bestBETs

A 45-year-old man attended the Emergency Department (ED) with one-hour history of chest pain that could be of cardiac origin. His ECG did not reveal acute ischemic changes. It is important to substantiate or rule-out ACS in this situation. This analysis is aimed at finding whether a hs-cTnT measurement taken at 0-hour and 1-hour after presentation is sensitive enough for this purpose.

Whilst on a clinical shift in the Emergency Department you attend to a 24 year old female who has taken a clinically significant paracetamol overdose, and requires n-acetylcysteine (NAC), you are wondering if a reduction in infusion rate of NAC will reduce adverse side effects such as vomiting and nausea?

On-going CPR on a 50 year-old male is occurring in your ED. He remains pulseless after 20 minutes and you doubt about the cardiac activity on the POCUS examination. You wonder what your other colleague would say.

A 60 year old male of African origin comes to emergency department with intermittent flashing lights and floaters for 24 hours. He refuses consent for pupil dilation as he intends to drive back home if discharged. Its not possible to gain a clear view of retina with ophthalmoscope. Can you use the bedside ultrasound with linear array probe to diagnose retinal detachment ?

A 54 year old female presents to the physiotherapy department for treatment of lateral hip pain of insidious onset on going for more than one year. Pain is aggravated by prolonged standing and laying on the affected side. GTPS has been diagnosed on ultrasound. She had a steroid injection which had no long-lasting effect and has now been referred to try exercise rehabilitation in physiotherapy.

A 37-year old patient who has never been to your hospital presents for shortness of breath. He reports a history of HIV, but is not currently on treatment and does not know his last CD4+ count. His oxygen saturation is 94% on room air, and lung sounds are distant. His CXR shows possible interstitial markings in the right middle lobe, his LDH is 240, absolute lymphocyte count (ALC) is 2200, and he has a normal A-a gradient. In addition to covering for community acquired pneumonia, should TMP/SMX be started in the ED?

A 45 year old man (Mr X) sustained significant trauma in a road traffic accident (RTA). From clinical examination and a trauma series CT scan Mr X is diagnosed with grade 3 liver and splenic injuries. Mr X is haemodynamically stable and has no evidence of ongoing bleeding, initial plan is to manage the patient non-operatively. Mr X is in significant discomfort and is not mobilising from bed, you wonder about the safety of prescribing low molecular weight heparin (LMWH) venous thromboembolism (VTE) prophylaxis.

A 14 year old boy is seen in the Emergency Department for exertional heat stroke that was subsequently complicated by multiorgan failure including acute liver failure (ALF). You wonder if N-acetylcysteine (NAC) which is used routinely in acetaminophen-induced ALF will be useful in the management of this teenager in the Children’s Intensive Care Unit (CICU).

A 32 year old man attends casualty with a large abscess on his bottom, painful and ready to burst. You wonder whether you should pack the abscess after draining it. He is self-employed and needs to get back to work quickly.

You review a young adult (or child) in the emergency department with a soft tissue infection. Upon clinical examination you are unsure whether there is a cutaneous abscess present. You wonder whether bedside ultrasound will help you make a definitive diagnosis.

You treat a cutaneous abscess in young adult male in the emergency department with incision and drainage. You wonder which method of wound closure will allow the wound to heal the quickest - primary suture straightaway or leaving it to heal by secondary intention

You treat a cutaneous abscess in young adult male in the emergency department with incision and drainage. You dress the wound and discharge him however wonder whether you should prescribe a course of antibiotics.

A patient is sent to the ER after being involved in a car accident while driving under the influence of alcohol. Basic trauma interventions and investigations are applied to rule out life-threatening injuries, and you keep him under surveillance until his alcohol blood level normalizes. Could a brief alcohol intervention or counselling be useful in order to decrease the risk of trauma recidivism and alcohol intake?

A witnessed non traumatic out-of-hospital cardiac arrest occurs in your neighbourhood and the paramedics are rapidly called on scene. Basic Life Support (BLS) guidelines are applied and ventilation may be necessary at this point.