bestBETs

One month after social distancing measures were introduced in the UK, a 35 year-old man attends with shortness of breath and is streamed to be seen by you in your COVID-19 assessment area. He has been isolating at home for the last three days after developing myalgia and a fever. He is normally fit and well and has not been tested for COVID-19. His oxygen saturations are 93% at rest on air and his respiratory rate is 22 breaths per minute. You know the NHS England guidance advises you to consider conducting a 40 step test to see if the patient desaturates on exertion. You wonder if this advice is evidence-based.

A middle aged otherwise fit and well gentleman presents to your emergency department with symptoms highly suggestive of COVID-19 infection. He is streamed to be seen by you in the Amber area. He has been isolating at home for the last three days after developing myalgia and a fever. His oxygen saturations are 95% at rest on air and his respiration rate is 22 He is normally fit and well. Would a Computed Tomography (CT) scan help you to risk stratify him and decide whether admission is required?

One month after social distancing measures were introduced in the UK, a 35 year-old man attends with shortness of breath and is streamed to be seen by you in your COVID-19 assessment area. He has been isolating at home for the last three days after developing myalgia and a fever. He is normally fit and well and has not been tested for COVID-19. His oxygen saturations are 93% at rest on air and his respiratory rate is 22 breaths per minute. You consult the NHS England guidance which advises that the decision to admit or discharge should be based on a senior clinical assessment. You wonder if a model is available to guide this decision.

A 70 year old man presents in PEA cardiac arrest. An ED echocardiogram shows cardiac activity but no pulse is palpable. Pseudo-PEA is diagnosed. You wonder whether CPR timed to systole may improve his chances of survival.

A patient develops flu-like symptoms 3 days after taking Holy Communion at church. You wonder whether in the current climate of coronavirus (Covid-19) risk does the sharing of a communion cup practiced by millions of Christains around the world put it's participants at risk of infection?

25-year-old presents to the emergency department after sustaining a laceration to his ankle after cutting his leg on a piece of metal. The wound is hemostatic on presentation. There does not appear to be any gross contamination and a simple closure is adequate with nonabsorbable sutures. After closure the patient is given routine discharge instructions when he questions you about removing his sutures at home.

A 67-year-old female with a history of diabetes and hypertension, on metformin and an ACE-inhibitor, presents to the emergency department (ED) following an episode of syncope while walking into her bathroom. She had preceding lightheadedness, but no other symptoms. She has a blood pressure of 158/87 with a heart rate of 78, unremarkable ECG, and her blood glucose is 84 mg/dL. As part of her diagnostic evaluation, you consider whether orthostatic vital signs will help to rule out any life-threatening causes of her syncope?

The pandemic of COVID-19 affects many households. Governments install strict policies to prevent the further spread of the novel coronavirus. Schools are closed and working from home is recommended. A woman goes to her general practitioner to ask advise. Her child, who is now at home as well, had contact with a classmate who tested positive for sars-CoV 2. Her husband, who works now at home, belongs to the risk population because of reduced immunity. The woman wants to know if her asymptomatic child should be isolated from her husband, the grandparents and/or herself. Does it make sense to avoid contact with healthy children to prevent virus transmission?

Since the outbreak of COVID-19, we are facing an imminent shortage of surgical facemasks and respirators to protect patients and healthcare workers. Inspired by the widespread use of cloth masks in Asia, alternatives out of cotton and old bras are on the rise in Belgium. This raises the question whether these homemade facemasks are effective in the prevention of virus transmission. And if so, which materials are most suitable.

A 55-year-old male with a history of hypertension, depression, and obesity presents to the Emergency Department with back pain that began 2 days ago after he was helping a friend move into a new apartment. He describes the pain as 10/10 in severity, radiating down his right leg and not improved with 600 mg of ibuprofen twice daily. He denies a history of similar back pain or traumatic injury but is requesting medication to relieve his pain so he can go back to work at a local manufacturing plant.

A 65-year-old obese female with a history of atrial fibrillation and chronic back pain returns to the emergency department for exacerbation of her low back pain. Her vitals are normal and her exam reveals reproducible paralumbar muscular tenderness consistent with previous exams. You would like to treat her pain but are concerned about her risk of falling at home given her risk factors of age, anticoagulant use, and polypharmacy. You wonder about the effectiveness of trigger point injections for this patient’s musculoskeletal pain.

A 50-year-old female from Eastern province of Saudi Arabia presented with symptomatic severe aortic stenosis. She was known to have sickle cell trait(HbSS), with hardly any vaso-occlusive crisis. A transthoracic echocardiogram demonstrated severe Aortic stenosis and moderate LV systolic dysfunction. Her coronaries were normal on angiogram and hence it was decided to proceed with surgical Aortic valve replacement. The patient wanted to know if cardiac surgery could increase her mortality and if there was any alternative, including Transcatheter aortic valve replacement.

You are a physiotherapist working on a vascular ward. A 30 year-old female is admitted to the ward after first rib resection surgery with no complications intra-operatively. Post-operative instructions request day 1 intensive physiotherapy input but no guidance has been given. What acute postoperative physiotherapy exercises should be provided for optimum recovery?

A 47 year old female presents to the ED with a 6 cm superficial laceration on her forearm. She sustained the injury while cutting wood to build an outdoor patio set. She is very anxious and complaining of severe pain making it difficult to exam the entire wound or provide local anesthetic. You wonder how to proceed with irrigation and closure. Distraction methods are commonly used in paediatric emergency departments to ease anxiety and reduce pain perception in children undergoing painful procedures. Can distraction methods, specifically virtual reality, be effective in decreasing pain perception in adults undergoing painful procedures?

A 24 year old male presents to the ED in an acute sickle cell pain crisis. He is requiring increasing amounts of opioids to control his pain with little effect. You wonder if a subdissociative dose of ketamine may be effective to control his pain and reduce his overall opioid consumption.

A 2 month old infant is admitted to hospital with 2 day history of fever, irritability and reduced feeding. A septic work-up including lumbar puncture is performed. CSF white cells are raised and culture confirms Neisseria meningitidis organism. The infant is appropriately started on antibiotic regime as per local anti-microbial guidelines. On day 2 of admission, the infant develops focal motor seizures. It is well established that infants with a diagnosis of meningitis are at risk of developing seizures. You wonder whether the infant should have been prophylactically started on an antiepileptic medication when the diagnosis of meningitis was confirmed.

Is anterior serratus nerve block a good analgesic choice for patients with rib fractures in Emergency Departments?

The Royal College of Obstetricians and Gynaecologists (1) reports that 11 pregnancies per 1000 are ectopic and that the maternal mortality rate from ectopic pregnancy is 0.2 per 1000. The Healthcare Safety Investigation Branch (2) found of the 12 maternal deaths in early pregnancy in the UK between 2009-14, 9 were related to ectopic pregnancy.

A 46 year old male presents with a 4 month history of 'tennis elbow'. He is wondering if there is any benefit from using of the elbow support?