A 37 year-old man attends the emergency department with cyanosis unresponsive to high flow oxygen. When blood is drawn it is a dark ‘chocolate’ colour and does not lighten when exposed to air. The patient reports he has recurrent methaemoglobinaemia of unknown origin and is currently under haematology who are attempting to illicit a cause. When is this man safe to be discharged?
Does inhaled budesonide improve outcomes in adult patients with confirmed COVID-19 infection?
A 70-year-old woman presented to the Emergency Department with hypoxia and confusion. Her chest X-ray findings are consistent with severe COVID-19 pneumonia. COVID-19 infection was confirmed with RT-PCR testing. A colleague mentions inhaled budesonide as a possible treatment. You wonder if inhaled budesonide would reduce mortality or time to recovery. You also wonder if it is associated with increased adverse events.
A 66-year-old man came to the emergency department by ambulance for cough and viral illness. His chest X-ray revealed bilateral infiltrates concerning for viral pneumonia. RT-PCR test confirmed the diagnosis of COVID-19 infection. You wonder if monoclonal antibody therapy would provide any benefits to mortality, length of stay, requirement for ventilation.
Jefferson’s Burst Fracture treated with nPosterior C1 Lateral Mass Screw nApproximation
A 20-Year-old female front seat passenger with the seat belt on sustained a neck injury from a frontal collision car Accident that left her with a fronto-parietal scalp laceration; presented to the Emergency Room with cervical spine precautions. Primary survey demonstrated a non-disabling local neck pain and tenderness. The neurologic examination was normal with no disabilities, and no cranial nerve involvement. Glasgow coma scale was 15/15. Past medical history is unremarkable with no previous incident. An X-Ray, Computed Tomography (CT) scan and MRI of the neck revealed only a Jefferson fracture with a 12 mm widening of the lateral mass of C1. The Anterior Atlanto-Dens Interval (ADI) was normal (2mm) and the Space Available for the Cord was 17mm.
First line investigations in adult patients presenting following Melanotan II injections.
A 35 year old male patient presents to ED feeling non-specifically unwell following subcutaneous administration of 'Melanotan II' for the purposes of tanning. He describes hyperpigmentation around the injection site, but otherwise no localising symptoms.
Effective pain relief from fascia iliaca block using levobupivacaine in femoral neck fractures
A 78 years old female, a 87 years old male, a 64 years old male and a 53 years old female, all had falls and confirmed fracture neck of femur. All had received IV Morphine for pain by the ambulance crew. They received fascia iliaca block (FIB) with 0.25% levobupivacaine adjusted to their estimated weight by the emergency physicians. Their pain scale varied between moderate to severe. We were expecting drastic improvement in pain within the first 30-60 minutes after instilling the blocks. Instead all had no pain relief even after 1-2 hours and required additional analgesics to reduce the pain in the emergency department.
An 11-month old boy is admitted with difficulty breathing, cough and poor feeding. On examination he has bilateral wheeze with fine inspiratory crepitations and moderate recession. His oxygen saturations are 88% on room air. Management with nasogastric feeds and supplementary oxygen is commenced in line with national guidelines. The Nurse in Charge suggests placing him in the prone position. You wonder what effect ‘proning’ may have on his clinical outcome and what the evidence for this is.