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Clinical Question: Which ultrasound-guided nerve block is best for acute pain management of rib fractures in the ED?

In Clinical Questions by Sulman ZahidLeave a Comment

A 72-year-old male presents to the emergency department (ED) with severe chest pain and difficulty breathing after an MVC. Physical examination reveals tenderness and localized swelling over the left lateral chest wall, with X-ray confirming multiple rib fractures. The patient’s vital signs are stable, but he is visibly distressed and struggling to find a comfortable position. What are nerve blocks? Nerve blocks involve administering local anesthetic near specific nerves to block pain signals …

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Can diltiazem replace adenosine as part of the initial management of stable supraventricular tachycardia?

In Clinical Questions by Raymond YuLeave a Comment

A 50-year-old female presents to your ER with a chief complaint of palpitations. A 12-lead ECG shows supraventricular tachycardia at a rate of 165 bpm, and she is put on telemetry. She is clinically stable. You attempt the modified Valsalva maneuver with no effect. You explain that you will have to give her medication to bring her heart rhythm back to normal. She asks if you will give her “that adenosine drug” and …

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When do you use X-ray vs CT for pediatric head injuries?

In Clinical Questions by Maryam YossofzaiLeave a Comment

A 3-year-old boy is brought to the ED by his anxious parents following a head injury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. As you observe him calmly playing on his tablet in the waiting room, his parents are inquiring about the necessity of skull x-rays. You consider the role of such imaging in investigating pediatric head injuries – …

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Clinical Question: How does the sensitivity/specificity of lung ultrasound compare to plain films in diagnosing acute decompensated heart failure?

In Clinical Questions by Neil SenguptaLeave a Comment

A 64 year old woman presents to the emergency department with dyspnea.  On exam she is mildly tachypneic, has an oxygen saturation of 94% on 2L nasal prongs, and bilateral crackles to auscultation.  You suspect acute heart failure and wonder about the role of lung ultrasound as you await her chest x-ray.   Clinical question: What is the sensitivity and specificity of lung PoCUS compared to chest radiograph for diagnosis of acute decompensated …

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Clinical Question: Can stable patients presenting to the emergency department with blunt abdominal trauma be managed safely without a CT scan?

In Clinical Questions by Kylie SuwaryLeave a Comment

You are working in a rural Emergency Department (ED). You assess a 25-year-old male patient who crashed his car into a tree. Vitals are normal and GCS is 15. Airway is patent and protected. There is bilateral chest rise, no abdominal tenderness or seatbelt sign. Pelvis is stable, and you notice some swelling over his right wrist. What is Blunt Abdominal Trauma? Blunt abdominal trauma is an injury to the abdomen without an …

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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 …