Buckle and Greenstick Fractures

What?

A 9-year-old male presents to the Emergency Department (ED) following a fall whilst playing rugby at school earlier that day. He presents with left wrist pain and mild swelling. There are no wounds or breaks to the skin. On examination he is noted to be both swollen and tender over the distal radius. An x-ray is requested which confirms a buckle (or “torus”) fracture. (more…)

Bronchiolitis

What?

An 8-month old female is presented to the emergency department (ED) with a 3-day history of reduced feeding and less wet nappies. Accompanied by her parents and 4-year old sister, they report no fever (Temperature is recorded as 37.8C) but are concerned regarding the lack of fluid and dietary intake. Over the last 12-hours they have become more worried about her breathing, which they describe as noisier than normal, and with feeding times becoming more distressing for all, have arrived at the ED for further assessment. (more…)

Fever – is it cool to be hot?

What?

A 60-year-old female has presented to the ED with a cough and fever for 2 days. She has her observations recorded in triage and has a fever of 38.1C (tympanic). She otherwise feels well and does not trigger the sepsis screening tool. She has no pain and appears comfortable as she walked into the department. A member of the nursing team asks you to prescribe 1g paracetamol (PO) to reduce her fever….. (more…)

Urine – to dip or not?

What?

An 84-year-old female was found on floor by carers. No obvious head injury and was alert on scene with some mild confusion. Paramedics had documented strong smell of urine and a collateral history from her family stated she had reduced oral intake recently and was not her normal self for the past few days. (more…)

Paediatric hypertension

What?

A twelve-year-old girl presents to the Emergency Department (ED) having had a fall at school, she is diagnosed with a sprain to her left wrist and minor head injury (contusion to her forehead). During the episode of care her physiological parameters are measured on a number of occasions and an incidental finding of persistently raised blood pressure is discovered (observations shown in table 1). (more…)

Head injury and anticoagulation

What?

A 79 year old gentleman attends the Emergency Department (ED) after having tripped over his dog whilst out walking. He sustained a laceration to the back of his head. He did not lose consciousness, he has not vomited, has no amnesia, GCS 15 throughout and there was no evidence of a depressed or basal skull fracture. (more…)

AXR in abdominal pain

What?

A 52-year-old male presented to the emergency department (ED) with a 1 day history of severe central abdominal pain and nausea. An AXR was undertaken as part of his care in the ED that demonstrated distended bowel loops in the upper abdomen leading to a diagnosis of possible bowel obstruction and a referral to the surgical team. (more…)

Palpitations

What?

A 71-year-old man with a history of Atrial Fibrillation (AF) presented to the Emergency Department (ED) with a 3-day history of increasing palpitations following the reduction of his daily digoxin dose (from 125mcgs to 62.5mcgs). (more…)

Caustic Soda

What?

A 3-year-old male was admitted to the ED after his mother had witnessed him drinking caustic soda. Whilst cleaning the house she had accidentally left open a cupboard where he was able to access drain cleaner containing the substance. (more…)

Ectopic Pregnancy

What?

A 36-year-old female presented to the emergency department (ED) with a 3-day history of diarrhoea (approximately 5 episodes per day). The diarrhoea initially had a small amount of blood but had subsequently become green and very offensive. She had been diagnosed with gastroenteritis by her GP, however the patient could identify no causative factor. The day before this attendance she had developed sharp and intermittent upper abdominal pain. The pain had no exacerbating factors and she had been apyrexial and systemically well throughout the entire episode.

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CURB-65

What?

A 72-year-old male presented to the Emergency Department (ED) in the morning having woken with shortness of breath and a slight change to the colour of his sputum. His temperature had been recorded as 38.1C by the ambulance crew who brought him to hospital.

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Acute Alcohol Withdrawal

What?

A 33-year-old male was admitted to the emergency department after having 2 alcohol withdrawal seizures. He had been drinking 30U alcohol per day for many years and over the previous week he had been trying to reduce his alcohol intake without any support.

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