bestBETs

A 31-year-old woman presents at the Emergency Department by ambulance following a heroin overdose. She requires naloxone for opioid-reversal. She has made a full recovery and is ready for discharge.

A 36 year old female presents to the emergency department (ED) with symptoms of acute migraine. She has a history of migraine. She is systemically well. You wonder whether this patient could get symptomatic relief from a sphenopalatine ganglion (SPG) block via administration of intranasal lidocaine.

A 46 year old female presents to the Emergency Department out of hours with left leg swelling. Wells score for DVT is +2. You suspect a lower limb DVT and wonder if you can use point-of-care ultrasound to make your diagnosis.

A 37 year-old man attends the emergency department with cyanosis unresponsive to high flow oxygen. When blood is drawn it is a dark ‘chocolate’ colour and does not lighten when exposed to air. The patient reports he has recurrent methaemoglobinaemia of unknown origin and is currently under haematology who are attempting to illicit a cause. When is this man safe to be discharged?

A 70-year-old woman presented to the Emergency Department with hypoxia and confusion. Her chest X-ray findings are consistent with severe COVID-19 pneumonia. COVID-19 infection was confirmed with RT-PCR testing. A colleague mentions inhaled budesonide as a possible treatment. You wonder if inhaled budesonide would reduce mortality or time to recovery. You also wonder if it is associated with increased adverse events.

A 66-year-old man came to the emergency department by ambulance for cough and viral illness. His chest X-ray revealed bilateral infiltrates concerning for viral pneumonia. RT-PCR test confirmed the diagnosis of COVID-19 infection. You wonder if monoclonal antibody therapy would provide any benefits to mortality, length of stay, requirement for ventilation.

A 20-Year-old female front seat passenger with the seat belt on sustained a neck injury from a frontal collision car Accident that left her with a fronto-parietal scalp laceration; presented to the Emergency Room with cervical spine precautions. Primary survey demonstrated a non-disabling local neck pain and tenderness. The neurologic examination was normal with no disabilities, and no cranial nerve involvement. Glasgow coma scale was 15/15. Past medical history is unremarkable with no previous incident. An X-Ray, Computed Tomography (CT) scan and MRI of the neck revealed only a Jefferson fracture with a 12 mm widening of the lateral mass of C1. The Anterior Atlanto-Dens Interval (ADI) was normal (2mm) and the Space Available for the Cord was 17mm.