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.
Outline Croup and its management
- parainfluenza (>80%)
- 6 months to 5 years
- Westley croup score components
- Stridor 0-2
- Retractions 0-3
- Air entry 0-2
- cyanosis 0, 4, 5
- Level of consciousness 0, 5
- Treatment
- dex 0.15mg/kg
- adrenaline neb 0.5mg/kg (max 5mg)
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Describe some other stridorous infections
- baterial tracheitis
- diptheria
- mainly an exotoxin disease
- causes myocarditis too
- airway obstruction due to pharangeal exudate (the pseudomembrane)
- treatment
- usual airway stuff
- antitoxin
- IV erythromycin
- epiglottitis
- haemophilus influenza the main bug
- everyone is immunised but immunity wanes so there’s lots of it in older folk
- 2-7 the child age
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Where do ingested foreign bodies lodge and how are they managed
- swallowed coin
- sticks at
- C6, cricopharyngeus
- T4, aortic arch
- T10, gastroesophageal sphincter
- on AP xray
- round if in oesophagus
- vertical line if in trachea
- sticks at
- button batteries
- everybody panic!!!
- rapid oesophageal perforation (within hours)
- can also cause septal perf if in the nose but slightly less drama needed
- xray chest and belly
- look for the “edge” to distinguish it from coin
- once in the stomach there’s rarely issues
- endoscopy rather than foley catheter the preferred method
- magnets
- concern seems to be with these small rare earth magnets (sold in packets of hundreds of them, they’re small round and shiny and kids eat them)
- magnets on either side of a loop of bowel will attract each other causing a pressure necrosis and perf
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