A 55-year-old woman attends the Emergency Department following a fall, during which she sustained an injury to her left shoulder. She complains of pain and is unable to abduct her arm to more than 90 degrees. An x-ray shows no fracture or dislocation and you suspect a rotator cuff injury. You know that MR imaging is a reliable method of confirming this type of injuries but also that it is expensive and time-consuming.<br><br>You wonder if ultrasound is as an accurate imaging modality at confirming a rotator cuff injury.
In children do steroids prevent biphasic anaphylactic reactions?
A 6 year old boy has been brought into the paediatric emergency department after an anaphylactic reaction to granary bread. After appropriate treatment the child's symptoms resolve. You wonder whether discharging with steroids will prevent a biphasic reaction?
A 53-year-old unrestrained driver who has been involved in a head-on collision arrives at the emergency department. He is immobilised on a spinal board and is wearing a semirigid cervical collar. As he has had opiate analgesia and might have had a head injury you are worried about the risk of vomiting (and subsequent aspiration of gastric contents). A junior member of the team asks whether antiemetic agents could be used prophylactically in all trauma patients, in order to limit the risk of vomiting. Interested in the result you set them the task of researching current literature and returning later in the week with the answer.
Bedside ultrasound for the diagnosis of necrotizing fasciitis
A 54-year-old man attends the emergency department complaining of a rapidly progressive pain and swelling in his right arm. He is mildly tachypnoeic and tachycardic. His arm is very tender and painful even at rest but is only slightly erythematous. He can move his hand, wrist and elbow with complete range of motion. You suspect a necrotising fasciitis. You wonder whether an ultrasound of the soft tissue night help to differentiate between cellulitis and a necrotising fasciitis.
Energy Drink Use and Adverse Effects Among Emergency Department Patients
A 19-year-old male is brought via EMS to the emergency department for seizure like activity, agitation, and anxiety after reported ingestion of multiple Monster Energy Drinks. Following a negative urine drugs of abuse screen you question whether his symptoms could be caused from toxicity from energy drink use?
A 6 year old boy was admitted for 60% full thickness body surface area burns. His stay in pediatric intensive care unit (PICU) was complicated with recurrent episodes of sepsis hampering the progress of enteral nutrition. The team wondered if beta-blockers can be used in this patient to reduce his hypermetabolic state.
You are a junior doctor in the neonatal intensive care unit. A preterm neonate has a loud murmur with bounding femoral pulse. Echocardiogram shows a haemodynamically significant patent ductus arteriosus. He is ventilated, but is otherwise well and has been tolerating full enteral feeds for a few days. A decision is made to commence intravenous Ibuprofen. You wonder whether oral Ibuprofen could be used and whether this would be as safe and efficacious as the intravenous route.
A multi disciplinary team working with diabetic and non diabetic patients who have had a lower limb amputation. A challenging area for the team is whether the diabetic patients can mobilise/weightbear after a partial foot resection. Situations have arisen in the past where consultant teams have had opposing views over the weightbearing status of the patient; non weight bearing or partial weight bearing with appropriate footwear.
Use of Magnetic Resonance Imaging for the diagnosis of acute appendicitis in children
A 7 year-old boy presents to the emergency department with acute onset abdominal pain. His symptoms are not entirely classical for acute appendicitis but you are concerned this could be the start of its presentation and refer him to your surgical colleagues. The surgical registrar on call asks you to arrange an abdominal ultrasound for him which is carried out whilst he is waiting for a hospital bed. Unfortunately the report is returned as “unable to visualise the appendix”. The surgical team say they will adopt a “wait and watch” approach but his parents are unhappy with this as their son is in pain and ask you if there are any other investigations that can be performed. You are reluctant to request an abdominal CT due to radiation exposure and wonder if there is any evidence for the use of MR scanning in diagnosing appendicitis in children as you have seen it used to diagnose appendicitis in pregnant women.
A 58 year old woman with a history of DVT attends A&E with pleuritic chest pain. She is haemodynamically stable with normal saturations, ECG and chest x-ray. D-dimer is positive. You would like to rule out a pulmonary embolism. You wonder whether it would be safe to discharge the patient home overnight before the CTPA, which is booked for tomorrow morning.
A 42-year-old man is brought to the ED with a single stab wound to the left lateral aspect of his chest and a systolic blood pressure of 85 mmHg. He is alert, well perfused and anxious but talking to you. Appropriate management is underway to stabilise his condition; should this include early restrictive intravenous fluid resuscitation prior to definitive surgical intervention?
A 29 year old male postman is referred from the acute knee clinic to physiotherapy 4 weeks following a clinically diagnosed ACL rupture. He feels his knee is regularly giving way and asks whether rehabilitation will ease and prevent his recurrent instability.
39 year old male presents to the medical facility at an international air show having spent the day on grass and concrete watching the air show. Clinically he presents with significant confusion, disorientation, tachycardia, tachypnoea, and absence of sweating. On initial assessment he is found to have a rectal temperature of 41.2 degrees and HR of 118. Following rapid assessment he is taken to the decontamination shelter where he is taken through the tent which is spraying cool water - he is passed along the tent twice and following this his rectal temperature is 39.3 degrees. He returns to the P1 (resuscitation) area and cooling and treatment continues with fine mist water spraying (plant sprayers), blow by air and IV fluids. After 1 hour of treatment his core body temperature has returned to normal and he is alert and orientated.
The subsegmental pulmonary embolus: Should all clots be treated equally?
A 36 year-old gentleman presented with pleuritic chest pain to the emergency department of St Vincent’s Hospital, Melbourne. He was low-risk for pulmonary embolism with a modified Well’s score of 0 but had a raised d-dimer of 0.7 mcg/ml. A CT pulmonary artery scan (CTPA) was performed, showing a subsegmental pulmonary embolus . He was subsequently admitted to hospital for anticoagulation and investigation of underlying risk factors. The prospect of systemic anticoagulation for three months was unappealing for him. He was otherwise clinically well and was a young person with an active lifestyle. This raised the question of whether the use of oral anticoagulation was justified in this gentleman, or whether the potential harm would outweigh the benefits.