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Boring Question | Do patients with liver disease need FFP before procedures?

In Clinical Questions by Michael Garfinkle1 Comment

I was recently asked to give fresh frozen plasma to a patient with liver disease and an elevated INR before a therapeutic thoracentesis. He was otherwise healthy and had no history of bleeding diathesis. While I was asking for consent and explaining the risks and benefits of blood product transfusion, I began to wonder about the true benefits in his case. Knowing that liver failure leads to both pro and anti-coagulant deficiencies, I wondered: Is an elevated …

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Boring Question | Does this pediatric patient require a hard cast ?

In Clinical Questions by Patrick Bafuma2 Comments

It is a typical day in Fast Track, and you have a 8 year old who fell off their skateboard with a distal radius fracture that is commonly referred to as a “Buckle fracture” (AKA torus fracture). The child is very upset and concerned about having their arm splinted / casted given that they plan on spending a lot of time in a swimming pool this summer. You wonder, does this patient require …

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Boring Question | What do I do with my hands for CPR during an infant resuscitation?

In Clinical Questions by Nicholas McPhail2 Comments

The Case: A previously healthy two month old male is brought in with no vital signs after a large aspiration. Paramedics began CPR immediately after arriving on scene ten minutes ago, but so far have not been able to get a pulse. They will arrive at the hospital shortly and the resuscitation room is ready. Boring? Far from it! But then the staff physician turns to you and asks, “What is the evidence …

Boring Question: What is required for ‘medical clearance’ before referral to the psychiatry service?

In Clinical Questions by Danica DeJong4 Comments

The Case A 29 year-old man is brought to the ED by police. He was found wandering on the street, predictably at 3 a.m. He is well-dressed and appropriately-groomed, slightly agitated, paranoid, apparently responding to internal stimuli, and uncooperative. He has no known history on file. The Question What is required for ‘medical clearance’ before referral to the psychiatry service? The Background Patients presenting to the ED with psychiatric complaints represent a sizeable …

Boring Question: How useful are physical examination manoeuvres for an adult patient with suspected meningitis?

In Clinical Questions by Jatin Kaicker4 Comments

Background For a patient who presents with a headache, it is imperative to consider a broad initial differential diagnosis to rule out life threatening causes such as meningitis. Bacterial meningitis is a medical emergency with an annual incidence of 4 to 6 cases per 100,000 adults, with early treatment considerations being essential (1). We are commonly taught to consider a triad of symptoms including fever, neck stiffness and altered mental status. However, the …

Boring Question: Does my patient require admission for IV antibiotic administration?

In Clinical Questions by Patrick Bafuma8 Comments

We have all had a patient or two request admission for intravenous antibiotics. Usually, the argument is that IV administration is better because it ‘gets into the blood more quickly’. In fact, many of us have made that argument ourselves, or heard it from our peers. But, what if I told you that many of your favourite antibiotics have similar pharmacokinetic properties regardless of the route of administration? What if I also showed …