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I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here
From the NICE 2007 guidance on the subject (of note this is due for change this year or next i think so keep your eyes peeled…). This was not a simple and easy to summarise guideline and the mess of notes below reflect the detail contained within it. There is an RCEM summary too.
- clean catch preferred
- failing that pads
- failing that supra pubic
- usual symptoms
- antenatal renal issue
- Fhx VUR
- constipation
- spinal lesion
- high BP
- this is complicated and worth reading yourself
- from what i can gather
- under 3 months be guided by microscopy primarily
- 3 months to 3 years microscopy is preferred and disptick only if microscopy not available and only in the intermediate risk group (told you it was complicated…)
- over 3 years it’s much simpler and dispstick considered as useful as microscopy so just use a dipstick.
- assumes you’re culturing everyone
- pyelo
- “high to intermediate risk of serious illness”
- under 3 years
- +ve for leucs or nitrites
- recurrent UTI
- when symptoms and dipstick don’t correlate
- “seriously ill”
- poor flow
- abdo/bladder mass
- raised creatinine
- septicaemia (presumably they mean +ve blood cultures?)
- non e coli
- no response in 24 hrs
- under 3 months
- IVs and admit
- over 3 months with pyelo (which means fever effectively)
- orals are fine even in pyelo if suitable
- 7-10 days as length of course
- over 3 months with cystitis
- 3 days orally
- no routine antibiotic prophylaxis
- E Coli
- Klebsiella
- Enterobacter
- Proteus
- Yersinia enterocolitica
- i tried to neatly summarise but i really couldn’t and gave up… soz…
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