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Spinal Cord Injuries
⏱ 00:45
EMF Premium›Spinal Trauma · MRCEM Primary
Current Review / Skip Answered Correct Incorrect
A 41-year-old man is brought to your emergency department after diving into shallow water. He remains immobilised on a spinal board with a hard cervical collar. Examination reveals complete loss of motor and sensory function below the C5 level. His vital signs are:
– Blood pressure: 90/60 mmHg
– Heart rate: 52 beats/min
– Respiratory rate: 10 breaths/min
– Oxygen saturation: 94% on room air
He is increasingly short of breath and using accessory muscles to breathe.Which of the following is the most urgent next intervention?
  • Apply high-flow oxygen via non-rebreather mask
  • Perform rapid sequence induction and endotracheal intubation with in-line cervical spine immobilisation
  • Administer 1 mg intravenous atropine to treat bradycardia
  • Infuse a 500 ml crystalloid bolus to support blood pressure
  • Obtain an urgent CT scan of the cervical spine

Supporting Trainee With GMC Referral

FRCEM Management
08:00 8 minutes
Instructions

You are the ST4 in the ED and act as educational supervisor for Dr Sara Khan, an ST2 EM trainee. You have arranged a confidential meeting in the ED office at her request, after she opened a recorded-delivery letter from the GMC this morning informing her of an investigation under the Fitness to Practise (FtP) procedures.

The referral relates to a documentation entry Sara made nine months ago during a busy night shift on a 68-year-old man who re-attended 48 hours later with a missed posterior circulation stroke and significant residual harm. The Trust completed a PSIRF learning review (closed, system + individual factors identified). The family has now formally complained to the GMC.

Domain Weighting
Communication40%
Organisation30%
Clinical reasoning30%
EM FINAL EXAMS Critical Appraisal · Statistics

Number Needed to Treat (NNT)

The number of patients you must treat to prevent one extra bad outcome.

Definition

The number of patients treated, over a defined period, for one of them to avoid one extra adverse event. NNT = 1 ÷ ARR (absolute risk reduction). Lower is better; NNT 1 means everyone benefits.

The picture