Paediatric trauma assessment starts with mechanism. Persistent vomiting or tenderness after handlebar injury should prompt CT for duodenal haematoma, while a seat-belt sign plus abdominal pain raises bowel and Chance fracture risk. Observation needs review intervals and clear failure criteria, not passive waiting.

Stable epistaxis is usually controlled stepwise rather than packed on arrival. Clear clots, use topical anaesthetic with vasoconstrictor and a clamp for 15 minutes, then cauterise a visible point. Early ENT input matters when posterior bleeding is suspected or balloon packing is required.

MASLD triage is practical when anchored to fibrosis risk rather than transaminases alone. FIB-4 from routine bloods separates low-risk patients from those needing ELF testing, elastography, or hepatology referral, while 5%, 7–10%, and 10–15% weight-loss targets map to steatosis, inflammation, and fibrosis.

Multiple sclerosis care becomes inequitable early if women are offered lower-intensity disease-modifying therapy or slower escalation. Apply the same disease-activity thresholds regardless of sex, and when treatment pauses for pregnancy, document a restart date and early follow-up so high-efficacy therapy is not delayed without reason.

When recurrent anterior shoulder instability involves subcritical glenoid bone loss, distal clavicle autograft can restore bone and cartilage arthroscopically. Button fixation suits a round graft better than screws, and a flush articular surface matters more than over-tensioning or over-preparing the bed.

A spinal pressure ulcer over congenital kyphosis rarely heals until the underlying gibbus is removed. The practical lesson is to treat the bony cause, confirm shunt function before prolonged prone surgery, and resect to the curve of lordosis so the spine apposes for fusion.

During CPR, numbers can mislead. A high arterial pressure does not guarantee forward flow, so pair the arterial trace with capnography and watch for oscillations; a square capnogram suggests airway closure or poor recoil and should trigger recruitment breaths and reassessment.

In adolescent depression, fluoxetine still has the clearest drug signal, but medication is not the whole plan. Start with psychological therapy, review early for suicidality, and taper antidepressants slowly; TMS may have a role as augmentation for persistent symptoms where services and suitability align.

Eating-disorder assessment is clinical, not questionnaire-led. Three-minute orthostatic observations, ECG, and electrolytes help expose medical instability, while weight-loss prescribing with GLP-1 agents can be unsafe in underweight or actively restrictive illness unless specialist psychological and dietetic support is built in.

For acute dyspnoea, lung ultrasound often answers the first question faster than the inferior vena cava. Start with lung views for B-lines, sliding, and effusion, then use cardiac windows and EPSS to interpret ventricular function and avoid overcalling volume status from IVC size alone.

Refractory VF demands technical precision, not just repetition. Check pad position, keep the lateral pad truly mid-axillary, and change to an anterior-posterior vector with fresh pads after three failed shocks; during ventilated CPR, raise the pressure alarm so set tidal volumes are actually delivered.

Developmental delay should be judged against thresholds, not reassurance alone. No words at 16 months or no sitting at 9 months warrants assessment, and early hand preference before 18 months can signal hemiplegic cerebral palsy rather than normal variation.