You care for a 8 year old patient in paediatric A&E who is recovering from an anaphylactic reaction after a bee-sting. In accordance with NICE guidelines he should be discharged with an adrenaline autoinjector (AAI). The correct dose for adrenaline is 0.1mg per kg although only two strengths of AAI are available - 0.15mg and 0.3mg He weighs 23kg. You wonder which is the most appropriate one to prescribe?
To lie or not to lie – the best position for patients in anaphylaxis?
A 10 year old child presents to the paediatric emergency department after eating peanut butter to which he is allergic. His reaction is severe, he is struggling to breathe and his blood pressure is low. IM adrenaline, steroids and fluids are administered. You wonder if lying the child flat will help his symptoms.
A child attends the emergency department with an acute ankle injury. Clinically they are tender over the ankle and either partially or non weight bearing. A fracture is suspected but the xray appears normal. You wonder if the child could still have an occult fracture and wonder whether an USS would be of benefit for this child
A 45yo male without significant medical problems presents to the Emergency Department complaining of acute onset of chest pain. His initial EKG and troponins are within normal limits. The department is over-crowded as usual, and you contemplate whether coronary CT angiography would be a reasonable safe way to exclude ACS and discharge the patient from the department.
Does LAT gel reduce the need for general anaesthesia for wound closure in children?
You are assessing a wound on the forearm of a 4 year old boy who fell whilst playing football. There does not appear to be any deeper structure involvement but you feel the wound is likely to require suturing. Your department does not currently perform paediatric sedation and therefore the vast majority of young children presenting with wounds requiring suturing are referred to specialty teams for general anaesthetic for wound closure. You have worked in a department where topical anaesthetic is applied to wounds in children to facilitate closure and wonder whether the use of this in your department would reduce the number of children referred for closure under general anaesthetic.
A 40 year old male with a negative cardiac stress test performed 1.5 years ago presents to the emergency depart with symptoms consistent with ACS.
Steroids in addition to antibiotics for Community Acquired Pneumonia
A 38 year-old teacher presents to the ED with bilateral pneumonia. On arrival he is confused, SpO2 is 91% on air, RR is 38/min and BP is 105/59mmHg. You start treatment for severe CAP with a CURB-65 score of ≥3 and inform ITU. Would the addition of steroids to antibiotics improve this patient’s mortality and shorten his length of stay in hospital?
A multidisciplinary supported discharge team (Physiotherapists, Occupational Therapist, Rehabilitation Assistants) notice an increase in referrals for patients in the early post-op phase (2-6 weeks) following CABG. The team provide short-term rehab (up to 6 weeks) to patients in their own homes. Team physiotherapists are unsure what form of intervention is most effective at improving exercise tolerance in this patient group.
Is Norepinephrine better than Dopamine in vasopressor support of Septic Shock?
A 47-year-old female presents to the emergency department with fever, shortness of breath, tachycardia and tachypnea. Her O2 saturation is 90% with an Fi02 of 50% and her blood pressure is 75/35 mmHg. Her x-ray reveals a large consolidation compatible with the diagnosis of community-acquired pneumonia. After adequate fluid resuscitation and early antibiotics, she remains hypotensive and poorly perfused. You have dopamine and norepinephrine at hand for vasopressor support, and you wonder which one is the best in septic shock.
A 19 year old male who has been using crack cocaine for the past few days presents to the emergency room with chest pain and a wide complex tachycardia. He is quite agitated, hypertensive and uncooperative. You know that benzodiazepines are the recommended drugs for cocaine overdose, but what is the best medical treatment for cocaine induced arrhythmias.
High flow nasal oxygen therapy for acute respiratory failure in adults
A 62 year old man is brought in to hospital with a 48 hour history of breathlessness, a productive cough and fever. He is tachypnoeic and hypoxaemic with SpO2 on air of 89%. His oxygen saturations correct to 98% with high flow oxygen via a facemask. However, he is confused and uncomfortable and repeatedly removes the facemask resulting in recurrent desaturations. You wonder whether there is an effective alternative to face mask oxygen that he is more likely to tolerate.
A 42 year old man presents with severe constant upper abdominal pain with no nausea and vomiting preceded by two days of vague ‘heartburn’. He has been binge drinking over the weekend and is a smoker of 20 pack years. He had been diagnosed with peptic ulcer three years previously by his GP. He appears to be in obvious distress with a distended rigid abdomen, rebound tenderness, absent bowel sounds and is unwilling to sit up or be moved. His ECG is normal. You clinically suspect a perforated duodenal ulcer as your main differential diagnosis and as you resuscitate him you think if it is possible to detect free intra-peritoneal air using ultrasound.
Clinical Toxicity of the Designer “Party Pills” (Piperazine Derivatives)
An 30-year-old female is brought to your Emergency Department by ambulance with a chief complaint of drug overdose. The patient has intermittent tonic-clonic seizure activity and decreased responsiveness. In her pocket, you find several tablets later identified as party pills (or piperazine derivatives). As she is admitted to the hospital, you wonder what her prognosis will be.