BACKGROUND: Since demographic changes have contributed to the growth of emergency medicine, a highly populous nation such as India needs to give physicians associated due credit and recognition. The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians. METHODS: The data were collected by direct interaction with residents of the department. Additional information was gathered by observation. The data were verified for validity. RESULTS: This study was to bring out the benefits of proactive decisions that could further enhance the emergency department. But such decisions did not always result in positive responses and improved morale. When such decisions were retracted as it causes misalignment with the existing system. An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine. CONCLUSIONS: The problems faced by emergency department might be similar but the way in which one tackles the situation would be different. Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.

BACKGROUND: Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients. In case of acute ischemic stroke in pediatric age group, management is different from that of adult ischemic stroke where thrombolysis is a good option.METHODS: We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry. The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously. He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke.RESULTS: The patient recovered from acute ischemic stroke without being thrombolyzed.CONCLUSION: In pediatric patients, acute ischemic stroke usually is evolving and may not require thrombolysis.