A child presents to the paediatric emergency department in acute pain but you cannot give him intranasal diamorphine due to both a departmental and nationwide shortage. You are able to give them either IM or IV morphine but wonder whether you can use intranasal fentanyl instead
What is the efficacy of duct tape as a treatment for verruca vulgaris?
An 8-year-old girl attends a general paediatric outpatient clinic for medical review and it is noted that she has duct tape on her finger. When asked about it, her mother states that duct tape was recommended by a dermatologist for the treatment of verrucas on the girl's fingers and toes. You wonder what the evidence base is for this treatment.
The Pedi-Cap device (Covidien, Mansfield, Massachusetts, USA) is frequently used in neonatal resuscitation to check the position of the endotracheal (ET) tube in term and preterm neonates. As a paediatric trainee having worked in various regions of the UK you note a huge variability in this practice. Clinical assessment of chest expansion and air entry, with improvement in saturations, colour and heart rate have been used for decades and work well. Is the Pedi-Cap superior to clinical assessment for checking the position of the ET tube?
Is ketamine a viable induction agent for the trauma patient with potential brain injury.
A 26 year-old male is brought to the Emergency Department after being struck by a car. His Glasgow coma scale on arrival is 8/15 with obvious evidence of head injury and thoracoabdominal trauma. He has a profusely bleeding scalp wound and is tachycardic. You decide to undertake a rapid sequence intubation (RSI) and begin drawing up ketamine as an induction agent. Your colleagues raise a collective eyebrow and ask you to defend your choice of agent. You offer cardiovascular stability and familiarity as two main indications. They remain concerned about the risk of raising intracranial pressure (ICP) and insist that Ketamine is contraindicated in head injured patients. They are unable to cite any evidence to support this view. You propose a BET to methodically examine the literature.
What is the incidence of biotin deficiency in preschool children with global developmental delay?
A 3-year-old girl presents in clinic with mild to moderate general delay in all areas. There is no other relevant history, no family history and clinical examination is normal. The paediatric registrar decides to order some investigations, including the biotinidase activity level, to identify the possible aetiology of the global developmental delay (GDD).
Do wrist splints need to have a thumb extension when immobilising suspected scaphoid fractures?
A 23 year old man presents with a painful wrist following a fall on outstretched hand. On examination he has diffuse wrist pain and is tender in the anatomical snuffbox. His wrist and scaphoid views do not demonstrate a fracture. You organise a two week follow up appointment in the ED clinic and give advice regarding analgesia. You have decided to immobilise the wrist in a splint, but wonder if one with a thumb extension is better than a standard splint at immobilising suspected scaphoid fractures.
Prophylactic antibiotic use to prevent Weil’s Disease after immersion in water
A drainage engineer comes to the Emergency Department following a fall and total immersion in standing water. He is concerned about Weil's disease. You do not know whether prophylactic antibiotics are of any use in disease prevention.
You are a community paediatric registrar carrying out an outreach community clinic. You see a 12-year-old child who has difficulty settling down to sleep. You give his mother the usual sleep hygiene advice and discuss the importance of a good routine including having a period of ‘quiet time before lights out’. He currently plays computer games in his room before turning off the light. As part of your discussion you suggest that he stops playing computer games before bed. His mother, who is a staff nurse, asks what evidence there is to support this advice. You decide to examine the evidence.
A premature infant (30 weeks) weighing 1050g was recently admitted to the neonatal intensive care unit after an uncomplicated delivery. You have spoken to the mother regarding the benefits of expressed breast milk (EBM) compared to premature formula milk, including the decreased risk of necrotising enterocolitis (NEC), and this is being administered via a nasogastric tube. At the ward round the consultant suggests the addition of EBM fortifier to ensure the baby has an adequate intake of macronutrients and micronutrients and to maximise extra-uterine growth. You wonder if the addition of a cow's milk-based fortifier to EBM will confer an increased risk of NEC and decide to find out more.
A 3-week-old baby presents with cough and episodes of apnoea. Nasopharyngeal aspirate is negative for common respiratory viruses. You consider the diagnosis of pertussis and take a full blood count to assess the lymphocyte count. You wonder what the sensitivity and specificity of the lymphocyte count is for pertussis in infants.
A 2 year old boy is brought to your emergency department after a motor vehicle crash. He was wearing a seatbelt and the parents do not think he lost consciousness. No one else in the car was injured. On exam, the child is quite upset and you are unable to determine whether there is cervical tenderness. You do notice some bruising over his torso. There are no neurologic deficits on exam and he is able to ambulate. Should you obtain cervical spine imaging to rule-out injury?
My FY1 who had just seen a patient with a TIA was told by the stroke specialist nurse to prescribe clopidogrel. The FY1 had already given the patient aspirin and asked me whether clopidogrel was better for secondary prevention in this group of patients, and also should she give the clopidogrel as well as the aspirin?
Use of corticosteroids in the treatment of septic arthritis in children n
A 3-year-old child presents to the emergency department with High fever and pain in his right knee. You perform a diagnostic arthrocentesis and the stat gram is positive. You start the IV antibiotic treatment and you wonder if the addition of a corticosteroid would be appropriate.
A patient attends A&E with a painful sickle crisis. They have taken oral anlgesia including rescue oramorph with limited effect. You are unable to obtain IV access and wonder if there are any inhaled therapies (apart from oxygen) which could help the patient. You ask your registrar who is uncertain so you decide to check BestBETS
A 30-year-old man attends your emergency department after a deliberate overdose of his father's atenolol tablets. He is bradycardic, hypotensive and has had seizures. Despite fluids, atropine and a glucagon infusion, he remains hypotensive and you start treatment with inotropes. He remains unresponsive to treatment and very hypotensive and you wonder if an intravenous lipid infusion would help.
Bedside echocardiography for prognosis of emergency department cardiac arrest?
A 62 year old male emergency patient arrives in cardiac arrest. During resuscitation he is found to have pulseless electrical activity (PEA). Several rounds of ACLS are performed with no improvement in the patient's condition. You wonder if a rapid bedside cardiac ultrasound (echocardiography) would be of any prognostic or diagnostic utility.