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A two day old term neonate with meconium aspiration syndrome is on mechanical ventilation in a level III neonatal unit. He is diagnosed to have PPHN with a possibility to remain on the ventilator at least for another 24 hours. We know that dexmedetomidine is used in the paediatric intensive care units for sedation. But, can it be used in neonates? Is it more effective and safe compared to standard sedatives?

A 25 year old male presents to the emergency department in the late evening with symptoms of persistent nausea, vomiting and abdominal pain. He denies any diarrhea, fever, anorexia, sick contacts, or travel history. He reports daily use of 1-2g of THC/marijuana for the last 2 years, having started smoking in his early teens. He has had previous similar episodes in the last year lasting a few hours at a time. He typically takes 2-3 hot showers a day to improve his general symptoms of mild nausea and abdominal pain on a regular basis. He had a previous presentation and admission to hospital for two days with similar symptoms resolved with fluids and anti-emetics. This time, the symptoms have been persisting now for two days with no improvement. Clinically, he appears diaphoretic, and uncomfortable in pain. Vital signs are within normal limits. He appears clinically dehydrated with generalized abdominal tenderness but no acute peritonitis. History, physical exam, and investigations have ruled out emergent non-functional causes for his abdominal pain and vomiting. The clinical presentation is felt to be in keeping with cannabinoid hyperemesis syndrome (CHS). He received fluids, anti-emetics and pain control, all of which did not resolve his symptoms. You have heard that a single dose of haloperidol can improve symptoms of hyperemesis cannabinoid syndrome in the emergency department and avoid admission to hospital.

You arrive at a crash call on the ward. CPR is in progress and you are asked to manage the airway, but you are not trained in placing endotracheal tubes. You have been told that i-gels are easy to place but are unsure whether an LMA may be a more reliable way of securing the patient's airway. Which supraglottic airway device should you reach for?

You are seeing a 2 year old boy who has been non-weightbearing since sustaining a twisting injury whilst running. X-ray has revealed a toddler fracture of his left tibia (non-displaced spiral fracture). You are planning to place him in an above knee backslab but when you explain this to his mother she becomes upset because she feels this will be very distressing to him. You wonder if there are any other treatment options.

40 year old gentleman presents to your emergency department complaining of chest pain. After a full work up, there is no evidence of cardiac pathology, but the patient remains very anxious and distressed. Looking through the notes, you see that this is the third time this month he has visited your ED for chest pain, despite having had angiography some months ago which was reported as normal. You wonder if you can offer anything to this patient to help him understand his symptoms.

A neonate of 41 weeks gestation was born through Meconium Stained Amniotic Fluid (MSAF). Mild tachypnea was noted at 1 and 5 minutes, that did not respond to gentle stimulation and wiping of the mouth. Subsequently, intratracheal suctioning was performed with resolution of respiratory distress after brief NICU observation.

A 36yr old male patient is found at home in cardiac arrest. Initial ECG shows PEA and the resus is continued for 20 mins with one episode of VF but no ROSC. The decision is made to take him to the nearest A&E but there is no improvement and he pronounced dead in A&E. You wonder if being able to perform cardiac ultrasound would have helped the decision to continue or terminate the resus

As attending physisian in the cardiac arrest team your patient suddenly shows signs of awareness as CPR is performed even though spontaneus circulation is still not returning. Besides the ethical and communicative issues rising in your head, you wonder how you and the team should approach pain management and sedation while continuing cpr.

A neonate of 41 weeks gestation was born through Meconium Stained Amniotic Fluid (MSAF) subsequently developing MAS necessitating invasive ventilation in the NICU.

A 53 year old woman presents to the Emergency Department after falling on her right outstretched arm. On arrival her wrist appears to be swollen. X-ray examination reveals a displaced distal radius fracture. While performing Böhlers anesthesia, you wonder if US-guided closed reduction would increase the likelihood of reduction adequacy, thereby avoiding the need of repeat reduction or open reduction and internal fixation [ORIF].

A 62-year-old woman presents to the emergency department (ED) with difficulty walking due to five hours of constant vertigo. The dizziness is worse with head motion and better with her eyes closed. She has vomited twice but has no headache or other complaints. Her workup, including a CT scan, is negative. The patient remains ataxic despite meclizine and so she is admitted with diagnosis of peripheral vertigo. An MRI was done the following day shows a large cerebellar stroke. As the treating physician, you wonder how often the diagnosis of stroke is not recognized in the ED.

A 11yr old boy is involved in a pedestrian versus car traffic accident, sustaining head injuries with reduced consciousness. On scene he has a GCS of 6. He is intubated and brought to the major trauma centre emergency department. You wonder whether the evidence supports endotracheal intubation prehospitally for this patient.

You are evaluating a patient in the emergency department in whom you are considering the diagnosis of acute community-acquired bacterial meningitis. You perform a lumbar puncture and when ordering CSF studies wonder if sending a CSF lactate would help distinguish acute bacterial meningitis (ABM) from acute viral meningitis (AVM).

A 26 year old primigravida at 31 weeks gestation presents to the Emergency Department with shortness of breath and pleuritic chest pain. She is apyrexial, has a respiratory rate of 26, a heart rate of 110 and oxygen saturation of 95% on room air. There is no evidence of leg pain or swelling. Her ECG is normal and you are awaiting the report of her chest X-Ray. You suspect a pulmonary embolism (PE)- which imaging should you order next?

A 6-week-old presents to the emergency department with respiratory distress with no significant clinical findings suggesting a cardiac or respiratory cause at this point in time. You plan to take bloods and wonder whether Brain Natriuretic peptide (BNP) would be a useful biomarker to detect cardiac disease in this case.

You are asked to assess a 32-year-old who has waited two hours after being fully immobilised following a RTC. He has midline cervical tenderness and undergoes CT as X-rays are inadequate. You wonder whether immobilisation is doing more harm than good and if it actually prevents secondary neurological deterioration (SND).

A 62-year-old male is admitted to the intensive care unit with sepsis and is intubated and mechanically ventilated. He develops a moderate secretion load with reduced lung volumes and requires respiratory physiotherapy. You wonder if there is evidence to support the use of VHI to aid secretion clearance and improve lung compliance in this case.