bestBETs

A 45-year-old man presents to the emergency department with new onset abdominal pain, and the nurse asks you to quickly prescribe some paracetamol. You wonder if there is any difference in the analgesic effect by route of administration.

A 35-year-old male presents to the Emergency Department with an anterior abdominal stab wound (AASW). He is haemodynamically stable; you are unsure of the best method of investigation to detect significant intra-abdominal injury including hollow viscus perforation.

A child presents to the ED with distal fibular pain after a fall. The x-rays are negative for fracture, but the child still has significant pain despite analgesia. You suspect a Salter-Harris Type I fracture, but remember that your physical exam is not very specific for this injury; it could actually be a sprain. You do not want to immobilize this child without cause, so you wonder whether you can improve your diagnostic accuracy for a Salter-Harris Type I fracture with bedside ultrasound.

A sixty year-old woman presents to the Emergency Department with a three-hour history of right sided hemiparesis. She has a past medical history of hypertension and myocardial infarction. Rapid evaluation and prompt initiation of thrombolytic therapy in acute ischemic stroke is extremely important for prognosis. Diagnosis of acute ischemic stroke usually relies on clinical grounds, after excluding hemorrhagic stroke by computed tomography. The availability of rapid and accurate diagnostic biomarkers to discriminate hemorrhagic from ischemic stroke would be helpful. Ideally, distinction should be made at pre-hospital triage, thereby directing patients to adequate centers for optimal care. We wonder if such biomarkers are present in the evaluation of acute stroke.

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.