EVIDENCE BASED PRACTICE

Evidence Based Practice Process of a Clinical Case for which CT scan was used as a Diagnostic Tool

Evidence Based Practice Process of a Clinical Case for which CT scan was used as a Diagnostic Tool

Introduction

The paper discusses a clinical case of 19 years old patient, who was admitted to our healthcare facility. In the light of empirical evidence, the paper critically evaluates the role of CT scan as an effectual diagnostic tool. The paper summarizes research structure and results to collect evidence on the clinical question. Furthermore, paper highlights the use of clinical evidence to enlighten the practice.

Clinical Case

On December 12, 2012, 19 years old patient was intermittent moderate to a high degree of fever with swelling and pain in his right shoulder, which had occurred two weeks after been elbowed in a game of basketball one month prior to consultation. During the trauma, no fracture or open wound was sustained by the patient. Initially, the patient had been treated with cefaclor for one week in a clinic without any visible improvement (Godinez & Taguiang-Abu, 2008, p. 65).

Clinical Examination

Our medical history review of the patient showed unremarkable results. Clinically, the patient was shown as a highly febrile (figure 1), scrawny patient, with tenderness over his right shoulder, a fluctuant mass on the right area of the scapular and soft swelling in tissues (figure 2). Moreover, we observed that the patient had nail beds and conjunctiva (Godinez & Taguiang-Abu, 2008, p. 65).

Figure 1: Clinical Examination (Godinez & Taguiang-Abu, 2008, p. 65)

Figure 2: Condition of Patient's Shoulder (Godinez & Taguiang-Abu, 2008, p. 65)

The patient was diagnosed leukocytosis with anemia and left shift. We did not find evidence of dislocation or fracture on AP/L views of the right shoulder. Empirically, the patient was prescribed high dose (8 grams per day) of intravenous oxacillin for 6 equivalently divided doses. As illustrated by figure 3, drainage and incision had been done by draining about 700cc of purulent nonfoul smelling discharge (Godinez & Taguiang-Abu, 2008, p. 66).

Figure 3: Drainage Process (Godinez & Taguiang-Abu, 2008, p. 66)

During clinical examination, we recommended CT scanning and MRI subsequent to ultra sound, as diagnostic tools. Consequently, the patient was diagnosed with CA-MRSA on sensitivity and cultural testing. Nonetheless, prescription was shifted from Oxacillin to TMP-SMX 800/160 mg one tablet twice a day for 30 days. After one month treatment, right shoulder swelling and fever was resolved. There was visible improvement in patient's health due to incision and drainage (Godinez & Taguiang-Abu, 2008, p. 68).

Clinical Question

Is CT scan the best diagnostic tool for young patients while taking into account the protection and safety against radiation?

The Evidence

Relevant articles and evidence based studies were revealed through search engine by using CT scan and CA-MRSA patient as key words. An article, 'Comparison of clinical diagnosis with computed tomography in ascertaining type of stroke' (Khan J. and Rehman A, J Ayub Med Coll Abbottabad, 2005, Volume 17, Issue3 pp. 1-3) was the first relevant source that I found on the subject ...