bestBETs

You are asked by a junior colleague to help place a difficult peripheral cannula in a patient in ED using ultrasound guidance. You wonder if there is an increased risk infection from the ultrasound equipment.

A 59 year old women has painful osteoarthritis of the 1st MTPJ (great toe). She has been told that a MTPJ fusion is the best surgical solution but has read on t'internet that there are now joint replacements for the big toe MTPJ. She asks for your advice but before imparting wisdom, you wonder if there has been any study comparing the two techniques.

A 65 year old man presented to the Emergency Department with hypoxia and confusion. Chest xray is consistent with severe COVID-19 pneumonia. COVID-19 was confirmed with PCR testing. A colleague mentions Azithromycin as a possible treatment. You wonder if Azithromycin would reduce mortality or length of stay. You also wonder if it is associated with increased adverse events.

A 52 year old presented to the Emergency Department with a 9 day history of coryzal symptoms including sore throat and fever, after 5 days developed a dry cough and shortness of breath on exertion. Shortness of breath had become more severe over the last 24 hours, now breathless at rest and complaining of right sided pleuritic chest pain. Chest X-Ray and blood result findings were highly suspicious of COVID-19 and this was confirmed on PCR testing. With ongoing research into novel therapies for COVID-19, you wonder if Lopinavir-Ritonavir would reduce mortality or length of hospital stay for this patient.

The ambulance service is called to a 33-year-old-gentleman who has been found unresponsive. The dwelling is dark and confined with poor hygiene. The patient is confirmed to have self-administered opiates intravenously and is also reported to be HIV positive. On examination the patients peripheral vasculature is delicate and bruised. The intranasal (IN) route, as opposed to intravenous (IV) or intramuscular (IM) routes, of administering Naloxone is considered.

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A 25 year old female attends your emergency department with fever and cough. She is streamed to the Amber area for assessment where you see her and diagnose probable COVID-19. Are there specific points from the history and specific blood test which would help you assess her risk of disease progression, and therefore influence your decision to admit or discharge?

A young patient has been stabbed in the right lower abdomen and is in PEA cardaic arrest. You wonder whether emergency thoracotomy would improve his chances of survival?

A 55 year old with a background of hypertension is brought to the emergency department with a 7 day history of fever, cough, and shortness of breath. His oxygen saturations are 93% on 6 litres of oxygen via facemask and arterial blood gas results suggest type 1 respiratory failure. You suspect COVID-19 and refer to the medical team for conservative management and inpatient care. Having made the referral, you remember listening to a podcast about prone positioning and wonder if this would improve his oxygenation or reduce the likelihood of clinical deterioration?

You are present in resus when a 35 year old arrives as a standby, with a low GCS. The anaesthetic team is in attendance. This history is of recent overdose of sedative and antidepressant medication, but there is also a history of recent respiratory illness. Blood gas analysis reveals a mixed acidosis and a decision is taken early to sedate and ventilate for airway protection and predicted clinical course. You don PPE, discuss roles during the team brief and agree to be the primary intubator, with anaesthesia administering induction drugs and providing team leadership. During the checklist you suggest an airway plan that starts with direct laryngoscopy (DL). The anaesthetic team recommend use of videolaryngoscopy (VL), stating that not only will this allow them to see a bit more of what is happening but also now has an evidence base suggesting better first pass success rates. They also suggest it is recommended for intubation of COVID-19 patients in several international guidelines. You did not know this and resolve to have a look at the evidence. Right after you’ve intubated this patient….

A 60-year old gentleman travels by ambulance to ED Majors. A varicose vein on the dorsum of his foot was caught on his sock while dressing. A puddle of blood quickly appeared. Despite direct pressure by the person and the ambulance service, the varicosity is still bleeding. You elevate the foot above the person's heart. You apply a compression dressing up to the level of their knee. You consider applying tranexamic acid as a topical haemostatic agent to reduce blood loss.

A 30-year-old male presents to the emergency department with cough, fever, and an infiltrate on chest x-ray. He is subsequently diagnosed with community-acquired pneumonia. You would typically prescribe him amoxicillin-clavulin as an outpatient but he is reporting a vague history of penicillin allergy. You wonder whether this is a true allergy.