bestBETs

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 24 year old male presents to the emergency department with complaint of sensation of esophageal obstruction and inability to swallow liquids. This started while eating steak dinner. He has not had any vomiting, although he has not been able to tolerate any liquids by mouth since the onset of symptoms, and he has never had this before. You diagnose him with esophageal soft food bolus impaction. He asks how you are going to treat him.

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.

Young lady has presented with overdose to the emergency department. She is drowsy at presentation and is suspected to have a mixed overdose of medications. Her urine toxicology screen is positive for benzodiazepines.

A 40-year-old man attends the emergency department after a road traffic accident. Although haemodynamically stable, he has sustained a blunt chest injury and has bruising across his anterior chest. You are uncertain about its significance. You wonder if you can perform any tests to help guide your management.

A 45 year old male is involved in a head on RTC whilst driving his car. He suffers blunt trauma to his left thorax from the steering wheel and develops a haemopneumothorax. You place a tube thoracostomy and ask if prophylactic antibiotics should be given to reduce the incidence of infection in the thoracic cavity.

A 34-year-old man presents to the emergency department directly from the local gym with sudden-onset shoulder pain and immediate loss of function. He had lifted a weight with shoulders abducted and hyper-extended, feeling his right shoulder immediately give way. Plain radiographs demonstrated anterior dislocation of the humeral head. The shoulder is reduced under conscious sedation with good clinical result and appropriate follow-up is arranged. As you order 'routine' post-reduction radiographs, you wonder if they will really influence management in the emergency department?