RCEMLearning

UPDATE: Editors Note - It is easy to fall into the drama triangle, especially with TRES. It is important to document meeting minutes and agreed plans going forward. Remember that you can always ask for help and advice and that you won’t always have the answers.

https://www.rcemlearning.co.uk/foamed/managing-educational-supervision/

NEW: A 33-year-old male with haemochromatosis and mental health history presents with recurrent dizziness and chest tightness. Despite extensive normal investigations, symptoms persist, raising the challenge of diagnosis.

https://www.rcemlearning.co.uk/modules/when-normal-doesnt-mean-nothing/

SUNDAY QUESTION (Sensitive content)

Careful physical examination was entirely normal. What is the most likely diagnosis?

Missing the annual conference?

Robert Hirst has us covered with the "RCEM AC Megamic May 2026". Rob catches up with several speakers/presenters at the conference who discuss topics such as deconstructing culture around the EM, three interesting papers in PEM or working in the ED as an older clinician.

Check it out the RCEMLearning website or wherever you get your podcasts
https://www.rcemlearning.co.uk/foamed/rcem-ac-megamic-may-2026/

UPDATE: A 45-year-old man attends the ED with a 48 hour history of nausea and vomiting. He also has a diffuse upper abdominal pain

https://www.rcemlearning.co.uk/modules/complications-of-alcohol-excess/

NEW: A febrile patient presents with severe headache, periorbital swelling, proptosis, painful ophthalmoplegia and cranial nerve deficits following recent facial or sinus infection

What is the most likely diagnosis?

https://www.rcemlearning.co.uk/modules/cavernous-sinus-thrombosis-a-life-threatening-cause-of-ophthalmoplegia/

Ophthalmoplegia, Proptosis, Cranial nerve palsy

UPDATE: In this we're talking about hyperglycaemia in the ED. There aren't any official guidelines on management, but our experience has shown that there's a huge variation in practice, and many cases are mismanaged

https://www.rcemlearning.co.uk/foamed/hyperglycaemia/

SUNDAY QUESTION

They should be fluid challenged in the normal manner with 500-1000 mls of crystalloid, Catheterise the patient to measure urine output, Avoid nephrotoxic antibiotics, If the patient has a tunnelled line, remove it immediately

True or False?

NEW: An elderly female patient presents to the ED with abdominal pain, constipation, and vomiting, with a picture of large bowel obstruction with unusual aetiology.

a). Dilated bowel loops with central distribution
b). Prominent haustra that do not extend across the entire lumen
c). Valvulae conniventes visible across the full bowel width
d). Multiple air-fluid levels at different heights

https://www.rcemlearning.co.uk/modules/rare-cause-common-presentation/