A 6-year-old child presents to the ED with a painful wrist following a fall. His x ray shows a buckle fracture of the distal radius. You apply a removable brace as you have recently read a 2008 BestBET that suggests that it will support healing as much as a full cast. Your next question is whether he really needs fracture clinic follow-up with repeat x ray(s) or whether this type of fracture will always heal with no risk of loss of position or residual functional deficit.
The use of ultrasound for diagnosing paediatric wrist fractures
A 4-year-old boy attends the emergency department (ED) complaining of a painful wrist following a fall. You suspect a torus fracture. However, his mum is pregnant and he bursts into tears when you tell him she cannot go into the x ray room with him. You wonder whether ultrasound can be used to diagnose a fracture of the paediatric wrist accurately?
A 27 year female has had PF pain for several months following an atraumatic onset. As well as the standard muscle exercises to the thigh and calf, you wish to instigate some hip muscle exercises, but the patient is surprised that she may have weak hip muscles and she wants to know if this weakness is recognised and has been investigated.
Eccentric exercise in the treatment of Achilles Tendinopathy
A 31 year old male presents with a 3 year history of Achilles tendinopathy. You are planning to use standard treatments of electrotherapy, ICE and strengthening exercises to improve his symptoms. You have heard from a colleague about an exercise regime based on eccentric muscle contractions and you wonder if there is any evidence of greater efficacy compared to the other treatments.
A 50-year-old male patient came to the emergency department with the symptoms of acute onset of severe rotatory vertigo, nausea, and postural imbalance. Physical examination revealed right-beating nystagmus in all positions of gaze but otherwise no focal neurological findings. After physical and neurological examinations, a clinical diagnosis of acute vestibular neuronitis was made. You wondered if steroids were useful to reduce his symptoms and improve time to recovery.
Intracranial pressure monitoring in central nervous system infective process
A 15 year old boy was admitted to paediatric intensive care unit, with bilateral otitis, mastoiditis and clinical features of meningitis. He was bradycardic And hypertensive. He had nausea, photophobia and neck stiffness. He went to operating theatre for bilateral tube myringotomy. He had a bolt inserted to monitor his intracranial pressure. You wonder whether intracranial pressure monitoring improves outcome in central nervous system infective process.
Does more than 48 hours of chest pain rule out acute coronary syndromes?
A 42-year-old man arrives at the Emergency Department with four days of chest pain. He has no cardiac risk factors including diabetes, tobacco use, hypertension, abnormal lipids or family history of coronary artery disease (CAD) and his EKG demonstrates equivocal ST elevations in anterior leads. He wants to go home and states he is “only here because my wife made me.” You wonder if more than 48 hours of chest pain is sufficiently reliable to exclude ACS in a patient with no other risk factors and an equivocal EKG.
a patient presents with pleuritic chest pain, hypoxia and dyspnoea. A CT pulmonary angiogram confirms significant PE. The patient is haemodynamically stable but you are aware of the mortality and long-term sequelae associated with PE. Should you proceed to thrombolysis or anti-coagulate?
An adult with an acute onset of severe, colicky, left-sided loin pain presents at your emergency department. Your clinical examination and laboratory results suggest a diagnosis of ureteric stone disease. As the majority of renal calculi will pass spontaneously, the focus of acute management should be rapid pain relief. While opiates can offer pain relief by subduing patients' awareness of these stimuli, NSAID's can actually treat the pathophysiological mechanisms that cause them in the first place.
Prophylactic intravenous magnesium post successful resuscitation from VF or pulseless VT arrest
You have just successfully defibrillated a 66 year old man who attended the ED with chest pain and suffered a VF arrest. He is maintaining his own airway,and starting to speak, with BP 159/77. His ECG shows an anterior MI and multiple ectopics. You are concerned he will suffer another pulseless arrthythmia and wonder whether prophylactic loading with magnesium would be useful. Your consultant says you should wait for his levels before commencing the infusion as this was not a torsades de pointes. You wonder if there is any evidence that magnesium would be beneficial here.
A 55 year old man has presented to the emergency department with a dislocated shoulder. As you prepare to sedate him the nurse puts on 5LO2 via a face mask. You know that the advantage of supplemental oxygen is that it permits a longer period of normal oxygenation in the event of apnoea or respiratory depression. However oxygen may also negate pulse oximetry as an early warning device and respiratory depression. You wonder if supplemental oxygen can limit the incidence or severity of hypoxia without masking the presence of underlying respiratory depression.
Little evidence for current optimal antibiotic therapy in febrile neonates.
26 day-old male is transferred to OHSU ED for further work-up of 1 d h/o fever and a UA showing elevated WBC and bacteria. Blood cultures were drawn, and an LP was performed. The newborn was given tylenol for fever. He was admitted to the pediatric inpatient service for ROS. There was question as to whether to begin empiric therapy with either gentamicin/ampicillin or cefotaxime/ampicillin.