A 79 years old man presents to the Emergency Department with acute onset of central abdominal pain and one attack of bloody diarrhoea. The pain is severe and not relieved by simple analgesia. Abdominal examination shows central abdominal tenderness but no guarding. On general examination the pulse was 110/minute irregular but other examination was unremarkable, serum amylase was also normal. The patient gave a history of hyperlipaedemia, hypertension, smoking and peripheral vascular disease. You started titrated doses of morphine to relive the pain. You suspect acute mesenteric ischaemia and wonder if any blood test can help in supporting or excluding the diagnosis.
Diphoterine eye wash is better than normal saline in treating acute chemical eye burns
35 year old builder presented to A&E after having bleach spashed into eyes. Does the new solution Diphoterine offer better visual outcome compared to normal saline when used to irrigate acutely contaminated eyes?
A 25 year old female presents to the emergency department after falling from her bicycle on to her left shoulder. After x-ray and physical exam, she is determined to have sustained an uncomplicated anterior shoulder dislocation and undergoes closed reduction. She has no prior history of shoulder dislocation. You wonder how long her shoulder should be immobilized, and whether you should place her shoulder in external or internal rotation.
A 65 year old female presents to the Emergency Department acutely short of breath. You diagnose an acute exacerbation of COPD. You take an arterial blood gas, but wonder whether a venous one would have sufficed.
A non-obese 68-year-old man is brought to the emergency department by his family with a history of progressive dyspnea over the last week; he has both a productive cough and a fever. He’s very confused and non-combative. His initial saturation is 84% with a reservoir oxygen mask; he is tachypneic with a respiratory rate of 35. You decide to intubate this patient and you need to optimize his saturation before induction. One of your colleagues suggests that you should try Continuous Positive Airway Pressure (CPAP) prior to intubating him. You have not yet used this technique in similar situation. You wonder if CPAP should be used as a means of optimizing oxygenation in non-obese patients with hypoxia before intubation.
A 78 years old lady presents to the Emergency Department with right lower quadrant abdominal pain for 2 days. She is known hypertensive and take bisoprolol 5 mg every morning. Clinical examination showed very slight tenderness in the right lower quadrant and suprapubic area, there is no guarding, masses or organomegaly. Urine dip and bowel sounds were normal. General examination is otherwise normal with temp of 37 degree Celsius, pulse of 58 beat per minute. You wonder if you can rely on normal blood tests to be able to exclude appendicitis.
A 56 year old palliative care patient with transitional cell urothelial carcinoma presents with excruciating cancer related pain in the Emergency Department (ED). He is no longer responsive to opioids for moderate pain and now requires management of his severe cancer related pain. He has experienced constipation, nausea, vomiting and decreased cognition since being placed on morphine (70 mg/day) previously and would like to avoid significant side effects of his medication and focus on maintaining a good quality of life.
A 6 month old child is referred to Occupational Therapy (OT) from the consultant led clinic with camptodactyly. You want to try to correct the flexion deformity at the PIP joints and wonder if splinting may be a useful technique effective in improving PIP joint range of movement (ROM) and hand function.
Individualised hospital care pathways for children with autism
A young person with autism comes to hospital for an intervention and the procedure is cancelled as a result of the patient’s challenging behaviour and distress. You wonder if an individualised care plan would have reduced patient anxiety and improved cooperation with the intervention.
Is a radial pulse a reliable indicator of blood pressure in the adult trauma patient?
You heard from a colleague that "if there is a radial pulse, then the SBP is at least 80mmHg", you wonder if this is actually true in the trauma patient.
A 78 year old lady is admitted on a saturday follwing a fall at home and acopia. She is then admitted to the acute medical unit. Physiotherapy and Occupation Therapy assessments only occur Monday to Friday between 08:15am and 16:15pm. We wonder whether a seven day therapy service on the acute medical unit would decrease her length of stay.
Long-term cognitive outcome following out-of-hospital cardiac arrest
A 48-year-old, well-trained, long-distance runner collapsed at the finish of a half marathon. Against his usual practice, the athlete tried to accelerate on the last hundred meters towards the finish line. Immediately after the collapse, cardiopulmonary resuscitation with defibrillation of ventricular fibrillation was successfully carried out. After ROSC, the patient was arousable but not fully alert. We sought to understand the long term neurological outcomes for patients with out of hospital cardiac arrest from ventricular fibrillation?
A 60 year old male, brought in by ambulance crew,with the complaint of sudden onset severe right flank pain. He is also known to have cardiac problems and is on several medications. On examination his systolic blood pressure is 100 mm of Hg and the pulse rate of 65 per minute. The immediate concern is a ruptured AAA. Can ultrasonography by emergency physicians detect accurately the presence or absence of an abdominal aortic aneurysm,AAA and affect the immediate management strategy in this patient?
A 4 year old child is brought to the Emergency Department by her parents. She presents with protracted seizures. It proves difficult to gain intravenous access for administration of IV Lorazepam, which is the standard of care. You wonder whether intranasal administration of Lorazepam may be an acceptable alternative.