A 72-year-old woman presents to the emergency department (ED) with hip pain after a fall from standing. She is unable to weight bear. You notice extensive bruising around her left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve her outcome when she later undergoes surgery.
Predicting Re-attendance of Older Adults to the Emergency Department
A 70 year-old gentleman has presented to the Emergency Department (ED) for the 3rd time in 7 months. Your SHO insists that he should be admitted or he will just come back again. What factors in his assessment suggest that he is more likely to re-attend?
A 42 year old male presents to the ED with opioid withdrawal symptoms of moderate severity. He is hoping to be prescribed opioid agonist therapy treatment with buprenorphine. He has no other complaints.
A 65 year old man who has a history of AF on apixaban presents to the emergency department with a minor head injury (GCS 15, no loss of consciousness, no neurological deficits) after a trip and fall on the street. He does not have a headache, did not vomit, there were no haematoma or laceration wounds on his head. Does he need to be admitted for 24 hours neuro-observation?
Children with abdominal pain, vomiting or constipation should receive AXR to guide management
A 5 year old boy is brought into the Emergency Department by his mother. He complains ofconstipation. You consider ordering an AXR to rule out intra-abdominal pathology and guide management.
Accuracy of the Physical Examination for Pediatric Skull Fracture
A 5-year-old female presents to the emergency department after a fall from playground equipment. Parents are concerned about significant head injury. You perform history and physical exam and would like to use a pediatric head injury algorithm to help guide your need for advanced imaging and you hope to avoid unneeded imaging. You wonder how accurate your exam is for pediatric skull fracture.
You are working in an Emergency Department during the Influenza season. You see a patient who has presented with typical symptoms of influenza. Their point of care influenza test is positive, but they don’t have ‘high risk’ clinical features making Oseltamivir (Tamiflu) an appropriate option. You wonder whether, for [patients with suspected or proven influenza], whether [products containing Echinacea Purpurea extract] might reduce the [clinical symptoms or duration of illness] compared to [placebo or Oseltamivir].
A 64-year-old woman is brought to your Emergency Department with acute onset isolated lip and tongue swelling. Despite having no other symptoms of anaphylaxis, she quickly receives intramuscular epinephrine and intravenous methylprednisolone without any effect. Her history reveals that she has been taking ramipril for two years to treat her hypertension. You suspect a bradykinin-mediated ACE-inhibitor angioedema and have heard that icatibant may help this patient, but you’re not sure if there is convincing evidence for its use.
The Effectiveness of Using Metronome in Chest Compression (update)
Paramedics often perform cardiopulmonary resuscitation in out-of-hospital setting. Dynamic yet stressful environment may hinder them to perform quality cardiopulmonary resuscitation.
Capsaicin cream for cannabinoid hyperemesis syndrome: a peppered body of evidence?
A 27 year old man presents with a 24 hour history of recurrent vomiting. You note he has had 5 previous presentations in the last 6 months. He has a history of daily cannabis use and it appears that his vomiting has been difficult to manage on his previous attendances. He states he often feels better after a hot shower. You have heard someone mention that there can be similar relief to hot shower by getting the patient to apply a capsicum based cream which causes a similar heating to the skin. You wonder if there is any evidence to back this up.
51 year-old man present to ICU with respiratory symptoms, increased oxygen requirement, SOB and increased WOB. He has a background of TIIDM. ABG revealed type one respiratory failure. Patient not weaning. Clinical examination reveals bilateral dull percussion, reduced basal expansion. Portable CXR bibasal consolidation/atelectasis ?infection. COVID -ve. Consultant perform lung ultrasound and revealed bilateral pleural effusion worse on right which was tapped. You wonder if doing ultrasound on everyone would change clinical management and impact on patients quality of care if done routinely.
A 12-year-old child presents to the emergency department following a major trauma. Primary survey reveals signs of shock so you commence initial resuscitation for this. Tranexamic acid is widely used for adult trauma patients and you wonder if using it in this child would reduce the bleeding and improve outcomes.
38-year-old female, 30 weeks of gestation with her 3rd child, had 1 miscarriage a year ago due to pre-eclampsia. At her last doctor's visit, she was placed on medication to keep her blood pressure under control. The patient is staying 4 hours away from the closest rural hospital. The patient was educated on hypertension and instructed to keep track of her blood pressure daily. The patient called one night and stated that she ran out of her blood pressure medications two days ago, and her blood pressure reading has been increasing since this morning and is now reading 170/116. The closest airport is 10 minutes away from her, and the flight time is 1 hour. The aircraft was activated immediately. Would oral nifedipine be better than labetalol in stabilizing this patient pre-hospital?