bestBETs

A 63-year-old gentleman with a history of hypertension comes to the Emergency Department complaining of sudden onset of right-sided weakness and slurring of speech 2 hours ago. You request an immediate non-contrast CT brain. However, you wonder if blood biomarkers could be used instead to diagnose a stroke, or more accurately, an ischaemic stroke.

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 5 year-old boy presents to the emergency department with an acute exacerbation of asthma, with a tight chest and an oxygen requirement. He is followed up regularly in a paediatric respiratory clinic and is normally on a preventer inhaler. Along with back-to-back mixed nebulisers, you prescribe oral prednisolone, which he vomits 10 minutes later. The paediatric SHO says she has heard of a recent RCT that shows that a single dose of oral Dexamethasone is as good as 3 days of Prednisolone in the management of acute wheeze and you know from your own experience that oral Dexamethasone is usually well tolerated by kids presenting with croup. Given how often you see children vomit Prednisolone, you ask yourself whether the emergency department should switch to oral Dexamethasone instead for childhood wheeze?

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 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 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 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.