bestBETs

A paramedic crew brings a 27 year old patient with a suspected cervical spine injury to the emergency department following an RTA. At the scene of the accident the patient had full spinal immobilization, which consisted of a long spinal board, a correctly sized cervical collar, and head blocks with straps to secure the head to the board. In the emergency department the patient is becoming increasingly distressed by the presence of the neck collar and requests that it is removed. You wonder whether the cervical collar provides any additional benefit in terms of immobilizing the spine.

A 59 year old man presents with an exacerbation of COPD. You wonder whether it is better to nebulise salbutamol or ipratropium bromide alone, or a combination of the two.

A 3 year old child presents to the emergency department with a short history of limp, temperature and difficulty in weight bearing on the left leg. The pain is principally located at the hip joint and you fear this may be a septic arthritis. You wonder if an Erythrocyte Sedimentation Rate (ESR) will help in excluding the diagnosis of septic arthritis.

A 45 year old man is brought to the emergency department with acute, central chest pain. You have diagnosed an acute myocardial infarction from the ECG for which he is receiving thrombolysis. You know that giving him a beta-blocker will improve his outcome but you only have tablets in the department and wonder whether he will be at a disadvantage for receiving this rather than an intravenous dose.

You are the doctor on-scence of a road accident attending a 30 year old male who has sustained blunt trauma to the abdomen. Systolic BP is 70 mm Hg despite resuscitation. Someone suggests using the pneumatic antishock garment (PASG). You cannot remember from your recent ALSG course whether this can be used to support blood pressure in hypotensive patients. You wonder if PASG use has been shown to have any effect on mortality.

A 20 year old man presents to the emergency department with a history of something having blown into his eye. Clinical examination reveals a small abrasion to the cornea. You prescribe chloramphenicol ointment and discharge the patient. A friendly Ophthalmologist suggests that you should have given a dilating drop as well. You wonder if there is any evidence to support this.

A 45 year old man attends emergency department having fallen off his bicycle. He has pain around his left upper arm. Examination reveals a probable fracture of the humerus and an x-ray confirms this. There are no neurovascular complications. You have received differing advice about the best way to support the arm after this injury. You wonder whether a broad arm sling or collar and cuff is best.

An 8 year old patient presents to the emergency department with a six hour history of right iliac fossa pain; examination is suggestive of acute appendicitis. You wonder whether an ultrasound scan would be helpful for diagnosis.

A 5 year old shocked child is presented to the emergency department via ambulance. Intravenous access is not possible and you decide to place an intraosseous needle. You find that the trolley has been stocked with standard bone marrow aspiration needles rather than the special intraosseous (IO) needles that you are used to. You swear loudly and eventually gain access with great difficulty using a cutdown technique. You later wonder whether you could have used the standard bone marrow needle instead.

A 32 year old man presents to the Emergency Department following a fight. He complains of pain around the base of the right thumb metacarpal. X-ray reveals an undisplaced Bennetts' fracture. You wonder whether he should be treated conservatively or surgically.

A 23 year old woman attends the Emergency Department having taken 60 500mg paracetamol tablets 2 hours prior to presentation. You wonder whether she should receive activvated charcoal.

A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to rule out possible myocardial damage and wonder whether a single troponin T measurement taken at this time is sensitive enough to do this.

A 45 year old man attends the Emergency department with 30 minutes of chest pain. An ECG shows ST segment depression in the inferior leads. You wonder whether he should be treated with low molecular weight heparin or a glycoprotein IIa/IIIb complex inhibitor.

A 3 year old boy is brought into the Emergency Department by his mother. She says that he swallowed a coin 2 hours earlier. The boy is asymptomatic. You wonder whether a chest x-ray should be done to exclude oesophageal impaction.

An unresponsive young adult is brough to the emergency department. No history is available. Neurological examination reveals no focal abnormality and pupils are mid-size and reactive. Blood glucose is normal. You suspect an overdose and wonder whether flumazenil should be given to ascertain whether benzodiazepines are involved.

A 25 year old man atttends the emergency department having trapped his right index finger in a door. He has a compound fracture of the distal phalanx. You wonder whether antibiotics should be given after wound care.

A 21 year old man presents on a saturday morning having been involved in a drunken brawl the night before. He has a painful swollen right (dominant) hand. An x-ray reveals a fracture of the neck of the fifth metacarpal with some angulation.

A 30 year old man attends the emergency department having been bitten by a dog 4 hours previously. He has puncture wounds and a 1 cm laceration on his forearm. His wounds are thoroughly cleaned and a dressing applied. You want to know whether to prescribe antibiotics as well.

A 25 year old man presents to the emergency department with a left anterior shoulder dislocation. This is reduced satisfactory. You wonder how long his shoulder should be immobilised? There is no previous history of a dislocation.

A 3 year old girl presents to the emergency department after catching her face on the edge of a table. She has a 2.5 cm laceration to the cheek which requires closure. The wound is not suitable for steristrips. The parents are very worried abbout her having stitches and also about scarring. You wonder whether glue is the best option for this child.