bestBETs

A neonate of 41 weeks gestation was born through Meconium Stained Amniotic Fluid (MSAF). Mild tachypnea was noted at 1 and 5 minutes, that did not respond to gentle stimulation and wiping of the mouth. Subsequently, intratracheal suctioning was performed with resolution of respiratory distress after brief NICU observation.

A 36yr old male patient is found at home in cardiac arrest. Initial ECG shows PEA and the resus is continued for 20 mins with one episode of VF but no ROSC. The decision is made to take him to the nearest A&E but there is no improvement and he pronounced dead in A&E. You wonder if being able to perform cardiac ultrasound would have helped the decision to continue or terminate the resus

As attending physisian in the cardiac arrest team your patient suddenly shows signs of awareness as CPR is performed even though spontaneus circulation is still not returning. Besides the ethical and communicative issues rising in your head, you wonder how you and the team should approach pain management and sedation while continuing cpr.

A 62-year-old woman presents to the emergency department (ED) with difficulty walking due to five hours of constant vertigo. The dizziness is worse with head motion and better with her eyes closed. She has vomited twice but has no headache or other complaints. Her workup, including a CT scan, is negative. The patient remains ataxic despite meclizine and so she is admitted with diagnosis of peripheral vertigo. An MRI was done the following day shows a large cerebellar stroke. As the treating physician, you wonder how often the diagnosis of stroke is not recognized in the ED.

A 53 year old woman presents to the Emergency Department after falling on her right outstretched arm. On arrival her wrist appears to be swollen. X-ray examination reveals a displaced distal radius fracture. While performing Böhlers anesthesia, you wonder if US-guided closed reduction would increase the likelihood of reduction adequacy, thereby avoiding the need of repeat reduction or open reduction and internal fixation [ORIF].

A neonate of 41 weeks gestation was born through Meconium Stained Amniotic Fluid (MSAF) subsequently developing MAS necessitating invasive ventilation in the NICU.

A 11yr old boy is involved in a pedestrian versus car traffic accident, sustaining head injuries with reduced consciousness. On scene he has a GCS of 6. He is intubated and brought to the major trauma centre emergency department. You wonder whether the evidence supports endotracheal intubation prehospitally for this patient.

You are evaluating a patient in the emergency department in whom you are considering the diagnosis of acute community-acquired bacterial meningitis. You perform a lumbar puncture and when ordering CSF studies wonder if sending a CSF lactate would help distinguish acute bacterial meningitis (ABM) from acute viral meningitis (AVM).

A 26 year old primigravida at 31 weeks gestation presents to the Emergency Department with shortness of breath and pleuritic chest pain. She is apyrexial, has a respiratory rate of 26, a heart rate of 110 and oxygen saturation of 95% on room air. There is no evidence of leg pain or swelling. Her ECG is normal and you are awaiting the report of her chest X-Ray. You suspect a pulmonary embolism (PE)- which imaging should you order next?

A 6-week-old presents to the emergency department with respiratory distress with no significant clinical findings suggesting a cardiac or respiratory cause at this point in time. You plan to take bloods and wonder whether Brain Natriuretic peptide (BNP) would be a useful biomarker to detect cardiac disease in this case.

You are asked to assess a 32-year-old who has waited two hours after being fully immobilised following a RTC. He has midline cervical tenderness and undergoes CT as X-rays are inadequate. You wonder whether immobilisation is doing more harm than good and if it actually prevents secondary neurological deterioration (SND).

A 62-year-old male is admitted to the intensive care unit with sepsis and is intubated and mechanically ventilated. He develops a moderate secretion load with reduced lung volumes and requires respiratory physiotherapy. You wonder if there is evidence to support the use of VHI to aid secretion clearance and improve lung compliance in this case.

A 48-year-old man with a history of pulmonary embolism (PE) and antiphospholipid antibody syndrome taking rivaroxaban presents to the ED with shortness of breath, hemoptysis, and pleuritic chest pain. Chest CT demonstrated multiple PEs. You wonder what is the incidence of recurrent venous thromboembolism (VTE) despite anticoagulation.

A 26-year-old male athlete presents to emergency department with a knee injury during playing basketball 4 hours ago. According to history and physical examination, anterior cruciate ligment tear is suspected with knee instability. You wonder whether an ultrasound scan is helpful in the diagnosis of anterior cruciate ligment rupture.

An 8 year old girl is brought to your emergency department after falling in the local park and sustaining a laceration across her cheek. The wound needs to be cleaned and sutured. You feel that she will require sedation in order to fully comply during the procedure, and have heard about dexmedetomidine which is already being used safely and effectively in sedation for painless procedures. You wonder if this agent will provide you with effective procedural sedation without increasing her adverse event risk.

A 35-year-old male presents to the Emergency Department with an anterior abdominal stab wound (AASW). He is haemodynamically stable; you are unsure what the best method of investigation is to detect any significant intra-abdominal injury including hollow viscus perforation.

A 14-year-old boy presents to the Emergency Department with abdominal pain that started 3 days ago and yesterday became more intense and moved to the right lower quadrant. He has decreased appetite, two episodes of emesis today, and low-grade fever.