PEM Review 016: PARASITES // RESPIRATORY INFECTIONS // GENDER AND SEX // ANOREXIA // SEPSIS // RASHES

PEMgeek3The leaves are brown, it’s chilly outside and the wards are full of bronchy babies. Hope you’ve all had your flu vaccines, because Winter Is Coming.

          1. CREEPY CRAWLIES

Just missed Halloween with this post, but here are some real life scary monsters for you. Scabies, lice and bedbugs. (Feeling itchy already?) Another great 5 minute primer from @EMin5.

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respiratory-distress   2. DISTRESS SIGNALS

Here’s some essential viewing for new F2s/SHOs who are just about to spend their first winter in A&E – a collection of videos on @Damian_Roland ‘s blog demonstrating the various causes of respiratory distress you are about to become extremely familiar with. Start thinking about illness trajectory, as well as severity of clinical signs on assessment, and you will be off to a good start.

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trans        3.  GENDER/SEX/SEXUALITY

Many transgendered people recognize very early on (even pre-teenage years) that they feel a mismatch between their sex and gender identity. Sadly many of these individuals present with psychological issues and self harm, so might first come to the attention of the EM doctor. Knowing the issues and proper terminology is the first step towards better care. Guest blogger on ADC blog, Anna Birtles, has written a useful article on the differences between gender, sex, and sexuality and what it means to be trans, trans*, genderfluid or genderqueer.

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marsi  4. MARSIPAN

(What a brilliantly inappropriate acronym for an anorexia guideline). The ‘Management of Really Sick Patient with Anorexia Nervosa’ document will guide you in risk assessing a young person with severe anorexia, and also discusses the process of compulsory admission and treatment. There is a good section on inpatient management with useful guidance for the nursing team.

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epinephrine         5.   SEPSIS: DOPAMINE vs EPINEPHRINE

@CoreEM reviews the results of a recent double-blinded RCT comparing dopamine and epinephrine in children with fluid-refractory septic shock. This was a single centre study so results should be interpreted with caution, however there was significantly greater mortality in the dopamine group (20.6% vs 7% epinephrine) and because of this, the study was stopped early. Could epinephrine be the vasopressor of choice for sepsis? Will be fascinating to see if more trials replicate these results.

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    6.    A IS FOR AIRWAY

There is a reason A is the first letter of the alphabet: pretty much EVERYTHING we do in the ED starts with establishing a patent airway. Michael Oh and Muhammad Waseem (on @emdocsdotnet) give us a few pointers on airway management in kids. Get the basics right (positioning, preparation, equipment), then the rest will be easier (and your anaesthetist will be happy).

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pox   7.  RASH DECISIONS

If your descriptive limit in dermatology stops at ‘red’ and ‘maculopapular’ then you need to listen to this podcast from @pedscases. The team talks through a strategy for evaluating rashes (SCALDA is a useful mnemonic – Size, Colour Arrangement, Lesion morphology, Distribution and Always to check mucous membranes, hair, between fingers and toes)

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