SAQ 4: Anesthesia & Pain Relief

Regarding anesthesia in the A&E department:

1)      Name 4 different methods of anesthesia which can be used to reduce a Colle’s fracture.  (2 points)

2)      What is the maximum dose of lignocaine with and without adrenaline. (1 points)

3)      Name 3 general anesthetic drugs which can be used in RSI for induction and their doses. (3 points)

4)      Until what age is straight blade laryngoscope preferable and why? (2 points)

5)      Name the Mechanism of action of Suxamethonium. What are the C/I of using Suxamethonium for paralysis in adults. (2 points)

Emergency Orthopedics

Series of Video Lectures on Emergency Orthopedics for residents from West Virginia University

Lecture 1: 

Lecture 2:

Lecture 3:

Lecture 4:

Lecture 5:

The videos were part of Residency Teaching Modules at the Emergency Medicine Residency Program at the West Virginia University and were conducted by Dr. A. J. Monseau. Thank you Dr. Monseau for the wonderful review on Emergency Orthopedics.

Neuropathy in DM type 2

It is not very uncommon to see some walk in diabetic patients with complaints of neuropathic pain in the fast track or Family medicine clinic. Often times, we attribute their symptoms to the complications of Diabetes itself. However, as a clinician, it would be advisable to seek the history of the Oral antidiabetic drugs the patient is on and for how many years.
In a recent study, it was found that these neuropathic symptoms were associated to a potentially reversible cause in more than 30 % patients on METFORMIN for more than 10 to 15 years. Metformin reduces Vitamin B12 absorption in the terminal ileum through calcium dependant pathway. It has been recommended  to Supplement these patients with oral B12 and Calcium therapy, and determination of annual B12 level.

(Source: David S.H. Bell, MD; Southside Endocrinology and Division of Diabetes, Endocrinology, and Metabolism, University of Alabama Medical School, Birmingham, AL, "Metformin-induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy," South Med J. 2010;103(3):265-267)