2018

Articles from 2018 that should guide practice

• Clinical Updates

• Cardiology• ACS workup

• CT-CA

• Psychiatric workup• Suicide risk assessment

• Stroke• Thrombectomy

• Other clinical trials

• Bronchiolitis/NIV

• Paediatric DKA – fluids

• Syncope• Brugada

• Fasting for procedural sedation

• Paediatric head injury

• Renal colic - tamsulosin

• IVC filters

• Button battery ingestion

A 7 yr-old girl (25kg) presents unwell with malaise. RR 26, HR 125, BP 95/55. She has BSL 28 mmol/L, pH 7.05, HCO3 8 BE -15, K 4.6 mmol/L. Fluid management should be

A. 20 ml/kg bolus 0.9% saline, then calculated 10% deficit replacing half over 12hr, and half over further 24hr.

B. 10 ml/kg bolus 0.45% saline, then calculated 5% deficit over 48hr

C. 10 ml/kg bolus 0.9% saline, then calculated 5% deficit over 48hr

D. Any of above

20 m

l/kg

bolus 0

.9%

salin

e, then...

10 m

l/kg

bolus 0

.45%

salin

e, th

e...

10 m

l/kg

bolus 0

.9%

salin

e, then...

Any of a

bove

25% 25%25%25%

Never start insulin without knowing K

Further management should involve

A. Discharge from ED

B. Overnight monitoring in SSU

C. Admission to CCU with serial troponin and cardiac workup

D. Discuss end of life care with wife

Discharg

e from

ED

Overn

ight m

onitorin

g in S

SU

Admiss

ion to

CCU w

ith se

rial t

r...

Discuss

end o

f life

care

with

wife

25% 25%25%25%

Vasomotor syncope in elderly is common

May not recall prodrome

CDRs are not meant to be followed blindly, but

rather are helpful decision tools.

A 32yr man has a 5mm renal calculus mid left ureter with moderate hydronephrosis. Tamsulosin increases the % of d stones passing without intervention by

A. 0 %

B. 5%

C. 10%

D. 15%

E. 100% (if you ask a urologist)

0 % 5%10% 15%

100%

(if y

ou ask

a u

rolo

gist

)

20% 20% 20%20%20%

I think my child swallowed a button battery

Articles from 2018 that should guide practice

• Clinical Updates

• Cardiology• ACS workup

• CT-CA

• Psychiatric workup• Suicide risk assesment

• Stroke• Thrombectomy

• Other clinical trials

• Bronchiolitis/NIV

• Paediatric DKA – fluids

• Syncope• Brugada

• Fasting for procedural sedation

• Paediatric head injury

• Renal colic - tamsulosin

• IVC filters

• Button battery ingestion