bestBETs

32 year old female fit and healthy, presented with excessive hair loss for the past 1 year. She was investigated thoroughly and diagnosed with Androgenic Alopecia. She tried topical minoxidil and other oral supplements and found some improvements. She heard about PRP and wanted to have the treatment.

A patient presents to the Emergency Department with acute upper gastrointestinal bleeding and is awaiting endoscopy. Intravenous proton pump inhibitor therapy is commenced before endoscopic evaluation. The treating team questions whether administration of PPI therapy before endoscopy improves patient outcomes compared with no pre-endoscopic PPI therapy

A patient presents to the emergency department with a simple leg laceration requiring sutured closure. Traditional teaching often emphasizes precise approximation and wound edge eversion to optimize healing and cosmetic outcome. However, increasing attention has been directed toward wound tension as a potentially more important determinant of scar formation and wound integrity. You wonder whether low-tension closure techniques improve healing outcomes compared with standard interrupted closure methods.

A 23-year-old patient presents to the Emergency Department with the chief complaint of ankle pain after inversion injury while playing soccer. The patient has tenderness, edema, and ecchymosis over the lateral aspect of the ankle, with positive anterior drawer and talar tilt tests. X-rays are negative for fracture. As the treating physician, you diagnose the patient with a lateral ankle sprain and prepare their discharge recommendations. You wonder if placing them in a semi-rigid brace versus using an ACE wrap will help the young athlete return to play sooner.

A 58-year-old male suffers a witnessed collapse at home and receives immediate bystander cardiopulmonary resuscitation (CPR). Paramedics arrive 7 minutes after arrest onset; he is found to be in pulseless electrical activity (PEA) at the initial rhythm check and is given epinephrine 1 mg intravenous (IV). He is transported to the emergency department (ED) where resuscitation is continued and on subsequent rhythm checks he remains in PEA. As you consider additional treatments, you wonder what the optimal time interval is for additional doses of epinephrine.

You are working overnight as a registrar in a Major Trauma Centre. A patient is builder is brought in with a significant crush injuries to his legs after being run over by a digger. Due to environmental challenges he remained trapped beneath the digger for a prolonged period whilst the Emergency Services freed him. Following hand over, the critical care paramedic advises that the team had had a discussion at the scene as to whether to apply a tourniquet or not and she asks if you know of any evidence for or against its use in the management of patients with crush injuries to the limbs.

A 28 year old lorry driver comes in to ED following an RTC. His legs were trapped and crushed and due to the location of the incident, it took a very long time for the fire service to extricate him. When he presents to ED, you ask yourself - I know this man is at risk of rhabdomyolysis and needs intravenous fluids to manage this but - what is the best fluid resuscitation strategy?

A patient with recurrent melasma seeks alternatives to hydroquinon. The clinician considers TXA delivered via micro needling and wants to evaluate the efficacy.

You are working in a busy emergency department when a 34-year-old woman presents with a severe acute migraine. She has a well-established diagnosis of episodic migraine and has already taken a triptan and NSAID without relief. She is photophobic and vomiting, and is reluctant to receive intravenous medications because of a previous adverse reaction to metoclopramide. You wonder whether a greater occipital nerve block could improve her acute pain relief.

A 23 year old farmer presents to the Emergency Department having trapped his legs by a piece of falling machinery. He is diagnosed with a crush injury of the lower limbs. Initial blood gas results show a potassium of 7mmol/L. You want to provide the optimum strategy for managing the hyperkalaemia.

A 25-year-old male has sustained a gunshot wound to the thorax in a hunting accident. On-scene, emergency medical services find that he is sitting upright, appears anxious, has jugular venous distention, and has weak peripheral pulses. Bleeding is grossly controlled. Vital signs include a heart rate of 128 bpm, blood pressure of 92/68 mmHg, respiratory rate of 26/min, oxygen saturation of 95% on 4L/min by nasal cannula, and temperature of 36.2 °C. Emergency medical services must decide between taking the patient directly to a level 1 trauma center forty-five minutes away, or to the critical access emergency department five minutes away.

A 30-year-old emergency medicine resident is working an evening shift on a July weekend at a busy Level 1 Trauma Center. She’s already five charts behind, and more patients are filing into the waiting room by the second. As she heads in to see her next patient, she thinks about all the documentation that awaits her once her shift is over. She wonders if using the latest AI-assisted charting tool her residency program just rolled out will help her complete her documentation and get her home on time.

A 16 year old girl is brought into the Emergency Department after falling from a horse, which subsequently rolled on top of her and she has sustained crush injuries to both her legs. You are aware that the sequalae of crush injuries include hyperkalaemia and metabolic acidosis - logically you question whether the administration of intravenous sodium bicarbonate may be of benefit to this patient and want to know if there is any evidence to support its use.

You are the ICU registrar working in a over night in a Major Trauma Centre. A 32 year old man, who had been caving with friends, has been brought in to the Emergency Department, after sustaining a crush injury to both his legs when a large boulder in the cave system they were exploring dislodged and trapped him. Due to the remote location of the incident and challenges of the environment he remained trapped for a prolonged period before being extricated and brought to hospital. You are aware that crush syndrome can cause Acute Renal Failure and wonder whether if commencing Renal Replacement Therapy early on in this patient's care would be beneficial.

You are the A&E registrar on night shift. There has been a major incident involving a stadium collapse and your department has received 25 patients with various crush injuries. The level 3 patients have been moved to intensive care but you are to provide ongoing care to 5 patients overnight due to bed pressures. All the patients have a CK of > 5000 and you know they all are likely to have rhabdomyolysis. You wonder if alkaline diuresis (using sodium bicarbonate infusion fluid alongside a diuretic e.g mannitol or furosemide), will improve their chances of not developing acute renal failure, requiring haemodialysis or survival?

A 24 year old tree surgeon is brought into the emergency department after a tree she was felling landed on and trapped her arm. As she was working alone she was not found for several hours during which time the arm was trapped. You suspect she has sustained a crush injury to it. You consider what the best management strategy is with regard to the limb in improving her outcome.

A woman who is 9 weeks pregnant presents to the emergency department with debilitating early morning sickness. She is already taking several prescribed medications and would prefer to avoid adding another tablet if possible, asking whether any non-pharmacological options are available. A member of the emergency department team suggests inhalation of vapour from an isopropyl alcohol wipe, a technique occasionally used for nausea in other clinical settings. The clinician is uncertain whether there is evidence to support its use during pregnancy.

A 2-year-old child presents to the Emergency Department at 2 am with stridor at rest, mild-to-moderate intercostal recession, normal air entry on chest auscultation, normal oxygen saturations and a normal conscious level. You diagnose moderate croup. The parents report that the child's symptoms appeared to improve after being carried from the car park in the cool night air. You wonder whether there is evidence to support cold air exposure as a therapeutic intervention in children with croup.

A 34-year-old man presents to the emergency department with acute cocaine-associated toxicity, manifesting as agitation, hypertension, and persistent sinus tachycardia with a heart rate of 142 beats per minute. Despite appropriate first-line management with intravenous benzodiazepines, tachycardia persists. The treating clinician considers adding a beta-blocker to improve heart rate control but is concerned about the risk of adverse cardiovascular outcomes, including coronary vasospasm or hypertension due to unopposed alpha stimulation.

A 23-year-old male presents to the emergency department with symptoms and signs of anaphylaxis after being unable to self-administer adrenaline before arrival, he is administered intramuscular adrenaline. Once he has clinically improved he asks whether he could be discharged with intranasal adrenaline due to a reluctance to administer intramuscular adrenaline as he has a needle phobia. You wonder whether intranasal adrenaline is as clinically effective as intramuscular adrenaline.