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RCEMLearning
@rcemlearning.bsky.social
230 followers 300 following 460 posts
Royal College of Emergency Medicine. ELearning and #FOAMed resource
https://www.rcemlearning.co.uk/
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UPDATE: A 7-year-old child presents to the Paediatric Emergency Department (ED) after falling forward from his scooter onto outstretched hands. His wrist is swollen and painful. The following x-rays are taken.

What is the most likely diagnosis? #SBA

www.rcemlearning.co....
RCEMLearning. Childhood Forearm Injury. SBA. UPDATE
January 20, 2026 at 7:48 PM
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UPDATE: A 94-year-old man, who lives alone in his home, and is fully independent for all his activities of daily living. He presents to the Emergency Department complaining of vomiting every time he eats

What's the most likely cause? #ClinicalCase www.rcemlearning.co....
Can't keep it in. Clinical Case. UPDATE. RCEMLearning. Mr Ship is a 94-year-old man, who lives alone in his home, and is fully independent for all his activities of daily living. He presents to the Emergency Department (ED) complaining of vomiting every time he eats. For the last 5 weeks Mr Ship has been complaining of vomiting after everything he eats. He is only able to keep a small amount of Weetabix down in the morning, and then has to survive on liquids from then on. He will still vomit small amounts of liquid. His vomit is clear with no blood. He also feels as though his trousers are starting to feel looser. He has put this down to poor oral intake. He has no abdominal pain, and his bowels continue to open every other day. He has had multiple ERCP’s for recurring cholangitis, and is on 30mg Lansoprazole for GORD following a recent presentation to the ED. On examination his abdomen is soft non tender, bowel sounds present, and his bloods are all normal. His past medical history includes hypertension, and barrettes oesophagus.
January 19, 2026 at 12:30 PM
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SUNDAY QUESTION: Which of the following is the most appropriate initial management option?

#eLearning #MedEdu
SUNDAY QUESTION - The patient looks clammy and is cool peripherally. Pulse is 130 beats per minute and blood pressure 80/40mmHg Which of the following is the most appropriate initial management option? a). Endoscopy b). Omeprazole 40mg IV c). Oxygen via non-breather mask d). Terlipressin 2mg IV
January 18, 2026 at 4:00 PM
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NEW: A 38-year-old female patient presents to the emergency department (ED) with an overdose of Bisoprolol 15 × 10 mg (150 mg total) and Amlodipine 15 × 10 mg (150 mg total). She reported that the time of ingestion was 4 hours ago.

Her findings are below...
Combined Beta Blocker and Calcium Channel Blocker Overdose. NEW. Clinical Case. RCEMLearning logo in white. Examination findings: Airway patent; speaking in full sentences but drowsy (GCS 14) Respiratory rate 18 min⁻¹, SpO₂ 98 % on air BP 60/40 mmHg, HR 30 bpm (sinus bradycardia) Capillary blood glucose 2.5 mmol L⁻¹ Peripheral cool; capillary refill > 4 s ECG: sinus bradycardia, PR prolongation (220 ms), narrow QRS Initial venous blood gas: pH 7.18, lactate 6.5 mmol L⁻¹, K⁺ 3.2 mmol L⁻¹
January 16, 2026 at 12:30 PM
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UPDATE: Burns are a major public health problem globally. In addition to physical damage, they can leave a long lasting psychological and social impact.

In the UK 130,000 people each year visit the Emergency Department with burn injuries.
RCEMLearning logo in white. UPDATE - Major Trauma - Burns. Learning Session/Reference
January 15, 2026 at 4:30 PM
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NEW: A 55-year-old presents with bilateral lower leg pitting oedema and heart failure symptoms. Given the clinical presentation and initial investigations, what is the most important initial investigation to perform next?#SBA
www.rcemlearning.co....

#Cardiac #Kidney
Breathlessness and Oedema: A Diagnostic Challenge in the ED SBA, NEW A 55-year-old gentleman presents to the Emergency Department (ED) with a two-week history of bilateral pitting oedema affecting both lower legs up to the knees. Over the past three days, he has developed progressive shortness of breath and orthopnoea requiring three pillows to sleep comfortably. He has no significant past medical history and takes no regular medications. He denies chest pain, palpitations, or recent travel. There is no family history of cardiac disease. Initial observations: Respiratory rate: 21 breaths/min Oxygen saturation: 95% on room air Temperature: 36.6°C Blood pressure: 216/115 mmHg Heart rate: 95 bpm, regular Examination findings: Cardiovascular: Heart sounds I + II + 0, no murmurs or added sounds, JVP not elevated. Respiratory: Chest clear to auscultation bilaterally, no wheeze or crepitations Abdomen: Soft, non-tender, bowel sounds present, no organomegaly Extremities: Bilateral pitting oedema extending to both knees, calves soft and non-tender General: Alert, afebrile, no lymphadenopathy Initial investigations: 12-lead ECG: Normal sinus rhythm, no acute changes Full blood count: Normal Inflammatory markers (CRP, ESR): Normal eGFR 64 mL/min/1.73m² Troponin: Negative
January 14, 2026 at 12:30 PM
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UPDATE: A 49-year-old man is brought to the Emergency Department (ED) by ambulance after waking this morning with severe vertigo

What features of the history are typical of acute peripheral vertigo? #ClinicalCase www.rcemlearning.co....
RCEMLearning logo in white. A boy looking out from a window. Vertigo: will it make your head spin?. Clinical Case. UPDATE A 49-year-old man is brought to the Emergency Department (ED) by ambulance after waking this morning with severe vertigo. He is unable to move his head, sit or stand without feeling very nauseous and has, in fact, vomited a number of times. He has not noticed any alteration in his hearing or tinnitus. He has no other symptoms, in particular no visual or speech problems and no limb weakness. He was well yesterday and has not suffered any recent illness or injury. The patient is normally fit and well and doesn’t take any regular medication. He drinks little alcohol but he has smoked 10 cigarettes per day for the last 25 years. His initial observations are pulse 78 / minute and regular, BP 166/85, respiratory rate 14 / minute, oxygen saturation 96% on air. His temperature is 36.5oC.
January 13, 2026 at 7:00 PM
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NEW: A 39-year-old man presents with a 4–5-day history of fever, rigors, general malaise, and worsening shortness of breath.

#ClinicalCase www.rcemlearning.co....
RCEMLearning logo in white. A picture of a man with a sore throat, holding it in pain. Post Tonsillitis Septic Shock. NEW. Clinical Case
January 12, 2026 at 4:56 PM
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SUNDAY QUESTION!

Which clinical feature most strongly suggests an ocular rather than central cause of his symptoms?
January 11, 2026 at 4:00 PM
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UPDATE: A 48-year-old male patient presents to the Emergency Department (ED) with central chest pain that woke him up at 2 am

What is the differential diagnosis of exertional syncope in this case? #ClinicalCase
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RCEMLearning logo in white. Non classic Chest Pain! Clinical Case. UPDATE. A picture of a ECG. A 48-year-old male patient presents to the Emergency Department (ED) with central chest pain that woke him up at 2 am. He reports feeling short of breath, shivery with clamminess and sweatiness for about 40 minutes. He’s improved shortly after arriving in the hospital. The patient reports having a brief period of exertional chest pain for a few minutes and fainting episodes while he was exercising the same afternoon. However, he has no symptoms of collapse, cough, haemoptysis or any respiratory symptoms or contact with anyone known to have COVID-19. He also denies genitourinary or gastrointestinal symptoms. He is normally active with no past medical, drug or surgical history of significance. Initial observations: Temperature 38.5 degrees Celsius, HR 125, BP 134 /67, sat 99 % RR 18 /min. Cardiovascular and respiratory examination is unremarkable. Electrocardiogram (ECG): showed sinus tachycardia HR 130 per minute.
January 9, 2026 at 6:56 PM
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UPDATE: Methaemoglobinaemia is a disorder characterised by a higher than normal level of methaemoglobin (MetHb) in the blood. In health, MetHb is < 1% (of total haemoglobin)
RCEMLearning logo in white. Blue with blurred lights in the background. Alt text: Methaemoglobinaemia. Learning Session/Reference. UPDATE
January 8, 2026 at 11:03 AM
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NEW: A 10-year-old boy presents with fever, malaise, and rapidly spreading painful skin lesions with oral and eye involvement, following a recent course of antibiotics.

What is the most likely underlying condition? #ClinicalCase
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RCEMLearning logo in white. A child lying down in pain. Alt text: When a Rash Turns Dangerous. Clinical Case A 10-year-old boy presents to the Emergency Department (ED) with his mother, reporting a 2-day history of fever, malaise, and rapidly spreading skin lesions. His mother states that the lesions initially appeared as small red spots on his trunk and face but quickly progressed into painful blisters and erosions. He also reports severe oral discomfort, making it difficult to eat or drink, along with painful swallowing and redness with irritation of both eyes. He describes mild sensitivity to light but denies any visual changes. He was commenced on oral amoxicillin seven days earlier for a mild cough and sore throat prescribed by his GP. There is no recent viral illness, vaccination, travel, or known exposure to infectious diseases. He is otherwise well, with nil past medical history of note. He has no known drug allergies, and family history is non-contributory. (cont. on RCEMLearning)
January 7, 2026 at 5:15 PM
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UPDATE: A 70-year-old woman attends the Emergency Department (ED) with ongoing epistaxis for the last 2 hours. She has a history of pulmonary embolism and is taking warfarin.

Which intervention is most likely to rapidly control her epistaxis? #SBA www.rcemlearning.co....
RCEMLearning logo in white. A close up of a white tablet. Alt text: Epistaxis on Warfarin. SBA. UPDATE A 70-year-old woman attends the Emergency Department (ED) with ongoing epistaxis for the last 2 hours. She has a history of pulmonary embolism and is taking warfarin. She has been applying direct pressure to her nose for the last 30 minutes, with no improvement. The examination shows profuse bleeding from both nostrils. Her observations are: RR 18, saturations 94% on air HR – 115 beats per minute BP – 105/65 You transfer her to the Resuscitation area and obtain iv access. Which intervention is most likely to rapidly control her epistaxis?
January 6, 2026 at 12:15 PM
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Our first #SundayQuestion of 2026. What is the most appropriate way of managing his c-spine?
Hayder is a 9-month-old who fell from his high chair. You go to do your primary survey. He’s currently wriggling around, staring intently at you as you walk around the room. A is fine – so you move on to consider his c-spine. What is the most appropriate way of managing his c-spine? Keep him in parent's arms and arrange a CT scan Keep him comfortable with a parent, and complete your primary survey Lie him on a trolley, apply collar, blocks and tape Lie him on a trolley, provide manual immobilisation
January 4, 2026 at 4:00 PM
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UPDATE: The diagnosis of hypothermia may be obvious, particularly when there is a history of severe environmental exposure, for example after a prolonged search and rescue effort in a wilderness setting.
RCEMLearning logo in white. A picture of a forest of bare trees. Alt text: Severe Hypothermia. Reference. UPDATE
January 3, 2026 at 9:00 AM
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Our final Curriculum Cup for the year is closing soon, which means this is your LAST chance to try and get on our leader board.

Do you think you can get 100% on our Gastroenterology and Hepatology quiz: www.rcemlearning.co....
RCEMLearning logo in white. A picture of a generated image of a person's organs. Alt text: Curriculum Cup: Gastroenterology and Hepatology.
December 30, 2025 at 8:00 AM
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NEW: A 56-year-old lady with Williams syndrome, presents to the Emergency Department (ED) with mild abdominal pain and distension, reporting she is unsure if her last bowel movement was 2 weeks ago.

What is the most likely diagnosis? #ClinicalCase
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RCEMLearning logo in white. An X-Ray of a persons bowels. Alt text: Blocked Bowels … but by what? Clinical Case. NEW
December 29, 2025 at 12:00 PM
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SUNDAY QUESTION, the last question of 2025!

What is the most appropriate management regarding prophylactic antibiotics for non-operative facial fracture?
What is the most appropriate management regarding prophylactic antibiotics for non-operative facial fracture? a). Prophylactic antibiotics significantly reduce infection risk and should be routinely given b). Prophylactic antibiotics should be given only for nasal bone fractures c). Routine use of prophylactic antibiotics is not supported due to the low infection rate
December 28, 2025 at 4:00 PM
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UPDATE: A 31-year-old man presented to the ED after falling off a wall into a bush. He sustained head and facial injuries. He complained of a mild headache. There was no loss of consciousness, amnesia or neck pain. On examination his Glasgow Coma Score was 15/15
RCEMLearning logo in white. A picture of a large lake and forest in the background. Alt text: Eyelid Injury. Clinical Case
December 27, 2025 at 3:00 PM
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UPDATE: Fabricated or induced illness (FII) is a form of child abuse. It is associated with significant morbidity (physical and psychological) and mortality. Recognition of FII is frequently difficult and subsequent management is complex.
RCEMLearning logo in white. A close up of a young child. Alt text: Fabricated or Induced Illness. Learning Session/Reference. UPDATE
December 26, 2025 at 9:00 AM
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UPDATE: As the days get shorter, the leaves fall from the trees, and winter draws nearer, so does the surge of bronchiolitis begin its annual descent upon paediatric emergency departments across the country.
RCEMLearning logo in white. Acute inflammatory exudate occluding the lumen of the bronchiole and acute inflammation of part of the wall of the bronchiole. It shows at the cellular level the inflammation that occurs in the bronchiole of a child with bronchiolitis. Alt text: Preparing for a Bronchiolitis Epidemic. Blog. UPDATE
December 23, 2025 at 8:04 AM
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NEW: A 34-year-old G2P1 IVF patient at 40+5 weeks presents with severe epigastric pain, bilateral leg swelling, hypertension and proteinuria. Despite initial management, she subsequently collapses #ClinicalCase

www.rcemlearning.co....
RCEMLearning logo in white. A person touching a pregnant person's stomach. Alt Text: Resuscitative Hysterotomy. Clinical Case. NEW
December 22, 2025 at 5:00 PM
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SUNDAY QUESTION: What does the X-Ray show?

#Shock #Limb #Injury
December 21, 2025 at 4:00 PM
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UPDATE: One of the nurses hands you the ATMIST sheet. 30-year-old male with a nosebleed. Their vitals seem ok: RR 20, sats 99%, HR 100, BP 90/60. There’s no more information. The paramedics arrive with an autistic gentleman with soaked clothes and a rare bleeding disorder [cont.]
RCEMLearning logo in white. A picture of sensory toys on a table. Alt text: Autism Spectrum Condition in the ED. Blog. UPDATE
December 20, 2025 at 6:36 PM
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UPDATE: A 13-year-old girl presents to the Paediatric Emergency Department (ED) with a 48-hour history of nausea, vomiting and abdominal pain. She saw her GP the previous day and was diagnosed with gastroenteritis.
RCEMLearning logo in white. A picture of a person holding their tummy. Alt text: Tummy Pain. Again! SAQ
December 19, 2025 at 11:51 AM