Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA according to the CDC. But Scombriod poisoning is missed as its put down to allergy. Read more
Dental Abscess requires a Dentist for Definitive Treatment
- Dental Pain
- Unpleasant taste
- Fever and Malaise
- Facial Swelling
- Regional Lymphadenopathy
- Tooth Decay
- Gum Swelling or tenderness
- Purulent Exudate
Not all Allergies are Anaphylaxis!
Anaphylaxis is defined as:
- Severe life-threatening systemic hypersensitivity reaction
- Where BOTH of the following criteria are met:
Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central [bad]?
Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic stewardship is everyone’s responsibility to prevent resistance developing.
Are there any concerns regarding airway compromise? – If yes – transfer to resus, give high flow Oxygen, IV steroids, IV antibiotics, Nebulised adrenaline 1:1000, IV fluids, take bloods and refer to both anaesthetics and ENT registrar.
Assess all under 5s with a temperature as per the NICE fever guidelines
Assess the patient for signs of severe sepsis – if present use the severe sepsis guidelines
If no signs of sepsis assess patient, exclude Quinsey (unilateral swelling, paina nd trismus) and calculate the FeverPAIN score and Centor score
FeverPAIN = 1 point for each of –
- Purulent tonsillar exudate
- Attendance within 3 days of onset
- severely Inflamed tonsils
- No cough/coryza
Centor = 1 point for each of –
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenititis
- History of fever >38
- No cough
Can the aptient swallow fluids and medication – if not give a stat dose of IV Dexametasone, IV antibiotics, IV fluids and analgesia – review in 2 hours. If they can swallow at this time then you can consider discharge with a patient information leaflet.
FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice
Patients to seek medical advice if become more unwell or not improving after 1 week
Self care advice – Paracetamol, Ibuporfen, Adequate fluids, Medicated lozenges
Phenoxymethylpenicillin 5-10 days
If Penicillin allergy – Clarithromycin or Erythromycin 5 days
Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.
In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more
Bell’s Plays is a lower motor neurone (LMN) lesion of the facial nerve (CN VII), which causes one side of the face to “droop” [1% of cases are bilateral], and patients are often concerned that it is a stroke.
However, unlike in stroke the whole face is affected, in stroke and other upper motor neurone (UMN) lesions the upper portion of the face is unaffected due to input from both sides of the brain. Read more
Tracheostomy Emergency Care – Dr Brendan McGarth
Needs to distinguish Tracheostomy from laryngectomy as a laryngectomy has no connection to the upper airway however a tracheostomy may have a connection so gives you 2 options for an airway.
Trachostomy problems commonly seen in the ED:-
Online learning modules available at the link
The Impact of Dental Presentations to the ED — Chetan Trivedi
Facial imaging his a high dose of radiation to senative tissues in often young people therefore careful examination is required prior tor Xrays.
Predictors of radiological abnormality in facial trauma-
Tenderness over maxillary
Step deformity in maxillary
Sensory loss over site of injury
Change in bite
Abnormal eye signs
Predictors of radiological abnormality in mandibular trauma-
Restricted or painful mouth opening
Tenderness over mandible
Sensory loss over site of injury
Change in bite/painful bite
Try to assess carefully prior or to imaging
Acute Ophthalmology— Felipe Dhawahir-Scala
Viral conjunctivitis all have preauricular or submandibular lymphadenopathy, highly contagious.
Do not give chloramphenicol to contact lens wearers use something with a broader spectrum.
Urgent conditions (reasons to get an ophthalmologist out of bed) —
Acute angle closure glaucoma -red painful eye, semi dilated pupil, – start iv acetazolamide immediately
Orbital cellulitis – eye doesn’t move, colour vision loss, fever, chemosis, proptosis -start Ciprofloxacin and clarithromycin orally, image and call ophthalmology.
Vertigo – Peter Johns
Concerning features- new or sustained headache or neck pain it’s a stroke or vertebral artery dissection until we prove it isn’t.
A central cause …Unable to walk or stand unaided, Weakness in limbs, the Deadly d’s… dysarthria, diplopia, dysphagia, dysarthria, dysphoria.
Short episodes of Vertigo (spinning/dizziness) on getting up/rolling over in bed, no spontaneous or gaze provoked nystagmus.
(End gaze nystagmus so normal variant, look to 30 degrees only.)
Need dix-hallpike testing likely BPPV – posterior canal BPPV.
Treat with Epley manoeuvre.
Horizontal Canal BPPV – Dix-hallpike manoeuvre is negative and they are less clear which side they turn to to get dizzy.
Spontaneous or gaze provoked nystagmus for days, nausea and vomiting and gait disturbance likely to be Vestibular neuronitis.
Test using HINTS plus Exam– nystagmus, test of skew, head impulse test, hearing loss. All components have a central or peripheral result for each component. If all 4 are peripheral results then it is a acute Vestibular neuroitis
Vestibular migraine – 30% never get headache, can last hours or days.
More common in women, perimenopausal, often get photophobia, phonophobia, nausea, vomiting and other typical migraine symptoms.
You tube – peter Johns (links here)