Medicine with limited imaging

Yesterday was appendicitis day: 3 of them. One was classic, straight to theatre without imaging. One had classic localized peritonitis, but a 3 day course and the localized tenderness was in the anterior axillary line rather than McBurney's point - surgery poo-pooed a bit, so we got a CT and as predicted by the ER, a retrocecal appendix wrapped around and up against the lateral abdominal wall where the tenderness was. The third had diffuse tenderness of the entire abdomen with no area that was clearly worse - until we gave him some fentanyl and he then localized nicely to the right lower quadrant - straight to theatre without imaging where he had a perfed appy with generalized peritonits - as predicted.

We've had a couple of big trauma resuscitations this week: 3 year old with isolated head injury (clipped in the head by the projecting bed of a flatbed truck), and an ultralight plane crash. We get the ICU critical care team (anethesiologists) as well as surgeons. It works remarkably smoothly (especially with the number of temporary folks here), is relatively low key - with lower ambient noise than I'm used to, and based on only 2 cases seems to work well. The drawback is that - the EM Registrars get treated as very much second class citizens in the resuscitation (not unlike the general flavor of everything here).

Inpatient beds were readily available (I presume no elective stuff over the 4 day Easter holiday, so lots of inpatient space). So, we had no boarders in the ER and it became remarkably efficient to move through fairly high volumes (it seemed to be crash your dirt bike motorcycle weekend - tons of fractures).