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Clinical Question – How Do I Approach Agitation and Aggression in Children with Autism Spectrum Disorder in the Emergency Department?

In Clinical Questions by Devika SinghLeave a Comment

A 7-year-old boy with autism spectrum disorder presents to the emergency department (ED) with upper respiratory infection symptoms. He starts becoming agitated as you try to auscultate his lungs and aggressively comes towards you. You are unsure of the best method to approach this situation. Research has demonstrated that almost one third of children with autism spectrum disorder (ASD) who present to the emergency department had negative experiences or unwanted outcomes.​1,2​ Children with …

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Clinical Question: When should patients be allowed to eat in the Emergency Department?

In Clinical Questions by David ZhengLeave a Comment

You have just finished seeing a 12-year-old boy who fell off the monkey bars about an hour ago. He has an obvious deformity to his right elbow and you suspect a displaced fracture that will require reduction. You would like to use procedural sedation to facilitate the reduction, but an empty granola bar wrapper stops you in your tracks. “We missed dinner rushing here and he couldn’t resist,” his mom says. Staring at …

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Clinical Question: What is the Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain?

In Clinical Questions by Shankar SethuramanLeave a Comment

Clinical Question: Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain A 73-year-old male presents to your Emergency Department with vague LLQ abdominal pain. Your differential includes stones/pyelonephritis, diverticulitis, obstruction, and neoplasm. You want a CT scan to assist in diagnosis. A colleague mentions you need oral contrast to diagnose obstructions, and intravenous contrast to diagnose diverticulitis but intravenous contrast hinders the diagnoses of stones. What is the …

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What is the role of POCUS to differentiate between cellulitis and abscess?

In Clinical Questions, Medical Concepts by Justin HsuLeave a Comment

A 30-year-old male presents to the ER with right forearm redness, swelling and pain. On exam, you are unsure whether this infection represents cellulitis or abscess. You wonder if point-of-care ultrasound (POCUS) can be helpful. Superficial soft tissue infections are a common ED presentation. Cellulitis appears as an area of erythema, edema and tenderness. An abscess is suspected when a discrete fluctuant mass is palpated within the infected tissue. However, relying on these …

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Substance use in the ED: Alcohol Use Disorders and the Emergency Department

In Clinical Questions, Medical Concepts by Gaibrie StephenLeave a Comment

Think back to your last three shifts. Did you see an alcohol related condition? You might even notice a pattern— the same patient, the “regular” who returns time and time again with the same presentation. You may even find yourself writing “discharge home when ambulatory” as you’ve “reached your wits end” and don’t know what to do anymore.  The use of alcohol is common and the emergency department is often where we see …

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What to do if your Patient is Poisoned by a Nerve Agent

In Clinical Questions, Medical Concepts by Tanishq SuryavanshiLeave a Comment

While working in your emergency department, you receive news a number of patients have been found at a bus station unconscious. It is suspected that some sort of attack may have occurred. The first patient is brought to your ER, with obviously soiled clothing, vomiting and aggravated. As you make your way towards the bedside, the patient suddenly begins to seize. Overview: This past month, the assassination attempt of a Russian ex-spy and …