During a lull in the action over the Festive Season, an Academic ST trainee and a Specialist Registrar are discussing a case. The ST trainee cites a paper to back up his arguments. The Specialist Registrar ignores the ST trainee, claiming that his experience and "old school expertise" are obviously superior. You wonder whether evidence-based medicine is truly superior to expert opinion. Expert opinion holds that evidence-based medicine is superior. But what does the evidence say?
A 25 year old man is brought to the Emergency Department after collapsing in a club. His friends report ingestion of Gammahydroxybutyrate (GHB) and alcohol. His Glasgow Coma Scale score is 3 on arrival and he is intermittently apnoeic. When you attempt to intubate him he seems to rouse but quickly becomes unresponsive again once you stop. You ask for anaesthetic help. The anaesthetic registrar has a similar experience on attempting intubation. You are sure you have read that physostigmine can be used to avoid intubation in this situation. You wonder if you have remembered correctly.
A 4-year-old boy with steroid-dependent minimal change disease has symptoms of a viral upper respiratory tract infection (URTI). Will changing from alternate daily to daily steroids reduce the risk that this infection will provoke a relapse?
A 3-year-old previously well boy presents with a fever of 38.6°C and several ulcers and erosions extending from his lips, along the tongue and cheek, to the back of the throat. The lesions have all appeared within the last 2 days. He has been crying inconsolably over the past 24 h and is refusing food and drink. Considering the current evidence we question whether the use of oral aciclovir is indicated for primary herpes gingivostomatitis in children.
A patient presents to the Emergency Department with complaints of abdominal pain and vaginal discharge. You find out she is pregnant and has chlamydia; will antibiotic treatment help decrease the incidence of miscarriage and/or preterm labor?
Use of pericardiocentesis for patients with cardiac tamponade in penetrating chest trauma
A 43-year-old male is brought into the resuscitation room having been stabbed with a knife in his left chest. The patient is hypotensive (blood pressure 80/40mmHg) but remains conscious, and cardiac tamponade is suspected. A focussed abdominal sonography for trauma scan (FAST) shows an obvious haemopericardium with early right ventricular collapse. There is no on site cardiothoracic support and the general surgeons want to transfer the patient to another hospital for definitive surgery. The on call surgical registrar decides to perform pericardiocentesis for this patient but you wonder if this procedure is useful.
Distinguishing between septic arthritis of the hip and transient synovitis in children
A 3 year old boy presents to paediatric A&E with refusal to weightbear for the last day and a temperature of 37.9 ° centigrade. The pain is located in his hip. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis?
Paramedics may be exposed to incidents in uncontrolled environments, managing potentially critically ill patients, other people, and other emergency services. In the presence of these factors, can paramedics still conduct drug calculations with a high degree of accuracy?
A 40 year-old man presents to the emergency department with multiple injuries after being involved in a road traffic crash. You wonder whether an initial serum lactate taken in the ED is a useful predictor of mortality.
A 36 hour old well baby born at term is jaundiced at their baby check and the serum bilirubin is 270 millimoles/litre (above treatment line according to Canadian PaediatricSociety guidelines, 2007). The baby is put under phototherapy but how much under the treatment line should the bilirubin be before the phototherapy can be stopped to prevent the baby needing to be readmitted for phototherapy.
Absorbable sutures are safe and convenient for use in traumatic skin wounds.
A 34 year old gentleman presents to the department with a cut to his right arm caused by a knife which slipped during a D.I.Y accident. The wound needs closure with sutures and you wonder if using an absorbable material would provide a more convenient and equally as safe option.