bestBETs

Headache is a common presenting complaint, but the incidence of subarachnoid hemorrhage is only about 9 per 100,000 patient-years. Is the Ottawa Subarachnoid Hemorrhage Rule a sensitive and specific clinical tool in predicting which patients merit further investigation with computed tomography?

A 6-year-old girl presents to the Emergency Department with two days of fever, mouth pain, and poor oral intake consistent with hand-foot-mouth disease. The parents ask you what they can do to maintain adequate oral intake while the patient is ill.

An 8 week old infant presents to the paediatric emergency department with a toe tourniquet formed from a hair thread. You struggle to unwind the thread but wish to avoid removing it via incision, and so consider the use of hair removal cream - but could it be effective?

A 15 year-old female presents to your emergency department after sustaining a scald burn from hot coffee. She has a mix of superficial partial thickness and deep partial thickness burns totaling approximately 15% total body surface area (TBSA). She was treated with cool water therapy (CWT) for 20 minutes in the field. You remember than CWT is recommended in first aid guidelines but also recall that not all experts are convinced of the value of the treatment. You decide to consult the literature to assess the benefits of CWT in acute burns.

You are part of the response team on route to a multi-vehicle road traffic collision. Initial reports state that one of the vehicles is an overturned minibus carrying 12 children, with all sustaining varying degrees of injury. Aware that you have limited clinical resources immediately available you consider whether a paediatric major incident triage tool would help to prioritise patients needing life-saving interventions.

A 25 year old male presents to the Emergency Department after punching a wall. He has a closed, minimally displaced fracture of the neck of the fifth metacarpal on his right hand. There is no rotational deformity of the little finger. The patient is not keen on being in plaster and asks is there another option?

A 7-year-old boy is accompanied by his mother into ED. He is complaining of a moderate headache with nausea, and he appears pale and lethargic. You have ruled out meningitis and want to treat him for a migraine, but wonder which analgesic would be the most effective.

Patients frequently attend the emergency department complaining of urticaria, skin itchiness or rash, allergic rhinitis, or runny nose. Is the 1st generation anti-histamine chlorpheniramine or the 2nd generation loratadine more effective in treating these symptoms?

A 67-year-old male with a history of type II diabetes and hypertension presents following an out-of-hospital cardiac arrest. Bystander CPR was initiated immediately. His initial rhythm was ventricular fibrillation and ACLS protocol was followed by EMS prior to arrival. Upon arrival, he remains in refractory ventricular fibrillation. A stat venous blood gas is obtained which reveals a pH of 6.8. You consider whether sodium bicarbonate would significantly increase the chances of obtaining return of spontaneous circulation in this patient.

26-year-old man presents to the emergency department (ED) with concern for recent perioral swelling, wheezing, nausea and urticaria after bee envenomation. He has a known allergy to bees and was able to administer 1 dose of intramuscular epinephrine. He arrived to your ED within thirty minutes and his symptoms of anaphylaxis are largely resolved. You consider how long to monitor the patient in the ED.

An emergency department patient needs a computed tomography angiogram to rule out a pulmonary embolism. The patient has a shellfish allergy noted on the medical record and you wonder if it is safe for the patient to receive intravenous radiocontrast.

A child is referred for Occupational Therapy (OT) assessment by a specialist paediatric consultant with a diagnosis of upper limb joint hypermobility syndrome. They experience pain and difficulty with fine motor tasks. We wonder if a prescribed hand strengthening exercise programme would impact on this.

33 year old male presented to the ED with pain around the Achilles tendon and decreased physical performance whilst training for a marathon. His symptoms had been gradually worsening as his training progressed, but now he was struggling to walk. He had seen a physiotherapist and was carrying out regular strengthening exercises. Furthermore, he had seen a podiatrist and now had specialised in-soles in his running trainers. You wonder if extra-corporeal shock-wave therapy (ESWT) conducted via referral is likely to improve his symptoms?

A 32 year old female was driving home on a cold winter night and lost control at the wheel. On EMS arrival, the patient is obtunded, cool, and clammy. She loses pulses at the scene and EMS personnel begin CPR. After a significant delay in extrication and travel via ambulance, the patient arrives at your hospital. She undergoes multiple rounds of CPR, bilateral chest tube placement, pericardiocentesis and was found to have a large pericardial effusion in the ED trauma bay. Unfortunately, time of death was called as it is now approaching an hour-long resuscitation without ROSC. You consider if her outcome would have changed had her out of hospital traumatic arrest been managed by a helicopter emergency medical service.

A 70-year-old man with a 60-pack year history with known lung cancer presents to the Emergency Department with hemoptysis that started 3 days ago. Hemoptysis was initially intermittent but has now become more persistent. Patient is hemodynamically stable. The pulmonologist on-call suggests trying inhaled tranexamic acid to control bleeding.