The attraction of Emerg Med (Los Angel) but also the challenge has always been its incredibly wide scope with no boundaries of organ, system or disease pattern. Professor Blaivas in his letter aptly describes this. One could be faced for example with a young previously healthy individual who presents with sudden loss of consciousness, sign of injury to the hand and limb spasms proceeding to Jacksonian seizures. While there are several types of epilepsy, and many recognised aetiologies for secondary generalisation, Ryan and Phillip remind us how the need for vigilance is required to allow timely diagnosis of tetanus infection. In a situation where the critical illness requires admission to the intensive care unit, the optimisation of energy supply by parenteral nutrition is of paramount importance. This has to take into account the pathophysiological changes during the disease process and the potential complications to various the organ systems. Poor et al provide some insight into this common but challenging scenario.

While large joint dislocations always provide a sense of adrenalin rush in the emergency department, dealing with a dislocation of the elbow has never ceased to be a serious challenge. Sears and Spear provide us with a review for the evaluation and management of such cases. Timely recognition and management will save limb and function. And if one thought that chest pain presentations are very common and very predictable, a read of Kurtipek’s short review will certainly be educational.

There is of course a variety of how far the role of the emergency physician extends before a specialist takes over. In this volume we see applications of ultrasound radiology. Zaragoza-Elmus and Melman report how an ultrasound supraclavicular block can be used for managing an open wrist fracture in a patient with a difficult airway, illustrating how ultrasound can help identify anatomical variations and allow specific regional blocks. But how useful and practical really is ultrasound scanning in the emergency department? Schonberger evaluates the clinical impact of this imaging modality in the emergency setting and discusses pertinent information.

There is no doubt that this issue will answer some of these questions and create a lot more, and all this is often less than a day’s work in the Emergency Department.