The irritable hip

Abstract

Anaesthetic training in accident and emergencyEDITOR,-I read with interest the comments of Boyle et al 1 regarding anaesthetic training for accident and emergency (A&E) specialist registrars. They suggest that there is a definite advantage of spending six months as a "true" anaesthetic SHO as part of the A&E specialist registrar scheme, rather than as a supernumerary extra in theatre. As someone who initially undertook a training in anaesthesia with a view to entering higher training in A&E via this route, I would agree that it oVers much more than the opportunity to become confident and competent at advanced airway management in the relatively controlled theatre setting. Training in anaesthesia oVers the chance to gain many other skills that are extremely useful to the A&E trainee, particularly in the resuscitation setting, including the assessment and management of critically ill patients, providing ventilatory and circulatory support where necessary, the use of anaesthetic equipment, invasive haemodynamic monitoring techniques and transportation of critically ill patients. The opportunity to become proficient at the various regional anaesthetic techniques and to gain an understanding of pain management is also very relevant to A&E practice.The possession of the FRCA, which requires at least 2.5 years of training in anaesthesia, is one of the established ways to enter the A&E specialist registrar grade. Surprisingly, in the current membership list of the British Association of A&E Medicine, only 60 (0.05%) members possess the DA (or old primary FRCA), with only 12 (0.01%) possessing the FRCA or equivalent.2 As our specialty continues to develop and accepts more responsibility for early advanced airway management, ventilatory and circulatory support and rapid sequence inductions, both within the A&E department and in the pre-hospital setting, I feel that we should encourage more of our junior trainees interested in a career in A&E to enter the specialist registrar grade via this route.

Acute lymphoblastic leukaemia presenting with atraumatic intermittent limp: a case report

“…A number of these have no known history of trauma and there is ongoing controversy on how to manage acute atraumatic limp [2][3][4][5]. Most cases show hip pathology with the majority being of benign origin [1,2,4] but the main concerns are not to miss serious pathology and to begin appropriate management for the underlying condition.…”

“…Our current practice of routine phlebotomy in each child presenting with atraumatic limp has been challenged by others previously [3], and many departments do not routinely carry out venepuncture as part of their initial assessment.…”

“…This has been challenged by others, and many departments do not routinely carry out venepuncture as part of their initial assessment [3].…”