RCEMLearning

A 45-year-old regular Emergency Department (ED) attender brought in by paramedics after being found unresponsive, GCS 11 (E2, M5 V4), in a lay-by near a local garage. The gentleman appears intoxicated. He does not smell of alcohol. Initial VBG indicates: pH 7.33, PaCO2 3.8, glucose 7.0, lactate 4.5, BE -5 Whilst waiting to be assessed the GCS drops to 9 and a repeat gas show pH 7.10, Lactate 6.2, BE -12. What is the most likely suspected cause of the abnormal VBG result?

UPDATE: Tis the season …. - #ClinicalCase

Regular attender is brought to ED with low GCS with suspicion of intoxication in cold winter season.

What is the most likely suspected cause of the abnormal VBG result?

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Key points from the Review Article "Mucormycosis"

Mucormycosis is a rapidly progressive and frequently lethal invasive fungal disease of the lungs, sinuses, orbits, and brain in immunocompromised hosts. Among the invasive mycoses, mucormycosis is widely considered to be the most rapidly invasive and destructive. Learn more: nej.md/3ZsLZ21

Happy Chinese New Year

We wish a happy Lunar New Year to all our colleagues, patients and visitors who are celebrating.

The Lunar New Year, also known as Chinese New Year, is a two-week festival marking the beginning of a new lunar year. This year, it takes place between 17 February and 3 March 2026.

Not the Usual Limping Child, NEW, Clinical Case

NEW: A 5-year-old boy is brought to the ED by his parents due to refusal to walk this morning. He experiences coryzal symptoms over the preceding days and develops a mild fever

What is the most likely diagnosis?

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RCEMLearning, The Aspirin Overdose, UPDATE, SAQ

While taking your initial history, you build up a rapport with him and he eventually admits to being very unhappy since his mother left. Further direct questioning reveals that he took an overdose of aspirin tablets with the intention of killing himself.

#SAQ www.rcemlearning.co....

RCEMLearning, The Aspirin Overdose, UPDATE, SAQ

UPDATE: [TW: Suicide] Paul, a 52-year-old electrician, has been in your department for three and a half hours with a presenting complaint of abdominal pain.

He has no previous medical history, medications or allergies. He normally resides with his mother but she has recently been taken into care.

Visiting Observer Fellowship Scheme Deadline 2nd March 2026 Apply for short clinical observer ship placements within the NHS

Are you an international medical graduation and looking for a short clinical placement in the UK? Apply to be our 2026 RCEM Global Observer. This scheme is open to those from low resource settings.

Visit the RCEM website for more information and apply by the 2nd March 2026.

rcem.ac.uk/internati...

NEW, Anti-Obesity Drugs: What EM Physicians Need to Know, Blog, RCEMLearning

NEW: GLP-1 agonists, hailed as “wonder drugs,” help shed weight rapidly. But how do they work and what risks lurk beneath? What do we need to know about them in the emergency department?

www.rcemlearning.co....

RCEMLearning, A Case of Muffled Hearing, Clinical Case, NEW

NEW: A 25-year-old Chinese male, who works in asset management, presents to the urgent care centre with a 5-day history of muffled hearing and tinnitus in the right ear.

What do you think is the most likely diagnosis? #ClinicalCase

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Caring for autistic patients and those with learning disabilities or complex needs in the ED - RCEM An updated one-day online study day looking at the barriers to healthcare and resultant health inequalities faced by neurodivergent patients and those with a learning disability in the ED.

Did you know people with a learning disability are TWICE as likely to die from an avoidable cause of death?

Join us online on 19th May to find out why and learn how we can improve outcomes.

@rcem.ac.uk @rcemevents.bsky.social @rcemlearning.bsky.social

#MedSky

rcem.ac.uk/virtual-even...

Imbalance of which pair of neurotransmitters is responsible for alcohol withdrawal syndrome (AWS)? a). Adrenaline and GABA b). GABA and NDMA c). NDMA and noradrenaline d). Carbon monoxide and NDMA

SUNDAY QUESTION: Imbalance of which pair of neurotransmitters is responsible for alcohol withdrawal syndrome (AWS)?

Tell us the correct answer?

RCEMLearning logo, Collapsed Neonate, SBA, UPDATE

UPDATE: A 3-day-old boy is brought in by his parents with increased work of breathing, increased lethargy and a blue tinge around his lips after short feeds.
What is the most likely cause of his collapse? #SBA

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NEW: The Rash Decision: A Surprising Culprit behind a Sudden Eruption. Clinical Case.

NEW: A 55-year-old gentleman presents to the Emergency Department (ED) with a striking, itchy rash most noticeable on his torso, arms, and legs.

Which term best describes the rash? Find out more about the case: www.rcemlearning.co....
#ClinicalCase

SBA Writing Day 2026, 20th March 2026, 10am - 3pm

RCEM Members, we are hosting an SBA Writing Day for you

When: 20/3/2026, 10am – 3pm
Where: Octavia House

Organised by our team & the eLearning Committee, this is a face-to-face workshop-style event involving collaborative group work & peer review activities
Register here: eu.jotform.com/form/...

RCEMLearning, Post-tonsillectomy Bleed. Learning Session/Reference. UPDATE

Learn more about Post-tonsillectomy Bleed from our #LearningSession (LS) and #Reference (Ref)

LS: www.rcemlearning.co....
Ref: www.rcemlearning.co....

RCEMLearning, Post-tonsillectomy Bleed. Learning Session/Reference. UPDATE

UPDATE: Tonsillectomy is a common procedure performed by ENT surgeons. The majority of post-tonsillectomy bleeds are self-limiting. However, bleeding can be occult and early identification is important to prevent further complications

Interview with Dr Elizabeth Herrieven: Insights on Caring for Patients with Learning Disabilities, Autism, and Complex Needs in the ED - RCEM Explore our exclusive interview with Dr Elizabeth Herrieven, the lead behind our popular study day: Caring for Patients with Learning Disabilities, Autism, and Complex Needs in the ED. The full study ...

A blog about me (not by me!) and the fab RCEM learning disability, autism and complex needs study day. Bookings open now for the NEW version! New speakers, new sessions - this may be the best year yet!

rcem.ac.uk/blog/intervi...

The Droopy Dribbler: Paediatric Presentations of Bell’s Palsy. UPDATE. Blog

UPDATE: Paediatric cases of Bell’s Palsy are relatively uncommon. Understandably, witnessing a rapidly developing facial asymmetry in a child will cause worried parents/guardians to rush to see a doctor #Blog

www.rcemlearning.co....

#FacialNerve #Palsy #BellsPalsy #ChildHealth

RCEMLearning logo in white. Mental Health, Curriculum Cup. NEW

NEW: It's a new month, which means another Curriculum Cup. 30 questions. 30 minutes.

Our user picked topic: Mental Health

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#Quiz #Curriculum #MedEdu #Education

SUNDAY QUESTION Which one of the following statements is correct regarding the pathophysiology and clinical presentation of a patient with Ramsay Hunt syndrome? a). The patient does not require any further infection control advice b). Facial weakness with vesicles on the contralateral side of the tongue is a diagnostic feature c). Ramsay Hunt syndrome causes an upper motor neurone weakness of the facial muscles d). The rash may be present on the side of the neck

SUNDAY QUESTION: Which one of the following statements is correct regarding the pathophysiology and clinical presentation of a patient with Ramsay Hunt syndrome?

The Child with an Unbreakable Fever Clinical Case Which is the most likely diagnosis? NEW - RCEMLearning

NEW: A 4-year-old boy, previously well, presents to the emergency department (ED) with a 6-day history of high fever, unresponsive to paracetamol.

Which is the most likely diagnosis? #ClinicalCase

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on her right hand. She complains of tingling and numbness of the hand with new onset of right shoulder pain. On secondary survey, the palmar surface of right hand is erythematous. No entry or exit marks found. No collateral injury. #ClinicalCase

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UDPATE: A 24-year-old restaurant cleaner was about to clean an electrical Bain Marie. All of a sudden she noticed a flash of light coming out of the instrument. Although her hand was not in contact on the surface, she immediately developed a burning sensation and erythema [cont]

Trauma in Pregnancy. Learning Session. NEW.

In the UK, it can be expected that 1 in 100 women of childbearing age suffering major trauma will be pregnant, although this is likely to be an underestimate

#LearningSession: www.rcemlearning.co....
#Reference: www.rcemlearning.co....

Trauma in Pregnancy. Learning Session. NEW.

Trauma in pregnancy, whether minor or major, increases the risk of preterm labour, placental abruption, foeto-maternal haemorrhage, and pregnancy loss. Delivery after a traumatic event carries significant risk of morbidity and mortality for both the mother and foetus

RCEMLearning logo. Sting on a Banjo String! Clinical Case. Update

On examination, a tiny bleeding point in the frenulum of the uncircumcised penis is revealed with no swelling, bruising or penile deformity. There is no difficulty in micturition. No injury elsewhere.

What is the most likely diagnosis? #ClinicalCase
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RCEMLearning logo. Sting on a Banjo String! Clinical Case. Update

UPDATE: A 22-year-male arrives in the Emergency Department (ED) at midnight with post coital pain & bleeding from the external genitalia. He doesn’t report any audible penile snapping or popping sound during intercourse.

Nothing significant on past medical history.

A young male is brought to you with a 7/7 history of gradually worsening headache and lethargy. He is from Uganda and has recently been home to see his family. He is cachexic and lethargic. He has a temp of 37.9oC. Which of the following is correct? a). This presentation is unlikely to be TB meningitis due to the sub-acute course b). You would expect CSF analysis to show very high levels of protein and high levels of glucose in TB meningitis c). Immunocompromised patients are at increased risk from Cryptococcus, toxoplasmosis and TB meningitis d). Brain abscesses are more common in females than males

SUNDAY QUESTION - Which of the following is correct?

You can't see my hand? Clinical Case. UPDATE

A 21-year-old female presents to Emergency Department (ED) with 6 day history of occipital headache and seeing flashing lights. She has otherwise been well with no fevers or collapses. PMH: Mitochondrial 3243 A>G Mutation O/E: Left-sided homonymous hemianopia, otherwise normal. VBG: pH 7.37, Lactate 3.7

UPDATE: A 21-year-old female presents to Emergency Department (ED) with 6 day history of occipital headache and seeing flashing lights. She has otherwise been well with no fevers or collapses.

What is the most likely diagnosis? #ClinicalCase www.rcemlearning.co....

Thank you to Age UK and Beccy Cooper for hosting an important event in parliament this week on the crisis of corridor care. Our VP, Dr James Gagg, engaged with MPs, along with health care sector leaders, to raise what our members, their colleagues and our patients are facing in EDs.