ED GovCast Episode 6
Emergency Medicine Clinical Case Discussions
Case 1 – POCUS in Chest Trauma
84M presented with chest pain post fall. Normal observations and unremarkable examination. Pain managed with analgesia.
Imaging:
- Initial CXR appeared normal.
- Bedside POCUS revealed a lung point – 100% specific for pneumothorax.
- CT confirmed moderate right-sided pneumothorax.
Learning Point:
- CT remains gold standard in trauma; POCUS can provide rapid bedside diagnosis.
Case 2 – Extravasation Injury Post-Cardiac Arrest
IV adrenaline administered peripherally during cardiac arrest. ROSC achieved. Later developed local extravasation injury.
Clinical Features:
- Pain, erythema, swelling, blistering.
Management:
- Stop infusion, mark area, leave cannula in.
- Use antidotes: Hyaluronidase, Phentolamine.
Learning Point:
- Always monitor cannula sites closely, especially in unconscious or post-arrest patients.
Case 3 – Decompensated Chronic Liver Disease
42F presented with acute confusion, jaundice. Vitals: RR 29, SpO2 94%, BP 96/46, HR 111, GCS 14.
Investigations:
- Sepsis with multiorgan dysfunction. CT showed portal HTN and cavitating lung lesion.
Management:
- Sepsis 6 protocol, early ICU referral. Intubation, vasopressors, RRT required.
Learning Point:
- Use the Decompensated Cirrhosis Care Bundle within the first 24 hours.
Case 4 – Bacterial Meningitis in a Young Adult
19F with confusion, headache, fever, rash.
Management:
- Administer ceftriaxone early.
- Add amoxicillin if Listeria suspected.
- Dexamethasone within 12 hours unless contraindicated.
Learning Point:
- Agitated or combative patients delay care—get senior/specialist support early.
Case 5 – Kawasaki Disease in an 8-Year-Old
Cracked lips, rash, conjunctivitis, arthralgia.
Differentials:
- Measles, SJS, Group A Strep.
Management:
- IVIG and aspirin. Echocardiogram and ECG for cardiac complications.
Learning Point:
- Kawasaki disease is a clinical diagnosis. Treat early to avoid coronary aneurysms.
Case 6 – Paediatric Foreign Body Ingestion (Magnets)
X-ray confirmed two magnets.
Management:
- Admit even if asymptomatic due to risk of bowel perforation.
Learning Point:
- Follow local guidance on magnet and battery ingestion.
References & Further Reading:
• RCEM Safety Alert Silver Trauma: https://rcem.ac.uk/wp-content/uploads/2021/10/Safety_Alert_Silver-Trauma_2019.pdf
• Extravasation injuries in adults: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664495/
• Decompensated Cirrhosis Care Bundle: https://www.bsg.org.uk/getattachment/...
• Kawasaki Disease Guidance: https://www.piernetwork.org/...
• RCEM Learning Case on Button Battery:https://rcem.ac.uk/…