A 9 year old child comes to the emergency department accompanied by his mother. The child complains of recurrent headaches which started a month ago. The headaches awakens him from sleep and are worse in the morning. He has also had recurrent vomiting associated with his headaches. On questioning, the childs mother reports that her son tends to be confused during the headache episodes, and that there has been a recent change in her sons personality. You are worried that this child could have a brain tumor. You wonder whether you should refer the child to radiologists for MRI scan of the head.
Your ED has recently instituted an Alcohol Health Service comprising two designated Alcohol Health Workers who administer brief psychotherapeutic interventions to children and adults presenting with alcohol-related events. You wish to find out whether such intervention is cost-effective...
No evidence for the use of either rectal or oral cathartics in children who have faecal impaction
A ten year old child presents to the A and E department complaining of abdominal pains and not having passed a stools for two weeks. After examination you decide that he has faecal impaction. You wonder whether there would be any added benefit if a rectal enema was used instead of oral laxatives.
A five year old child presents to the Emergency Department complaining of abdominal pains and not having passed a stool for at least two weeks. After an abdominal examination you diagnose faecal impaction. After the child has been successfully disimpacted, you are about to decide on the maintenance treatment you wonder whether there would be any difference in efficacy of the treatment if you used Movicol instead of Lactulose.
Dopexamine therapy for the patient with, or at risk of, acute renal failure
A patient under your care is diagnosed with acute renal failure. You have read the most recent BETs on dopamine, but you wonder if dopexamine may have different results. You investigate.
Is serum Cystatin C better than creatinine at predicting acute renal failure?
A patient presents to your A&E department acutely unwell, and you suspect acute renal failure, however creatinine does not appear deranged enough to account for the symptoms seen.
Fractional excretion of urate is better than sodium at diagnosing azotaemia
A patient arrives in your emergency department that has signs of acute renal failure,. You suspect this may be due to their fluid imbalance, causing the kidneys to be inadequately perfused, but you cannot completely rule out parenchymal disease. You have never been completely convinced of the reliability of the fractional excretion of sodium to differentiate between the two, but you wonder if fractional excretion of urate is more effective.
A man presents to your department with hyperkalaemia, and you are about to begin the standard insulin and glucose therapy, when you recall someone mentioning the use of salbutamol for hyperkalaemia. You quickly treat the gentleman before going to find out.
A patient presents to your A&E with signs of obstructive uropathy. You are reaching for the ultrasound machine, but then wonder if this accepted method of diagnosis is actually backed up by evidence. Perhaps another form of imaging would be better? You take it upon yourself to answer this question.
Is Vitamin D Supplementation Needed For Pregnant British Asian Women
Both authors work in the North-West region of England which has a relatively high proportion of people of Asian origin. We often encounter pregnant women and children from this ethnicity who are clinically and/or biochemically Vitamin D deficient. One solution to this is to supplement Vitamin D to all pregnant women at risk and this would benefit them and their baby. Currently, in our hospitals Vitamin D is given only to those with proven deficiency and not routinely to those at high risk. We decided to look at the evidence for this.
A normal plain radiograph does not always exclude osteomyelitis as a diagnosis.
A 58 year old male patient with long standing diabetes mellitus and peripheral neuropathy presented to the emergency department after having noticed a deep wound to the plantar aspect of his left foot. You suspect osteomyelitis and wonder what would be the most appropriate imaging modality- plain radiograph or MRI.
A plain radiograph does not detect Charcots osteoarthropathy in stage 0.
A 45 year old man with diabetes and peripheral neuropathy presents to the emergency department with a hot, red, swollen foot. There is no break in the skin and the patient cannot recall an injury. You suspect Charcot's arthropathy and wonder if plain x-ray or MR Imaging should be your imaging method of choice.
A 60 year old male patient in the Emergency Department has just been diagnosed with Charcot's arthropathy. You know that pamidronate is used to reduce joint destruction and wonder if there is any additional benefit to administering the drug before you discharge the patient compared to him recieving it a day later from the diabetes team.
A 69 year old female patient with diabetes and peripheral neuropathy presents to the emergency department with a wound to her left foot. On inspection there is an ulcerated area surrounded by callus. There are local signs of infection (swelling and erythema) requiring an antibiotic, but the patient is systemically well and fit for discharge to follow-up. You wonder if the wound can wait to be debrided by the diabetes team the next day or if there would be any benefit to sharp-debridement performed immediatly.
A 54 year old male with diabetes and peripheral neuropathy presented to the Emergency department with a hot, swollen, red left foot. He was investigated and found to have Charcots arthropathy. You know the best way to prevent further joint destruction is to off-load the foot but wonder what is they best way to achieve this.
A 45 year old male with diabetes, peripheral neuropathy and obesity presents to the emergncy department with a wound to the planter aspect of his left foot. On inspection you find an ulcer roughly 2cm x 2cm which does not appear to be infected. The man tells you it has been there for some time and is gradually enlarging, although it is not painful. You know that off-loading the pressure on the area should help it to heal and wonder what is the best way to do this.
Brief Intervention for Adults attending the Emergency department due to alcohol
An adult patient presents to the Emergency Department after an episode of binge drinking. You wonder whether a brief intervention by the alcohol nurse will reduce their drinking in the future
A patient arrives in the emergency department because of an alcohol related incident. You want to know whether they are at risk of further problems and believe the Paddington Alcohol test would be appropriate but are not sure if it is as useful as the better known CAGE questions.
A patient presents to the emergency department whom you believe to be a chronic alcohol abuser. Your worried he may be at risk of wernickes encephalopathy and wonder whether you should give him prophylactic Vitamin B supplementation
A patient in the emergency department shows the beginning of alcohol withdrawal symptoms. You know that you can start them on a standard tapering course of treatment but have been told by a colleague that symptom based treatment using the patients CIWA score would be better