bestBETs

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?

You are a midwife looking after a low risk primigravida in labour. How do you support her in preventing perineal tears of any grade?

A 45 year old male patient was referred to community physiotherapy via his GP with a diagnosis of Grade 2 knee OA confirmed by x-ray. The patient is very fit and active and previously ran four times weekly. The patient is worried about worsening of his OA and asked whether continued running would cause disease progression of his OA.

You are evaluating a pediatric 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 14 year old boy was brought to the emergency department in cardiac arrest following a single stab wound to the chest. The team performed an emergency thoracotomy but unfortunately were unable to resuscitate the boy and he was declared dead in the department. Following this the large family who were present became very distressed and emotional scenes continued for many hours. Due to the nature of the event there were large numbers of staff present who found the event very traumatic and discussion around the clinical decisions made continued for many days after. Following this event it was noted that some staff requested to not be placed in the resuscitation area and there were concerns that it increased sickness in the department.

A 37 year old man presents to the emergency department with a cough and feeling generally unwell. He has signs of sepsis with a high; temperature, pulse, lactate and respiratory rate. He is assessed in triage and taken to the resuscitation room. He has a history of alcohol excess and known cirrhosis of the liver. He has some diffuse crackles at his left base but no clinical changes on his chest x-ray. He has a soft but distended abdomen, with known ascites, which he feels has increased in the last 48 hours. He is treated for sepsis of unknown origin and transferred to the acute medical assessment area. Within 24 hours he has deteriorated, he is not accepted for intensive care due to his high child-Pugh score and after 12 hours of fluids and antibiotics he has a cardiac arrest and dies. The post-mortem report concludes spontaneous bacterium peritonitis as the cause of death.

A 14 year old girl is admitted to the Macmillan Cancer Centre for a cycle of MAP chemotherapy. She has recently undergone limb salvage surgery for a distal femoral tumour and is now undergoing rehabilitation and struggling with being unable to do activities which she found easy before, this in turn is impacting on her mood and quality of life. You wonder if there is evidence to support the use of cycling to aid return to function and improve quality of life after surgery

A 75 year old man has a right fem-pop bypass to improve critical limb ischaemia, should he be referred to an exercise programme to reduce the risk of needing further surgery and improve his function?

Whilst working in an Emergency Department an adult patients attends and is assessed at triage as having sepsis. The patient receives prompt appropriate treatment. Does the initial triage affect their outcome?

You are working in A&E and review a patient with suspected poisoning or overdose, you are unclear of the identity of the substance so can not yet confidently consult the local toxicology database but are aware of the occasional need for intubation in such patients to maintain a safe airway and oxygenation. You wonder if there are any other clinical risk factors or predictors indicative of need for endotracheal intubation in poisoned patients which you could use to support your decision to intubate or not.