bestBETs

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

25 year old Male presenting with a 2 day history of central abdominal pain associated with nausea, vomiting and poor appetite. On examination he is restless with pain, dehydrated and diffusely tender with guarding in his lower abdomen. CRP has not been done on admission bloods, and the specialty team want a CRP done before they will see him.

A young man attends the emergency department having sustained an acute anterior shoulder dislocation in a rugby tackle. Peripheral venous access has not yet been obtained. You wonder if inhaled methoxyflurane (MF) could be as effective as procedural sedation and analgesia (PSA) in facilitating successful shoulder reduction whilst reducing length of departmental stay.

A patient with a history of asthma presents to your Emergency Department with a severe exacerbation. Despite treatment with standard therapies, the patient continues to deteriorate, and you begin to prepare for intubation. You are aware of the reported potential bronchodilatory properties of ketamine and wonder if treatment with nebulized ketamine may avoid the need for intubation and mechanical ventilation.

A 63 year old male, presents with a 4 month history of a painful adhesive capsulitis or frozen shoulder. He is non-diabetic. He has restriction in motion in the capsular pattern of the shoulder. He experiences, a deep throbbing ache/ pain in his mid-upper arm, which is worse at night, affecting his sleep hygiene. A referral to physiotherapy for management of his range and pain made by his GP. If offered an injection, is there a significance of the dosage of CS (triamcinolone acetonide) on his pain reduction?

A 62-year-old gentleman attends thoracic outpatients with end-stage emphysema for consideration for lung volume reduction surgery. Imaging has identified heterogenous emphysematous areas in both upper lobes with minimal perfusion, and the patient is keen to discuss surgical options. You wonder what surgical approach would be most beneficial to the patient, bilateral or unilateral LVRS. You decide to undertake a review to investigate post-operative improvement following each procedure

Emergency physician clinical gestalt has been found to be overly optimistic regarding the incidence of PPCS; a recent study found while complete recovery was expected in over 90% of patients ~50% developed PPCS. A systematic review concluded that no available models adequately predict outcome after mTBI; many failing due to poor methodology. Subsequently, UPFRONT generated a prediction model which depends on psychological assessment at two weeks (the high number of patients precludes this in the NHS), and is not able to stratify patients on ED assessment. NICE Guidelines note there is an urgent need for a decision rule that risk stratifies patients at high-risk for PPCS early after presentation. There are a number of candidates to improve prediction – these include clinical features, premorbid factors and newer technologies including biomarkers and MRI. Current best models have found that clinical features ~2 weeks after injury are most predictive. However, there is some evidence that biomarkers within the ED visit and/or early MRI may help with earlier risk stratification. This search has focused on the key literature to show the current status of this area.

A patient has attended the Emergency Department following a head injury. They have had a normal CT head scan and are going to be discharged, however they still have a headache. You are concerned they are at risk for post concussion syndrome and wish to know if there are any interventions that may benefit them?

30 years old male presents to emergency department with SOB and known past medical history of asthma. Recently he was not using his daily puffers as prescribed by his family physician. You start managing him as acute asthma exacerbation, you wonder if there test that will guide your management and assess the patient response to medications given.

A 28 year old female is brought to the Emergency Department by ambulance after being in a road traffic accident. She is GCS 15 and on examination she is complaining of abdominal pain on palpation and has an abdominal seatbelt sign. You want to know how likely it is that a significant intra-abdominal injury (IAI) finding will be found on CT.

Your Head of Department is considering the implementation of psychological support for staff with poor resilience. He is wondering whether the COVID-19 pandemic worsens the level of resilience of frontline nurses during the COVID pandemic.

A 55-year-old woman presents with back pain and bilateral leg weakness. What would you do next?

A 55-year-old woman presents with shortness of breath, sinus tachycardia and low oxygen saturations. She is COVID-19 positive.

A 66y female presents to the ED. She has been unwell for 3 days with SOB, cough and lethargy. Her PMH includes hypertension, for which she is on Lisinopril. She looks unwell with a pulse of 112, RR 26/min, BP 106/45 and O2 sats of 92% on air. She has clinical and radiological signs of a left basal pneumonia. You begin treatment for a community acquired pneumonia, including oxygen and antibiotics. As well as routine haematology and biochemistry, you are aware that other blood tests may assist in prognostication and treatment planning, but are unsure which blood tests are best in this regard.