency defined by motor overactivity, emotional distress and imminent danger to self, staff or others. De-escalation first (verbal, environmental, autonomy-respecting), then the graded pharmacological ladder: oral (olanzapine 5 to 10 mg PO, lorazepam 1 to 2 mg PO) then intramuscular rapid tranquillisation (droperidol 5 to 10 mg IM, olanzapine 5 to 10 mg IM, midazolam 5 to 10 mg IM, haloperidol 5 mg IM). Post-administration monitoring (airway, SpO2, BP, ECG for QT). Restraint complications — positional asphyxia, excited-delirium death, rhabdomyolysis, neuroleptic malignant syndrome, torsades de pointes. The organic mimics (hypoxia, hypoglycaemia, sepsis, intracranial, post-ictal, toxidrome) excluded first. Differential of delirium versus psychosis versus intoxication versus withdrawal. ACEM-primary, globally tagged.

Acute appendicitis

Acute appendicitis — the obstruction of the appendiceal lumen (the faecolith, the lymphoid hyperplasia) driving the mucus accumulation, the bacterial translocation, the ischaemia and the perforation; the central pain migrating to the right iliac fossa over 12 to 24 hours with the anorexia, the nausea, the low-grade fever and the McBurney point tenderness (the Rovsing, the psoas, the obturator signs); the Alvarado (MANTRELS) and the Appendicitis Inflammatory Response (AIR) scores; the ultrasound first in the child and the young woman, the CT in the adult male and the atypical; the surgical referral, the laparoscopic appendicectomy first-line, the ceftriaxone 2 g IV plus the metronidazole 500 mg IV as the perioperative prophylaxis. ACEM-primary, globally tagged.