#FOAMed

I had never really had an urge to work in the prehospital environment, I'll be honest. As someone scared of flying the idea of helicopters did not appeal and on the whole I was quite happy in my temperate, well-lit resuscitation room with fabulous ED nurses and many hands to help look after the sickest patients.

It's been an interesting year. Social media is awash with all the awful things that have happened, the people we have lost, the success or failure of democracy (depending on your perspective), the war in Syria and many other awful events.

In recent years there have been great efforts amongst researchers in improving the diagnosis of appendicitis in the ED. A range of clinical risk scores, biomarkers and imaging techniques have been tested to improve our ability to make the diagnosis1.

Every so often, a paper comes along that contradicts your gut feeling and/or current practice and makes you really think hard. That happened to me this weekend.

I expect that some people will be offended by the image above. That's the point though, images, attitudes, initial impressions are powerful drivers of how we feel and behave.

Vessel wall rupture