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?
Recently, Drug Safety Update (a monthly newsletter from the Medicines and Healthcare products Regulatory Agency (MHRA) and the UK Commission on Human Medicines) issued an alert on the antiepileptic drug (AED) phenytoin (PHT) regarding an increased risk of Steven–Johnson syndrome (SJS) associated with the presence of the HLA-B*1502 genetic variant in patients of Asian origin. Likewise, the US Federal Drug Agency (FDA) recommended genotyping for the allele in all Asian patients before starting carbamazepine (CBZ). We wanted to explore the implications of this for our clinical practice.
Three-day-old twins are reported to have persistent bilious vomiting on the postnatal ward. You suspect midgut malrotation and it is suggested by a colleague that a Doppler ultrasound might be a better investigation than an upper gastrointestinal (UGI) contrast study, as it does not involve radiation and is non-invasive. You are uncertain which test is best.
PONV is a common problem after general anesthetic and has the possibility to cause delays from the recovery room. What is the incidence of post-operative nausea and vomiting (PONV) in fast-track patients after cardiac surgery?
70 yo male presents to ED with SOB and hypotension 75/40 with HR of 160. Pt found to be in afib. Pt does have h/o afib but usually rate controlled with dig. Pt is unsure how long he has been in afib. Pt is given 10mg of dilt after 1L IV NS bolus and pressure drops to 70/35. No change in HR. Would the addition of IV magnesium help with rate control of this patient?
A sixty-five year old man attends the Emergency Department with a twelve hour history of palpitations. An ECG confirms that he is in atrial fibrillation with a ventricular rate of 130 beats per minute. He has no cardiovascular compromise. You have heard that intravenous magnesium may be an effective and safe way of converting him back to sinus rhythm and wish to review the relevant literature.