The Effectiveness of Using Metronome in Chest Compression (update)
Paramedics often perform cardiopulmonary resuscitation in out-of-hospital setting. Dynamic yet stressful environment may hinder them to perform quality cardiopulmonary resuscitation.
A 64-year-old woman is brought to your Emergency Department with acute onset isolated lip and tongue swelling. Despite having no other symptoms of anaphylaxis, she quickly receives intramuscular epinephrine and intravenous methylprednisolone without any effect. Her history reveals that she has been taking ramipril for two years to treat her hypertension. You suspect a bradykinin-mediated ACE-inhibitor angioedema and have heard that icatibant may help this patient, but you’re not sure if there is convincing evidence for its use.
Capsaicin cream for cannabinoid hyperemesis syndrome: a peppered body of evidence?
A 27 year old man presents with a 24 hour history of recurrent vomiting. You note he has had 5 previous presentations in the last 6 months. He has a history of daily cannabis use and it appears that his vomiting has been difficult to manage on his previous attendances. He states he often feels better after a hot shower. You have heard someone mention that there can be similar relief to hot shower by getting the patient to apply a capsicum based cream which causes a similar heating to the skin. You wonder if there is any evidence to back this up.
A 12-year-old child presents to the emergency department following a major trauma. Primary survey reveals signs of shock so you commence initial resuscitation for this. Tranexamic acid is widely used for adult trauma patients and you wonder if using it in this child would reduce the bleeding and improve outcomes.
38-year-old female, 30 weeks of gestation with her 3rd child, had 1 miscarriage a year ago due to pre-eclampsia. At her last doctor's visit, she was placed on medication to keep her blood pressure under control. The patient is staying 4 hours away from the closest rural hospital. The patient was educated on hypertension and instructed to keep track of her blood pressure daily. The patient called one night and stated that she ran out of her blood pressure medications two days ago, and her blood pressure reading has been increasing since this morning and is now reading 170/116. The closest airport is 10 minutes away from her, and the flight time is 1 hour. The aircraft was activated immediately. Would oral nifedipine be better than labetalol in stabilizing this patient pre-hospital?
The mother of a 3-year-old boy, who was in excruciating pain and distress, accompanied him to the emergency room. The mother recounts the sequence of events: The boy's goal was to get his cereal from the cupboard. In order to reach it, he stood on a chair, which unfortunately toppled over, causing him to strike the underside of his chin against the corner of a table. When medical staff entered the room, the child would cry out loud, and the mother said that the boy had a large, heavily bleeding cut under his chin. Out of two medications you may use to sedate the youngster before examination and therapy, which would you prefer: nasal ketamine or nasal fentanyl?
51 year-old man present to ICU with respiratory symptoms, increased oxygen requirement, SOB and increased WOB. He has a background of TIIDM. ABG revealed type one respiratory failure. Patient not weaning. Clinical examination reveals bilateral dull percussion, reduced basal expansion. Portable CXR bibasal consolidation/atelectasis ?infection. COVID -ve. Consultant perform lung ultrasound and revealed bilateral pleural effusion worse on right which was tapped. You wonder if doing ultrasound on everyone would change clinical management and impact on patients quality of care if done routinely.
Tranexamic acid to all ‘Silver Trauma’ patients in the pre-hospital setting
As we are aware, trauma to elderly patients is significantly worse in terms of outcome compared to a younger adult. I wanted to investigate if the benefit would out weigh the risk for administering tranexamic acid to all 'silver trauma' patients.
A 39 year old man is experiencing acute on chronic non specific lower back pain, this is the second such episode he has had despite being active and a regular attendee at the gymnasium. His current employment requires a reasonable level of fitness and he is struggling without constant topical analgesia. A colleague suggests pilates, upon research he wonders if a certain style/type is more effective at reducing symptoms and preventing future episodes.
A 6 day old baby was seen in CEC with mild increase in WOB. The baby was saturating well and was feeding normally so parental education was given and they were advised to go home and return if things change. However, before discharge the parents mentioned they were worried about the yellow tinge to babys skin. The history revealed no risk factors for pathological jaundice, however, before discharge a serum bilirubin level (SBR) was done to ensure normal bilirubin levels and put the parents mind at ease. The results showed serum bilirubin was well below the treatment line (122umol/L). Was it necessary to bleed this baby or would a transcutaneous bilirubin measurement have been an effective method to rule out significant hyperbilirubinemia?
Surgical versus non surgical management in rotator cuff syndrome
A 38y/o male presents with persistent shoulder pain, after manual clinical assessment and ultrasound it is confirmed he has a rotator cuff tear. The patient expresses concerns and wants to know what his long term treatment options are.
IV paracetamol OR oral paracetamol for the treatment of pain
A patient you are treating is suffering with acute, moderate to severe pain. The patient does not have any reasons why they cannot take oral paracetamol. You wonder if the intravenous (IV) presentation is superior to its oral counterpart at reducing pain and wonder what route of administration is best for treating your patients pain.
BE-FAST, a better prediction mnemonic than FAST in the identification of strokes in adults.
A family have concerns over their 56 year old family member who has presented with sudden on-set coordination/gait problems, who has also vomited twice. An ambulance is called and the patient has been assessed as FAST neg. Despite this, the gentleman was transported to the local emergency department. When in the emergency department he was further assessed and found to also have ataxia and problems with vision. CT head revealed the patient was suffering with an ischemic stroke effecting a posterior artery.
You are working in the Emergency Department and a patient presents in acute pain. They have tried simple analgesics and are keen to avoid opiate medications. You are aware of Amitriptyline use in patient's with chronic pain. You wonder if there is any evidence supporting the use of Amitriptyline for symptom control in acute pain.
A 53-year-old patient presents to the Emergency Department with an altered level of consciousness from a suspected respiratory failure. The decision was made to intubate him. As you are preparing to intubate the patient, you wonder whether pre-intubation IVF bolus administration in your normotensive patient will reduce the risk of peri-intubation complications.
In paediatric major trauma patients is admission hypocalcaemia associated with adverse outcomes?
A 7-year-old girl has been bought in by ambulance to the emergency department having being involved in a motor vehicle collision. She is tachycardic, has abdominal bruising over her left upper quadrant, and is generally tender and guarding on examination. A venous blood gas on admission demonstrates hypocalcaemia. Since the ionised calcium level on a blood gas measures the physiologically active component of calcium (as opposed to total calcium which includes albumin bound calcium), you wonder whether the ionised hypocalcaemia might be related to adverse outcomes.