A 42 year old female presents at the emergency department with signs of apparent acute confusion. You wonder which is the best cognitive function test to diagnose her with delirium.
A child with diabetes requires a surgical procedure. Most recent hospital guidelines recommend the use of a ‘sliding scale’ for insulin delivery only in those children undergoing major or emergency operations. Administration of insulin intravenously as opposed to subcutaneously may facilitate tighter control of blood sugars throughout a procedure. Would this delivery method be beneficial for all diabetic children having surgery?
A child requires a surgical procedure and therefore must be kept nil-by-mouth for several hours prior to the operation. This precaution reduces the volume and acidity of gastric contents, thereby reducing the risk of aspiration. Although surgery may increase blood glucose via a systemic stress response, the period of pre-operative starvation may cause children to become profoundly hypoglycaemic(as they are less able to regulate their blood sugars effectively than adults). This problem is contributed to by the fact that the fasting period is often longer than planned because of bigger surgical lists or poor planning. Are current fasting practices getting the correct balance between prevention of complications and safe blod sugars?
A six year old boy attends the Paediatric Emergency Department. He has area of broken eczematous skin that appears to be infected. He has been treated with Flucloxacillin but it appears to have made no difference. You wonder if other bacteria may be present or if there is antibiotic resistance and what antibiotic to use.
Caffeine in the prophylaxis of post lumbar puncture headache. n
You are preparing to perform a lumbar puncture to exclude subarachnoid haemorrhage. The patient is concerned that he might develop a worse headache after the lumbar puncture as his father has experienced in the past. He asks you if there is anything you could do to ensure this does not happen. You are using the smallest available LP needle, and you wonder whether prophylactic caffeine could prevent post lumbar puncture headache.
Pericardial fluid adenosine deaminase in the diagnosis of tuberculous pericardial effusion.
A 65-year-old male, with past medical history of pulmonary tuberculosis, attends the Emergency Department with shortness of breath and central chest pain for 7 days. Physical examination reveals raised JVP and chest x-ray shows a globular-shaped heart. You wonder whether pericardial fluid adenosine deaminase level would assist in the diagnosis of tuberculous pericardial effusion.
A 3-year-old boy presents to Emergency Department having pushed a nut in to right nostril. The foreign body is easily visible in his nose but the child is very uncooperative for you to remove it. While you are about to refer the child to ENT, your colleague asks you to try parent’s kiss and you wonder whether it will work?
A seventy four year old female presents from a nursing home with altered mental status and recent diagnosis of pneumonia. She is febrile, tachypnoeic, tachycardic, anuric, and has a blood pressure of 72/35. Your attending physician suggests you start her on an infusion of norepinephrine, however epinephrine has more inotropic effect. You wonder what is the best vasopressor for your patient?
A 30-year-old woman suffers a witnessed out-of-hospital cardiac arrest. You lack experience with ETI and wonder what evidence supports routine use of LMA compared to ETI or bag mask ventilation for airway management in cardiac arrests.
Therapeutic hypothermia for paediatric traumatic brain injury within 8 hr
An 8-year old child presents to the Emergency Department within six hours of an unclear incident at home which left nonspecific bruising and acute change in mental status. Fundoscopic exam reveals retinal haemorrhages, and a CT scan done later into the work-up demonstrates a small subdural haematoma. While you consult an ophthalmologist to verify your findings and concentrate on maintaining supportive care, you remember that brain injuries in adults, both hypoxic and traumatic, are increasingly treated with therapeutic hypothermia, and you wonder if this could result in a better outcome for your paediatric patient.
Caffeine in the treatment of post lumbar puncture headache n
You performed an LP on a middle aged male patient and you were very pleased with the negative result. Forty-eight hours later the same patient returns with disabling headache associated with nausea and vomiting. After your clinical assessment it all fits into a post lumbar puncture headache (PLPH). You decide upon conservative management as a blood patch requires real expertise. You think you saw an anaesthetist using caffeine for a similar case and you wonder whether you should use it.
A 60 year old man is admitted to the stroke unit following a stroke. He has increased tone in the forearm flexors, causing malalignment of the wrist into flexion. You passively realign the wrist and facilitate activity during therapy sessions. You wonder if you should also provide a palmar resting splint to maintain the muscle length.
A 22 year old female presents to the emergency department with apparent acute confusion. You know thyroid dysfunction is a cause of delirium and wonder whether to check her thyroid levels or not.
A 55 year old male presents at the emergency department with apparent confusion. There are no obvious signs as to the cause. You wonder if it is due to infection.
What is the clinical utility of urinalysis in diagnosing urosepsis as a cause of acute confusion?
A 82 year old female presents at the emergency department acutely confused, with no obvious signs as to the cause. You wonder whether to test her urine to aid to the diagnosis of her confusion.
Is haloperidol superior to risperidone in managing delirium?
A 46 year old male patient presents at the emergency department with signs of acute confusion. He is being disruptive in the waiting room and you worry he will hurt himself or others. You wonder which out of Haloperidol and Risperidone would be better to sedate him effectively and safely.
Route of olanzapine administration for acute psychiatric agitation
An aggressive and/or hostile patient in the Accident and Emergency department requires a dose of olanzapine as a sedative measure. You wonder whether administering the drug orally or intra-muscularly is the best option to bring about safe and effective sedation.
screening for non-organic causes of agitation and aggression
An agitated and/or hostile patient enters the emergency room. You wonder if there is an underlying non-organic cause to their heightened state of aggression and perform the Mini Mental State exam to identify or exclude these causes.
A 50 year old patient attends the Emergency Department with a fever, and symptoms suggestive of a urinary tract infection. He has a T 39.1, HR 110, RR 20. As you are making your assessment, the staff nurse appears at your elbow, anxious to administer 1g paracetamol for his pyrexia. You muse that as pyrexia in response to infection is a result of thousands of years of evolution, it may well serve a purpose. You wonder whether treating pyrexia has a positive or detrimental effect on the body’s response to infection.
Does ultrasonography of the inferior vena cava predict volume responsiveness? n n
A 75 years old man presents at the ED with a pneumonia and severe sepsis. The patient is also known for cardiac failure. After being intubated and having received few liters of fluids, the patient does not seem to get better. The physician wonders if the ultrasonography of the inferior vena cava would help him to know if the patient is fluid-responsive or not.