bestBETs

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).

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 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 dress the wound and discharge him however wonder whether you should prescribe a course of antibiotics.

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.

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.

A 4 year old girl is brought to the Emergency Department with a rash that is obviously chicken pox and she is very distressed. The triage nurse comes to ask what analgesia can be given as paracetamol was given at home 30 minutes ago and they have heard that ibuprofen is contra-indicated in chicken pox.

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 40-year old female known pulmonary aspergilloma in the left upper lobe is scheduled for surgical resection.The patient questions which is better,VATS or Thoracotomy?

A 41 year old male presented to the emergency department with a 48 hour history of increasing erythema, swelling, and pain over his left lateral thigh. On examination you note a 4 cm area of erythema with associated fluctuance and induration. The decision is made to perform an incision and drainage, and you wonder whether irrigation of the abscess cavity would improve patient’s outcome.

A 50-year old patient presenting to ED falls in the department and sustains fracture of the wrist. What steps could be taken to reduce the number of falls in patients presenting to the ED/CDU?

When faced with a trauma patient in a prehospital setting there has been numerous looks into the use of blood products. The practice of prehospital transfusions has been revitalised by recent military conflicts and has been shown to increase casualty survival leading to a resurrection of military prehospital blood product (PHBP) resuscitation. This has began to apply in a civilian setting with increasing focus on the use of blood and blood products during prehospital trauma. However, when faced with a pre-hospital trauma situation there any prospective and comparative data to support giving blood or blood products over the current standard practice of crystalloid fluid resuscitation?

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.