bestBETs

A 67-year-old male presents to A&E with shortness of breath. He is found to be hypoxic, tachycardiac and tachypnoeic. Chest auscultation reveals bilateral wheeze and reduced air entry throughout. A clinical diagnosis of acute exacerbation of COPD is made. Patient is given Salbutamol and Ipratropium nebulisers followed by intravenous hydrocortisone. He is also given titrated supplemental oxygen. Since patient is already on theophylline and its serum levels is not available, intravenous aminophylline is not given. NIV is considered. You wonder if giving intravenous Magnesium Sulphate is of any benefit.

A 53 year old man attends the emergency department with a 2 hour history of chest pain that may be cardiac. You want to rule out possible acute aortic aneurysm dissection and wonder whether a D-Dimer level can help do this

a patient presenting to A&E with simple shoulder dislocation. Should they receive a USS guided interscalene block or a procedural sedation for the joint reduction

A 78 year old women with no cognitive impairment is brought to the ED with a story of an accidental fall from her height followed by right hip pain and inability to walk or bear any weight on her right leg. Initial evaluation followed by plain films denoted a stable right hip fracture. Initial pain management in the ED was limited. You are concern with the overuse of opiates and development of delirium in the ED and you wonder if the use of regional anesthesia using ultrasound guidance could beneficial for this patient in the ED.

A 32 otherwise fit and well man attends the ED two hours after running his hand along an old wooden broom. He sustained a penetrating wound from a large wood splinter which he thought he had removed. He now complains of ongoing sharp sensation in the ulnar border of his palm on palpation and movement. A radiograph by the triage nurse shows no foreign body but you know that wood is radiolucent 85-100% of the time. You consider whether ED ultrasound might be useful

You are confronted with a patient who has been in a house fire. They are unconscious, hypotensive, and have sooty deposits around their mouth. You recognise that an elevated blood lactate of 12mmol/l makes cyanide poisoning as an important consideration. You wonder whether the administration of an antidote (hydroxocobalamin) could reduce mortality or improve clinical outcome.

A patient who is to undergo an open thoracotomy for lung resection presents to a physiotherapist. The patient would like to know which physiotherapy treatment is the most effective at treating or preventing post-operative complications.

A 75 year old patient has been brought into the emergency department having been seizing for 20 minutes. The prehospital crew have administered buccal midazolam followed by IV Lorazepam but the seizure is ongoing. You have heard that phenytoin has side effects and drug interactions and you don't know the patients background history. You wonder whether levetiracetam is a safe and effective alternative to phenytoin in terminating this seizure.

A 52 year old gentleman presents to the emergency department with tacchypnoia and confusion, and is found to be tacchycardic, pyrexial, and hypotensive. You recognise that he is septic, and wonder if the addition to tranexamic acid to standard care might improve his risk of death?

A 35 year old patient is hit in the chest with a baseball bat sustaining multiple rib fractures and a haemothorax that requires insertion of a chest drain. You wonder if interpleural block is more effective than standard care at providing analgesia.

A 45 year old man attends the emergency department after being involved in a road traffic accident. He has sustained a blunt chest injury during the impact and has bruising across his chest wall. His ECG shows non specific ST segment changes and the chest radiograph are normal. You wonder about the benefit of performing a BNP level to aid the diagnosis or exclusion of myocardial contusion.

A 55-year-old female presents to the emergency department with an infective exacerbation of chronic obstructive pulmonary disease. The patient requires intravenous (IV) fluids and IV antibiotics whilst on non-invasive ventilation. The patient does not require ionotropic support. You and your fellow colleagues have failed at siting a peripheral cannula using traditional methods to administer IV medication. Does the use of US help obtain PIV and reduce the need for a CVC in this clinical scenario?

A 32 year old woman presents to the emergency department complaining of lower abdominal pain associated with bleeding. She has a history of bad period pain for which she takes medication. She has taken all her normal oral medication and is still in pain. You are familiar with salbutamol and it’s action on smooth muscle and know that it is used for tocolysis; you wonder if they may help her pain.

A 42-year old woman presents to the emergency department (ED) with an intentional paracetamol overdose. She is a known frequent ED attender due to paracetamol or insulin overdoses, but would often refuse the appropriate treatment. She has emotionally unstable personality disorder, with high levels of anxiety and distress when she comes into the department. You wonder if implementation of case management can reduce her number of ED visits due to overdoses.

A forty years old male attends the emergency department, with abdominal pain, nausea, heartburn, dyspepsia, reflux and bloating. Physical examination with stable vital signs, abdominal pain without peritoneal irritation. Contrast studies and upper endoscopy reveals a large hiatal hernia. We decided a laparoscopic repair, it has be with mesh or simple suture.

A 45 year old cyclist is brought up into resus after being knocked off his bicycle by a lorry. He is in traumatic cardiac arrest. ATLS is in progress you wonder whether IV adrenaline would improve his chances of survival?

A 7 year old boy is brought to the emergency department (ED) after falling onto the corner of a table. On examination he is noted to have a large laceration across his right cheek that needs suturing. The young boy is afraid of needles and will not allow you to place a cannula or give an IM injection. As the ED physician, you consider using intranasal dexmedetomidine for sedation in this patient.