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.
(Featured image: James Heilman MD on Wikimedia Commons, CC License)
Hopefully a brief one from the NICE 2014 guidance. I don’t find it the most helpful guidance but worth knowing.
What tests should we do?
- the guidelines do allow for the clinical diagnosis in primary care without a CXR
- for moderate/severe
- take blood and sputum cultures (though we know esp blood cultures are rarely helpful)
- ‘consider’ urine legionella and pneumococcus
- the say ‘consider’ CRP for monitoring
[collapse]
How do we assess severity?
- they suggest CURB-65
- (I have lots of issues with the CURB65 but it’s in the guideline)
- 2 or more for hospital treatment but they allow clinical judgement to guide this
[collapse]
How do we treat it?
- for low severity use single antibiotic for 5 days
- systems should be in place for diagnosis and antibiotics within 4 hours
- for moderate and severe
- ‘consider’ 7-10 days dual antibiotic
- amoxicillin/macrolide for moderate
- ‘beta lactamase stable’ (things like co amoxiclav and common cephalosporins) antibiotic/macrolide for severe
[collapse]
What should we tell patients to expect?
(this is practice changing for me…)
- 1 week: fever should have resolved
- 4 weeks: chest pain and sputum production should have substantially reduced
- 6 weeks: cough and breathlessness should have substantially reduced
- 3 months: most symptoms should have resolved but fatigue may still be present
- 6 months: most people will feel back to normal.
[collapse]
