A child attends the Paediatric Emergency Department with an exacerbation of atopic eczema. You ask the mother about their current medications and usage. You find that the mother is confused as to what the diagnosis means and is struggling to comply with the emollient regimes. She has frequently been to the GP who alters the lotions and indicates that the instructions are labelled. You are very busy in the Emergency department and try to impart some knowledge with regards to the condition and the treatment regime before discharging them. You wonder if a educational session would help improve the situation.
Duration of Antibiotic Therapy for Suspected Neonatal Sepsis
A term neonate presents at 24 hours of age with tachyapnoea and a temperature of 37.8 °c following a low-risk normal vaginal delivery. There had been no prolonged rupture of membranes and a high vaginal swab was negative for any significant pathogens. You provisionally diagnose suspected bacterial neonatal sepsis, perform a septic screen, and start IV antibiotics according to local antibiotic protocol. His CRP is 42 and FBC reveals a leukocytosis with left shift on blood film examination. Blood, urine and CSF cultures are all negative. CXR shows no significant focal abnormality. His symptoms resolve over the next few days and you wonder how long antibiotics should be continued.
It is a busy shift in the A&E, and you receive a courtesy call from the paramedics of a 65 years old gentleman with chest pain. When you see the patient you find out that he had crushing central chest pain with radiation to his left arm, diaphoresis, and nausea for about one hour, but he is pain free now. On further questioning you find that he is receiving Warfarin anticoagulation for previous pulmonary Embolism. You think of treating him for ACS, and decide that he should receive the Aspirin, but not the LMWH. But you are puzzled whether giving Clopidogrel is of any proven benefit or not?
A previously well, term 20 day year old male is brought into the emergency department one evening. His mother reports that he is hot, irritable and not feeding. Examination does not find a source of infection but his observations show that he is febrile with a temperature of 38.1 degrees and his heart rate is raised at 190 bpm (normal range 120-160 bpm). You wonder if his raised heart rate increases the likelihood that this neonate has a serious illness?
A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using rectal thermometry.
In the febrile neonate is supra-pubic aspiration the most reliable method of urine collection? n
A previously well, term 4 day old female neonate presents to the emergency department. On examination she is febrile with a temperature of 39.1 oC, tachycardic, tachypnoeic and has no focus for her fever. You decide to do a full septic screen and one of the things you need is a urine sample. You wonder whether a supra-pubic aspiration would be the best method for obtaining a sample in this neonate?
A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using tympanic thermometry.
You wonder why some hospitals splint buckle fractures and others plaster them. Is there any need to plaster these fractures? Only 1 study for futura splints (currently a 2nd trial in recruitment stage in Washinton USA). So looked for papers that compared plaster cast with alternatives including wool and crepe and tubigrip, 1 trial comparing splint with no treatment at all.
An 8 month old boy with atopic dermatitis attends the Paediatric Emergency Department. His mother's main concern is his itching which is causing him to become distressed and areas of skin to become broken down despite the use of emollients. You know that in older children the use of sedating antihistamines is recommended. You wonder if there is anything available to treat this infant's pruritus.
The use of immunosuppressant agents in immunocompromised children with atopic eczema
A five year old child presents to the Paediatric Emergency Department with a moderate exacerbation of atopic eczema. They have leukaemia and are likely to be immunocompromised. Usually you would give a mid-potency hydrocortisone cream but know they are only recommended by NICE in non-immunocompromised patients. You wonder whether any complications such as herpetic infection are increased when using potentially immunosuppressing drugs in immunocompromised children.
Estimating Systolic Blood Pressure in Children Attending the Emergency Department
You are attending a paediatric patient in the Emergency Department. You note from the triage observations that the patient, a normally healthy 6-year-old, has a blood pressure of 80/40mmHg. You wonder if this is a little low, but cannot recall what the normal blood pressure for a child should be. You ask your registrar, who insists that you should use reference tables, while an eavesdropping consultant suggests using the formula from the APLS course - though he can't remember what it is. You wonder how best to ascertain the normal value.
A 60 year old gentleman presents to the emergency department with a spontaneous epistaxis. The bleed is anterior, from one nostril and stops with simple pressure application The patient is extremely concerned about this happening again asks what can be done to stop it? You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?
Is above-knee cast better than below knee cast for the management of presumed toddler’s fracture?
2 years old boy presented to A&E after a fall and was not weight bearing since. The clinical examintation revealed some tenderness at the junction of middle and lower 1/3 of anterior aspect of tibia. xrays did not reveal any fracture of tibia or fibula. Would you treat him in above-knee or below-knee cast for presumed toddler's fracture?
An 8 year old child has a 5cm laceration that requires closure with sutures. You wonder if TAC or LAT would be more effective in reducing the pain of suturing.
A 28 year old male is referred to physiotherapy with a 18 month history of right patella tendinopathy. You plan to use a eccentric exercise programme and wish to know what the efficiency of this treatment is against other non-invasive treatments is.
The use of oral contrast, with CT, in acute abdominal trauma
A 19 year-old girl was brought in having fallen off her horse at a canter and kicked in the abdomen. An ED trauma call was initiated. She was alert, orientated, stable but tachycardic. She had external bruising to her abdomen and it was tender on palpation, a training FAST scan was negative. Analgesia was given and the tachycardia remained. A CT abdo was requested. The consultant radiologist insisted that oral contrast was given. I wondered whether giving oral contrast improved images and diagnosis enough to outweigh the delay to scan as well as the hazards of giving oral contrast.
Is Splinting better than Early Mobilisation in the Treatment of Wrist Sprains?
A 30 year old female presents to the emergency department with a swollen, bruised and painful wrist following a hyperextension injury. After examination and appropriate investigation you diagnose a wrist sprain. She asks you if she can have a splint to wear. You are unsure whether a period of immobilisation in a splint or early mobilisation is the best option.