bestBETs

You are the EM Specialist Trainee covering the resus room for respiratory patients. The 'red phone' rings to pre-alert the department about a 52 year old woman who tested positive for COVID-19 3 days ago. She is breathless with oxygen saturations of 74% on room air and will arrive in 5 minutes. During a recent conversation with a rheumatologist about a different patient, colchicine was mentioned as being currently under investigation for treatment of COVID-19 due to its well-known anti-inflammatory properties. You wonder if there is any evidence to suggest this potential treatment would be beneficial for your impending arrival...

A 4 year old boy attended the paediatric emergency department following a circumcision for religious reasons earlier that day. He had ongoing bleeding from the surgical site. Is there any evidence behind the use of topical adrenaline in the management of these patients.

A 50 year old man is brought into the emergency department with signs of an acute gastointestinal bleed. An urgent endoscopy is arranged. As you resuscitate him and prepare for this you remember that tranexamic acid has proven useful in major haemorrhage and wonder if it will aid haemostasis in this man and increase his chance of survival.

A 12 year old boy has sustained a head injury at a school rugby match. The coach takes him off the pitch, but the player is keen to finish the game. He is told he needs an assessment for traumatic head injury before he can continue to play. As the team doctor you perform the head injury assessment but wonder if it is useful for predicting outcome and guiding further management in mild traumatic brain injury (TBI).

A 48 year old male presents to the emergency department following a fall at work. He recalls grabbing a pole as he tried to slow his fall. He complains of right shoulder and elbow pain. Active elbow flexion and supination is painful and weak. Radiographs exclude fracture and/or dislocation at the shoulder and elbow. You suspect a distal bicep injury and recall there is a time urgency to manage such injuries. You perform the 'hook test' but are unsure of its reliability and accuracy in detecting Distal Biceps Tendon Rupture (DBTR). You consult the literature to support your discussion to expedite this case to the upper limb orthopaedic team.

A 25 year old non-smoker presents with a right sided spontaneous pneumothorax. He is breathless at rest with normal oxygen saturations on air and does not want to come into hospital for treatment.

A 42-year-old man presents to the Emergency Department (ED) with an acute anterior shoulder dislocation following a fall. He does not tolerate reduction with nitrous oxide and intravenous (IV) access is not possible. Your Consultant suggests using intra-articular lidocaine (IAL) to aid reduction. You wonder if IAL is a safe and effective alternative to intravenous analgesia with or without sedation.

A 13 year old adolescent presents to emergency department with one day history of unilateral headache associated with phonophobia and photophobia which gets better on lying down in a dark room after taking NSAIDs. There is a past history of recurrent headaches of similar nature and frequency has increased over past two months (4-5 episodes/month) and response to NSAIDS has also reduced. This affects his quality of life in terms of missed school days. After complete history and examination, a diagnosis of migraine is made. I wonder if migraine prophylaxis should be considered and if riboflavin is effective prophylactic medicine in reducing the frequency, duration or severity of migraine attacks.

A 45-year-old woman presents to the emergency department with a displaced Colles fracture two hours after slipping on ice. As you prepare for the reduction, you wonder whether a hematoma block would be adequate for analgesia versus conscious sedation.