bestBETs

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 60-year-old man is brought to the emergency department (ED) via Emergency Medical Services (EMS) after a fall with vital signs absent. EMS provided Cardiopulmonary Resuscitation (CPR) and was able to achieve return of spontaneous circulation (ROSC) on route, however the patient became pulseless again. In the ED the patient was assessed, CPR was initiated and he was intubated; ROSC is achieved once more. Shortly thereafter the patient is found to be pulseless and CPR is restarted. The ACLS algorithm has been followed and all standard resuscitation practices have been implemented. You wonder if the use of Esmolol could have helped you achieve sustained ROSC.

A 25 year old male is brought into the emergency department by police profoundly agitated. You wonder whether ketamine will work faster than lorazepam or midazolam to treat the agitation.

A 32 year old gentleman is brought to the Emergency Department via an ambulance. On arrival he is immobilised with a long board, cervical collar and blocks. The paramedics tell you that he has been involved in an RTC. He was the driver of a car and was wearing a seatbelt. He was driving between 30-35 miles/hour, when a car pulled out of a junction suddenly. Although the patient braked he collided with the car as it pulled out. On paramedic assessment he had mid-line c-spine tenderness so the patient was immobilised at the scene. The patient is finding the collar too tight. You wonder if a collar is essential and whether adequate c-spine immobilisation could be achieved with the blocks alone.

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.

A 59-year-old male is admitted to our ICU because of fever, low level of consciousness, decreased SPO2,he has a past medical history of diabetes mellitus. Chest radiography (CXR) was performed, which reported patchy air space opacity in the right upper lobe suspicious for pneumonia . Lung HRCT revealed bilateral ground-glass opacities (GGOs). LAB data shows leukocytosis and elevated CRP and ESR levels

Since the outbreak of COVID-19, there is a worldwide shortage in protective masks such as surgical and filtering facepiece (FFP) masks. However, your local government advises the public to wear an alternative protective mask, such as a homemade made from household materials or cloth mask, to avoid virus transmission during the pandemic. You are faced with the question whether in non-healthcare settings cloth or homemade facemasks are effective at preventing virus transmission or illness caused by viruses?

A 60-year old man in the emergency department develops a shockable arrhythmia leading to cardiac arrest. As you prepare to deliver a rescue shock, you instructed everyone to clear away from the patient. Knowing that minimizing interruptions to chest compression has been shown to improve outcomes,(1,2) you wonder if there is a safe way to perform hands-on defibrillation and deliver rescue shocks without interrupting chest compressions.

You are tasked to assess a 42-year-old solider who has developed sudden onset slurred speech and weakness in the right arm whilst on exercise. The National Institute for Health and Care Excellence (NICE) guidelines recommend the use of a validated stroke screening tool such as “FAST (Face Arm Speech Test)” in the pre-hospital setting, or “ROSIER (Recognition of Stroke in the Emergency Room)” in the hospital setting. Recognising different screening tools are recommended between settings, you wonder whether there is a difference in accuracy between the screening tools.

You are a clinician working in a busy Emergency Department overnight. A 35 year-old woman presents feeling very nauseous, and requests medications to alleviate symptoms while awaiting results of her investigations. You prescribe an appropriate antiemetic, but note that the nurses are busy dealing with a number of other patients. You therefore anticipate a delay in administration of the antiemetic and wonder whether there is anything you can offer in the short term. You recall an anaesthetic colleague talking about how they ask patients to smell alcohol-containing wipes to treat post-operative nausea. You wonder whether there is any evidence to support similar practice in the Emergency Department.