An 18 year girl went hiking for the first time. Unfortunately she had to interrupt the trip because she suffered from several friction blisters on her feet. When arriving at the emergency department with an infected blister, she asks you whether she could use antiperspirants in order to prevent blisters the next time.
A 30 year old patient presents to her general practitioner, she has been suffering from postprandial dyspeptic symptoms after dinner regularly. You have heard that a walk after dinner offers some benefit in such cases and wonder if there is evidence to support this.
A nine year old child is brought to the emergency department with a tender, red swelling on her eyelid. You diagnose hordeolum (stye) and recommend treatment with warm compresses four times a day. A colleague later challenges your advice and asks what evidence there is for it.
Do Early Warning Scores predict mortality in adult ED patients?
Whilst working in the Emergency Department you assess a 44 year old male patient with a large intracerebral haemorrhage. He only scores 2 on his early warning score due to his decreased level of consciousness, his other physiological variables being normal. Based on clinical indications, he is intubated and ventilated and taken to intensive care but dies two days later. Whilst reflecting on this case you wonder whether early warning scores are sensitive and specific enough to predict mortality in ED patients.
A premature infant (30 weeks) weighing 1050g was recently admitted to the NICU after an uncomplicated delivery. You have spoken to 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 adequate intake of macro 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.
Blood gas analysers are typically preset to assume a patient’s temperature is normothermic at 37 degrees centigrade. In clinical practice the temperature of the patient is infrequently taken at the time of sample or entered into the analyser. With emergency departments exposed to patients presenting with temperature extremes, you wonder whether the temperature entered into the gas analyser has a significant effect on results and subsequent clinical management.
A 38 year old man was brought to our Emergency Department (ED), one and a half hours following flame burns to his forearms while working in woods. He hadn't had first aid cooling. Partial thickness burns were diagnosed. I wondered whether delayed application of first aid cooling, as part of his treatment in ED, would improve his wound healing.
A term baby girl is admitted to the neonatal unit following concerns regarding abnormal movements noted on the postnatal ward. She is reported to have had tonic posturing of the limbs and back-arching at 10 h of age. As the neonatal registrar on the night shift, you are asked to review the baby and you wonder whether cerebral function monitoring (CFM) of the baby would be an effective and accurate method of detecting seizure activity.
Elbow extension as a ‘rule-out’ tool for significant injury in children
A 7 year old girl presents to the emergency department complaining of pain in her left elbow, having fallen onto her outstretched hand. On examination she can fully extend the elbow on the affected side. You have heard that full elbow extension can be used as a 'rule-out' tool for significant injury and you wonder whether there is any value in obtaining an x-ray.
A 3 year old child comes into the Emergency Department complaining of tummy ache. As part of the abdominal examination you listen for bowel sounds. You wonder whether this will aid the diagnosis.
A 28 year old male with known depression attends the Emergency Department (ED) six hours after a small overdose of benzodiazepines. He is threatening to leave the ED prior to mental health assessment. You wonder whether the SADPERSONS scale is useful in predicting his risk of further self harm or completed suicide.
A 41 year old female presents to the department hours after a FOOSH. She has pain on the radial side of the wrist and over the ASB. You wonder if she has had a fracture of the scaphoid and want to know the best clinical test to help the diagnosis
A 7-year-old boy presents to the accident and emergency department with cough, a high temperature and signs of respiratory distress. An x-ray shows pneumonia. Does this child require intravenous antibiotics, or would oral antibiotics be sufficient?