Essentials 1 Start the assessment of any patient with vaginal bleeding by excluding pregnancy. 2 Locate the anatomical site of bleeding and assess the severity looking for signs of hypovolemia and shock. 3 Familiarize yourself with the PALM-COEIN classification system.…
Essentials 1 Pelvic inflammatory disease (PID) is infection and/or inflammation of the upper genital tract. 2 The clinical features cover a spectrum of presentations that depend on the extent of infection and/or inflammation, the anatomical structures involved and the specific…
Essentials 1 History, abdominal and age-appropriate pelvic examination guide diagnosis. 2 History and examination can be supplemented, but not replaced, with appropriate investigations. 3 A normal pelvic examination should not preclude gynaecological referral, even in the absence of other findings.…
Essentials 1 Make sure that the ear-nose-throat (ENT) supplies in your emergency department are well stocked and maintained. 2 Develop agreed pathways/protocols with your local ENT department for common and serious presentations. 3 A foreign body in the ear requires…
Essentials 1 An avulsed tooth reimplanted within 30 minutes has a 90% chance of survival. 2 Dental caries is the most common cause of dental emergency attendance. 3 Dental caries requires analgesia in the emergency department and referral to a…
Essentials 1 Always test and record visual acuity: use pinhole if usual spectacles are not available. 2 Chloramphenicol eyedrops are not a universal panacea. 3 Pain: sharp/scratchy = anterior (cornea or conjunctiva); aching = intraocular (intraocular pressure or inflammation) Trauma…
Essentials 1 Emergency dermatology presentations may be divided into potentially life-threatening dermatoses, vesiculo-bullous conditions, petechial and purpuric rashes, and inflammatory dermatoses such as eczema, urticaria and psoriasis. 2 Potentially life-threatening presentations include Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), Sweet syndrome,…
Essentials 1 The mechanism of injury and biomechanics predict the soft-tissue damage caused. 2 Soft-tissue injuries can be as debilitating and painful as fractures in the same area, and may take longer to heal. 3 The so-called ‘minor injury’ can…
Essentials 1 Polyarthritis is a common adult rheumatological presentation with a wide differential diagnosis. 2 Recording articular and extra-articular involvement facilitates decision making, particularly with regards to patient admission. 3 Joint aspiration is paramount for both diagnosis and excluding a…
Essentials 1 Presenting features alone, including absence of fever, do not reliably exclude a septic arthritis, especially in older people and those who are immunosuppressed. 2 Synovial aspirate in appropriate pathology transport media should be performed prior to commencing antibiotics…