bestBETs

A 27 year old man presents with a 24 hour history of recurrent vomiting. You note he has had 5 previous presentations in the last 6 months. He has a history of daily cannabis use and it appears that his vomiting has been difficult to manage on his previous attendances. He states he often feels better after a hot shower. You have heard someone mention that there can be similar relief to hot shower by getting the patient to apply a capsicum based cream which causes a similar heating to the skin. You wonder if there is any evidence to back this up.

As we are aware, trauma to elderly patients is significantly worse in terms of outcome compared to a younger adult. I wanted to investigate if the benefit would out weigh the risk for administering tranexamic acid to all 'silver trauma' patients.

A 39 year old man is experiencing acute on chronic non specific lower back pain, this is the second such episode he has had despite being active and a regular attendee at the gymnasium. His current employment requires a reasonable level of fitness and he is struggling without constant topical analgesia. A colleague suggests pilates, upon research he wonders if a certain style/type is more effective at reducing symptoms and preventing future episodes.

A 38y/o male presents with persistent shoulder pain, after manual clinical assessment and ultrasound it is confirmed he has a rotator cuff tear. The patient expresses concerns and wants to know what his long term treatment options are.

A 6 day old baby was seen in CEC with mild increase in WOB. The baby was saturating well and was feeding normally so parental education was given and they were advised to go home and return if things change. However, before discharge the parents mentioned they were worried about the yellow tinge to babys skin. The history revealed no risk factors for pathological jaundice, however, before discharge a serum bilirubin level (SBR) was done to ensure normal bilirubin levels and put the parents mind at ease. The results showed serum bilirubin was well below the treatment line (122umol/L). Was it necessary to bleed this baby or would a transcutaneous bilirubin measurement have been an effective method to rule out significant hyperbilirubinemia?

A family have concerns over their 56 year old family member who has presented with sudden on-set coordination/gait problems, who has also vomited twice. An ambulance is called and the patient has been assessed as FAST neg. Despite this, the gentleman was transported to the local emergency department. When in the emergency department he was further assessed and found to also have ataxia and problems with vision. CT head revealed the patient was suffering with an ischemic stroke effecting a posterior artery.

A patient you are treating is suffering with acute, moderate to severe pain. The patient does not have any reasons why they cannot take oral paracetamol. You wonder if the intravenous (IV) presentation is superior to its oral counterpart at reducing pain and wonder what route of administration is best for treating your patients pain.

A 53-year-old patient presents to the Emergency Department with an altered level of consciousness from a suspected respiratory failure. The decision was made to intubate him. As you are preparing to intubate the patient, you wonder whether pre-intubation IVF bolus administration in your normotensive patient will reduce the risk of peri-intubation complications.

You are working in the Emergency Department and a patient presents in acute pain. They have tried simple analgesics and are keen to avoid opiate medications. You are aware of Amitriptyline use in patient's with chronic pain. You wonder if there is any evidence supporting the use of Amitriptyline for symptom control in acute pain.

A 7-year-old girl has been bought in by ambulance to the emergency department having being involved in a motor vehicle collision. She is tachycardic, has abdominal bruising over her left upper quadrant, and is generally tender and guarding on examination. A venous blood gas on admission demonstrates hypocalcaemia. Since the ionised calcium level on a blood gas measures the physiologically active component of calcium (as opposed to total calcium which includes albumin bound calcium), you wonder whether the ionised hypocalcaemia might be related to adverse outcomes.

An 18 years old gentleman presents to the Emergency department with a two hours history of an acute onset of severe left testicular pain. On examination, the left testicle is tender with absent ipsilateral cremasteric reflex.

A 72-year-old man is seen in the prehospital setting following an out-of-hospital cardiac arrest with successful return of spontaneous circulation. He has received prehospital emergency anaesthesia (PHEA) for the indication of ventilatory failure / inadequate oxygenation. You wonder whether bispectral index (BIS) monitoring would reduce the risk of inadequate depth of anaesthesia in prehospital care.

You are discharging a 52-year-old man who tested positive for COVID-19 recently from the emergency department. He lives in a remote area and asks you if there’s anything else you can give him to help “stay away from the hospital”. You vaguely remember some reports on inhaled budesonide and wonder whether prescribing an inhaler would help.

A 2 year old boy presents to the Emergency Department with pain to the lower leg and inability to walk after jumping from a low wall. His initial x-ray of the tibia and fibula shows no fracture. You suspect a possible toddler's fracture and wonder if point of care ultrasound (POCUS) would be useful to make a diagnosis.

A 40 year old male patient is brought to the hospital after being lost while snowmobiling for 3 days where the average temperature was -32 Celsius. After ensuring he is stable, you noticed he has frostbite on his feet. Despite appropriate rewarming, his toes and portions of his feet look very dark and you're worried about possible amputation. You wonder whether thrombolytic therapy could salvage his toes and feet.

A 78 year old man with chest pain presents to the ED accompanied by his daughter. He is recluctant to wear his hearing aid and is reliant on his daughter to communicate. You wish to be confident in assessing his level of chest pain and wonder if there were tools to get a more accurate pain score direct from the patient