bestBETs

A 28-year-old male football player has a blunt trauma to his quadriceps sustained 5 days previously. He now has painful, localised focal swelling over the lateral aspect of the mid-thigh and limited painful knee flexion. You suspect he may be developing Myositis Ossificans Circumscripta (MOC) within the Vastus Lateralis muscle. You decide that he would benefit from further investigation in the form of imaging. You have access to immediate point-of-care access to diagnostic ultrasound (US), but you wish to know if US will give you an accurate diagnosis comparable to that of the gold standard, computerised tomography (CT).

A 22 year old female attends the emergency department after falling on her outstretched hand. On examination she has tenderness over the scaphoid, scaphoid tubercle with pain on axial loading of the thumb as well. Initial plain radiographs are normal. You have recently completed a musculoskeletal ultrasound course and wonder if ultrasound as a modality is useful in the diagnosis of occult scaphoid fractures.

A young male was self-presented to the ED with sudden onset left-sided pleuritic chest pain. His physiological observations were within normal limits with an unremarkable physical examination, ECG and chest x-ray. The calculated two-level PE Well’s score was ‘0’ and the D-Dimer was reported as above the 99th percentile. He was clinically risk-stratified by sPESI scoring as low-risk mortality PE presentation. A CTPA could not be done until the following day and he wished to go home. The BTS guidelines 2018 recommends that patients with suspected PE who are deemed as low-risk are eligible for OP care with an alternative strategy of anticoagulation. Hence, can this patient with suspected PE be treated as OP safely pending radiological investigation?

A 40-year-old male with a history of hypertension and tobacco abuse presents to the emergency department (ED) complaining of chest pain. Workup is completed including a metabolic profile which is remarkable for a blood glucose of 294. He has no history of diabetes or hyperglycemia. The remainder of the workup reveals no abnormalities and undetectable troponin. The patient’s pain resolves after a dose of antacid in the ED. As you prepare discharge instructions, you wonder if you need to correct his hyperglycemia prior to sending him home.

A 28-year-old male with a history of IV drug use presents to the emergency department for injuries sustained during a motor vehicle collision. The patient was non-ambulatory at the scene with multiple injuries to his extremities including an obvious right-sided femur fracture. Upon arrival, the patient is hypotensive with weak distal pulses. Nurses are unable to obtain IV access but you successfully place an intraosseous (IO) line in the left proximal tibia. You consider whether administering tranexamic acid (TXA) via IO will have the same efficacy as IV or intramuscular (IM) administration.

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?

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.

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 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?