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 …
When do you use X-ray vs CT for pediatric head injuries?
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 – …
Clinical Question: How does the sensitivity/specificity of lung ultrasound compare to plain films in diagnosing acute decompensated heart failure?
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 …
Clinical Question: Can stable patients presenting to the emergency department with blunt abdominal trauma be managed safely without a CT scan?
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 …
Clinical Question – How Do I Approach Agitation and Aggression in Children with Autism Spectrum Disorder in the Emergency Department?
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 …
Clinical Question: When should patients be allowed to eat in the Emergency Department?
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 …