In February 1997, a proposal to develop diagnostic ultrasound (U/S) skills for emergency physicians at Surrey Memorial Hospital was presented to the Diagnostic Imaging (DI) Department and subsequently to the Medical Advisory Committee. To our surprise, this was accepted in principle, with no resistance. With the support of DI, maternity and emergency medicine developed a joint proposal to purchase a $160,000 portable U/S machine. It happened so easily that I became convinced God is an emergency physician.

Focused abdominal sonography in trauma (FAST) has in many centres replaced the diagnostic peritoneal lavage (DPL) for the early assessment of acute blunt abdominal trauma. In many cases a negative FAST obviates the need for further imaging and intervention. In well-trained hands, it is a very specific and relatively sensitive test for the detection of hemoperitoneum and has the advantage over DPL of being noninvasive. However, the introduction of this exam has raised many contentious issues around indications for the study, as well as who should perform and interpret the study. Ironically, the question of who should perform the test has in many ways overshadowed the issue of whether it should be performed at all.

You’ll start in the ER!” the Chief of Staff informs his prize new surgical fellow, Robert Yeats, played by Hollywood heartthrob Eric Stoltz. This is TV land, Chicago Hope to be exact, and a great set-up for a hard-hitting personality clash.

“I don’t want him,” the ER director and trauma surgeon, Dr. Keith Wilks, complains ineffectually. “I’m ‘way too busy today.”

A 21-year-old female presented to the emergency department complaining of wrist pain following a fall onto her outstretched (dominant) right hand. The injury occurred the previous night while the patient was riding her bike. She noticed some immediate wrist pain but believed it was only a “sprain.” The next morning she awoke with considerably more pain and was unable to move the affected wrist. She suffered no other injuries and was otherwise healthy.

The Royal Flying Doctor Service, or RFDS, is close to every rural Australian’s heart. Five aircraft in Alice Springs cover central Australia, an area of desert the size of Spain. People in need call the flying doctor, hundreds of miles away, by telephone or radio. These aircraft, really airborne ICUs, can be wherever help is needed in 45 minutes.

African hemorrhagic fevers are lethal, incurable viral infections with a notorious propensity to afflict health care workers. Lassa and Ebola are the best-known culprits, and these killers spread fear well beyond their geographic range. Chances are your hospital has a plan to deal with febrile travellers returning from endemic regions of Africa. Such plans involve isolation, space suit technology and desperate calls to public health and tropical disease experts.

Resident interest in emergency medicine (EM) is on the rise. Each year, postgraduate matches add to the ranks of Canadian EM residents, and the Canadian Association of Emergency Physicians (CAEP) Residents’ Section (RS) continues to expand. The numbers are inspiring. This year, 16 residents accepted Royal College EM postgraduate year-1 (PGY-1) slots. Many more began their CCFP(EM) PGY-3 year, and this doesn’t include the residents who matched separately to EM training programs in Quebec. At the same time, the Canadian Resident Matching Service (CaRMS) matched about 433 new Family Medicine residents and 63 new Pediatrics residents. A significant number of these groups will also go on to develop interests and skills in EM.

The patient’s x-rays show 2 abnormalities. On the AP (anterior–posterior) view there is widening of the scapholunate space, which measures approximately 3 mm. On the lateral view, just dorsal to the lunate, a triquetral fracture is evident. The diagnosis of scapholunate dissociation with fractured triquetral was subsequently confirmed with an MRI (magnetic resonance imaging), and the patient underwent operative repair.