Mr. Roberts is a 70 year old male that presents to the ED from a nursing home after feeling short of breath and unwell. A note from the nursing home states that Mr. Roberts has been quite fatigued and abnormal with his interactions with the nursing staff. Lab investigations reveals a urinary tract infection and CXR reveals a possible pneumonia. Talking to Mr. Roberts, he is unable to answer basic orientation related questions and appears quite withdrawn. There is no history of Dementia on his medical record, however you suspect a possible cognitive impairment. You wonder which clinical screening tool would be most sensitive, accurate and convenient to use on Mr. Roberts before attending to the many other patients in the waiting room.
A 40-year-old woman with known paroxysmal supraventricular tachycardia (PSVT) presents to the emergency department with an acute episode of palpitations, dizziness and chest tightness of sudden onset. She is found to have a further episode of supraventricular tachycardia on ECG and her systolic blood pressure is 55 mm Hg. Previous episodes have been terminated by DC cardioversion and you are aware of the algorithm recommending such treatment in the 2011 ALS course manual. However, the text also states that it is reasonable to give Adenosine to patients with regular narrow-complex tachyarrhythmias where there are adverse features while preparations are being made for synchronised cardioversion. You wonder whether it is really effective and safe to give adenosine first to unstable patients and whether this is so for children also.
A 58-year-old man comes to the emergency department complaining of upper abdominal pain, nausea and vomiting during the past 8 h. He has a history of alcohol excess. He is sweaty and pale. His blood pressure is 85/45 mm Hg and blood sugar 250 mg/dl. The upper quadrants of the abdomen are very painful to the touch. Abdominal ultrasound and blood tests analysis confirms a heterogenous pancreas with raised serum amylase, lipase, lactate dehydrogenase and transaminases. His white blood count is 22 000/mm3. The patient is admitted with the diagnosis of severe acute pancreatitis and a nasogastric tube is placed in passive drainage. On admission to high dependency you suggest feeding via the enteral route, but the local protocol suggests total parenteral nutrition (TPN). You wonder whether TPN, with its known associated complications is really needed in this case.
A 14 year old restrained male was involved in a MVA. He has a fractured forearm but no other significant injuries. He is currently alert and oriented times three and does not complain of abdominal pain. Is physical exam combined with laboratory studies sufficient to exclude any significant intraabdominal injury (IAI) in this child?
You are about to perform a rapid sequence intubation on a 26 year old man. You’ve heard rocuronium may provide similar intubating conditions to succinylcholine with fewer side effects, and wonder which should be your muscle relaxant of choice.
A 62-year-old man comes in with a new vesicular rash on his abdomen that has been present for 24 h. He complains of intense pain and tenderness in the same area as the rash. You diagnose herpes zoster. You start an antiviral medication right away, but you wonder what medication you could use to try to alleviate the patient's pain and reduce the incidence of post-herpetic neuralgia. You have seen your colleagues use pregabalin for that purpose, but wonder if there is good evidence to support this practice.
Use of non-speech oro-motor exercises in the treatment of dysarthria
A 72 year old man is admitted to the Stroke Unit following collapse and a suspected CVA. He presents with dysarthria and a CT scan confirms an acute stroke. You wonder whether oro-motor exercises will help to improve the intelligibility of his speech.
Should capnography be routinely used during procedural sedation in the Emergency Department?
A 35 year old man has a dislocated shoulder that will need to be reduced. He will require sedation and will be monitored with standard monitoring (ECG, BP, SpO2). You wonder if addition of capnography would be beneficial for the patient?
Does the ‘Seatbelt Sign’ predict intra-abdominal injury after motor vehicle trauma in children?
A 9-year-old boy presents to the Emergency Department (ED) following a motor vehicle collision. He was a restrained rear seated passenger involved in a head on crash at approximately 45 mph. His physical examination is unremarkable, except for the presence of bruising on the lower abdomen in the distribution of his lap belt, consistent with a ‘seat belt sign,’ (SBS). The boy otherwise looks well. You wonder whether there is evidence to help you decide to discharge the patient, pursue additional imaging, or admit the child for observation/further intervention.
A 25 year old male attends the emergency department after he slipped on some ice and onto his outstretched right hand. He has attended complaining of tenderness in his wrist and a lack of function. There is also marked swelling around his right wrist.
A 73-year-old male with known chronic obstructive pulmonary disease (COPD) presents to the emergency department with dyspnoea. He is diagnosed with an acute exacerbation of COPD. Despite optimal medical management he fails to improve, his arterial blood gases demonstrate type II respiratory failure with worsening respiratory acidosis. He is offered a trial of non-invasive ventilation but refuses as. A decision is taken that invasive ventilation is not in the best interests of the patient. You wonder if the respiratory stimulant doxapram may improve the patient's respiratory failure.
The effectiveness of therapeutic ultrasound in the treatment of acute sciatica.
A 30 year old male gym enthusiast presents with a 3 week history of sudden onset of back pain, after lifting heavy weight, His pain radiates from the lumbar spine to the right posterior thigh lateral calf and foot and has associated mild paraesthesia. He has had treatment with Ultrasound (U/S) before for a different condition and he is asking if U/S could be useful in this case.
Predicting the need for knee radiography in the emergency department: Ottawa or Pittsburgh rule?
A 30-year-old man presents to the emergency department (ED) after twisting his knee. You suspect a soft tissue injury and are aware that the Ottawa knee rule could be used to help determine whether radiography is necessary. A colleague suggests that you should use the Pittsburgh rule instead. You wonder which rule has greater sensitivity (thus missing fewer fractures) and greater specificity (thus reducing the need for unnecessary radiography).