• Fluid and air in the lung.

    A 52 year old presented to the outpatient department with one week history of shortness of breath. The family medicine resident text me the below Chest XR (Apologies for quality but we have film XR in Sierra Leone)   My first response “did have have any trauma” I was taught this pathognomic for hemopneumothorax. You would normally expect to see a curve to the fluid on the right hand of the chest, if you look closer you can see the absent lung markings which pneumothorax. On POCUS we can confirm lack of lung sliding sliding on right lateral aspect of chest. However, on the right inferior aspect where we would…

  • Outpatient management of suspected neonatal sepsis

    A review of some of the latest low-resourcs emergency medicine evidence Implementing WHO guidelines for unwell newborns. Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria Ayede A et al. Aim To test the feasibility of implementing an outpatient protocol for suspected neonatal sepsis when referral isn’t possible.  Rationale The WHO has developed guidelines that recommend a simplified outpatient antibiotic regime; however the implementation of these guidelines has not been examined.  Design An implementation study design (this I have not come across before but they used a reconcised framework of RE-AIM; Reach, efficacy,…

  • This week I learnt – 6

    That we may not have to use sterile gloves for suturing  Magnesium can help to rate control Atrial fibrillation (but interestingly not cardioversion). There is concern that high dose naloxone will lead to rebound agitation; however this did not seem the case in this observational study. The continued utility of TXA is demonstrated in this paper looking specifically at the low acuity injuries and still demonstrates a survival benefit (if given early).        

  • Can we use non-sterile gloves for suturing?

    A review of some of the latest low-resourcs emergency medicine evidence Use of non-sterile gloves for suturing Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial Juliette J M Zwaans ,Wouter Raven , Arthur V Rosendaal, Esther M M Van Lieshout, Geesje Van Woerden ,Peter Patka ,Juanita A Haagsma , Pleunie P M Rood Aim To assess if the use of non-sterile gloves gives equally as few wound infections for traumatic wounds as sterile gloves. Rationale Previous systematic reviews and one observational study in the emergency department have shown no difference in infection rates.…

  • TWIL 1

    This week I learnt . . . Antibiotics are no longer indicated for simple diverticulitis (NICE guidelienes from 2019), This is based on a bang up to date RCT from 2012. In major trauma, a high glucose(>11) is associated with mortality. (But not as much as age and hyperthermia). Emergency doctors and patients disagree about the presenting complaint about a third of the time. It probably makes not difference if you use Normal saline or hartmann’s/plasmaltye.