A 56yr old man with a chronic history of intermittent low back pain presents to your ED. It hasn’t been right since a motorcycle injury ten years ago and when his pain is exacerbated, as it has been this time for three weeks now, it affects his gait and daily functioning, with stiffness, difficulty standing from sitting, pain on movement, worse on rising. No red flags in history or exam. He is on co-codamol and difene as per his GP, and has tried agents for neuropathic pain previously but felt they were ineffective. No red flags in history or exam. Your consultant advises you to give him a prescription for a lidocaine patch and to get him out the door. You know that the patch is only licensed for post-herpetic neuralgia and wonder if you are just wasting the patient’s time and money with this measure.
You call the surgical SHO to refer a patient whom you suspect has acute appendicitis and he asks you what the patient's lactate is? You wonder the significance of a serum lactate in the diagnosis of acute appendicitis.
Intravenous Paracetamol and Morphine Use in Moderate to Severe Pain
A 35 year old male is brought to the emergency department with severe pain due to a fractured humerus. Intravenous access is available, and you wonder whether the use of intravenous paracetamol would decrease the amount of morphine analgesia he will need and provide better pain relief with less potential adverse effects.
In adult amputees does graded motor imagery reduce phantom limb pain?
Phantom Limb Pain is the sensation that an amputated or missing limb is still present and attached to the body. Phantom limb pain or phantom sensations are usually painful and can be an extremley troublemsome phenomenon.
A 70 year old man presents with back pain and collapse. His pulse is 120 and BP 90/63. CT shows a ruptured abdominal aortic aneurysm. You wonder whether giving tranexamic acid would reduce his risk of death.
A nine year-old child presentes to the emergency department with a laceration to his nail bed following trapping his finger in a door.
A 25 years old woman presents to the ER with a chief complaint of first trimester vaginal bleeding. Her vitals are unremarkable. You perform a transvaginal ultrasonography using a condom on the probe and confirm the presence of an intrauterine pregnancy. Once the exam is completed, you clean the probe. You wonder if probe sheaths and low level decontamination were studied regarding microbial contamination.
A 4 year old girl with DKA on fluid and insulin therapy in children's ward developed altered sensorium & unequal pupils. The registrar advised to commence her on mannitol (20%) to treat cerebral oedema. Intensivist from the transport team insisted on hypertonic (3%) saline. You wonder whether hypertonic saline is better than mannitol in treating cerebral oedema in children with DKA.
In the emergency department, you saw a young woman with severe symptoms of urinary urgency and burning. After your thorough evaluation, your diagnosis is a urinary tract infection. Before leaving, she asked you if you could give her something to relieve her symptoms while waiting the antibiotics to kick in ? You heard about phenazopyridine before but you wonder if it will really be helpful?
In community paediatric clinic you review a 4 year old boy with Down’s syndrome with attention difficulties. Parents report no concern with his sleep. At a recent meeting you remember a respiratory physician discussing screening for OSA in children with Down’s syndrome. Polysomnography is difficult to access in your area, you wonder whether overnight pulse oximetry would be an appropriate alternative. You realise you require three main questions answered: 1.tWhat is the baseline prevalence of OSA in children with Down’s syndrome? 2.tHow accurate is pulse oximetry in diagnosing OSA in children with Down’s syndrome? 3.tWhat is the post-test probability of OSA using pulse oximetry in my patient with Down’s syndrome?
Do hot drinks have any effect on the severity or duration of epistaxis?
A 46 year old lady attends the Emergency Department with significant epistaxis from the right nostril - this started spontaneously. Her nose is packed using a Rapid Rhino. She feels better and would like a hot cup of tea - you know the policy is to avoid hot food and drink for 24 hours to prevent further bleeding, however you would if there is any evidence to support this?
Can paediatric early warning scores predict serious illness in paediatric inpatients?
A three year old boy presents to his local district general hospital with a one day history of fever and shortness of breath. He is admitted to the paediatric ward for on-going observation and management. The nursing staff calculate a paediatric early warning score, based on physiological parameters, with each set of nursing observations. The student nurse on the ward notices that your chart is different to the one used by the paediatric ward on her last placement. She asks you how accurately paediatric early warning systems predict serious clinical deterioration, particularly cardiopulmonary arrest, paediatric intensive care admission or paediatric high dependency care admission.
A patient who works as a model, presents to the A&E with dog bite lacerations to the hand and arms. You check tetanus status and clean and irrigate the wounds. Having recently read the Cochrane review on not providing prophylactic antibiotics in dog bites, you wonder whether this also means you can primarily close the wounds.