bestBETs

You are put on standby by the paramedic emergency service for a cardiac arrest in a 2-year-old boy hit by a car. As you send for the ‘CPR step’, you wonder whether you really should give chest compressions as per ALS-teaching or whether they are ineffective in hypovolaemic or obstructive shock due to trauma (as recent opinion has suggested).

A 30-year-old male involved in a high-speed motorcycle accident is attended to by a prehospital critical care team. On scene the patient is moribund and in a shocked state. As the reversible causes of shock are addressed you wonder if resuscitation with blood products rather than crystalloid would improve the patient's chances of survival. Major haemorrhage protocols are used in hospital and intuition would suggest potential benefit if these protocols were administered at the point of injury, in order to reduce the later incidence of coagulopathy.

You are reviewing urine culture and sensitivity results in your ED. You come across a result growing a germ that is sensitive to ciprofloxacin only. You contact your patient to come and collect a prescription later in the day. Your colleague who has been listening to your phone conversation warns you of the increased risk of tendinopathy in patients taking fluoroquinolones. You wonder if this is just anecdotal. You decide to search and review the current literature to see if any evidence substantiates this risk at all.

A 4 year-old child presents to your local ED with respiratory symptoms and fever. In order to confirm your suspicion of pneumonia, you plan to order a chest radiograph, but a quick look into the child's medical record shows he has already undergone several X-rays in the last few years for the evaluation of upper respiratory tract infections. Being aware of the potential long-term effects of radiation on your patient, you wonder if bedside lung ultrasound could be used to diagnose pneumonia.

A 72 year old male presents to the emergency department with pulseless ventricular tachycardia. You wonder if a precordial thump is effective in restoring the heart to a sinus rhythm?

An 8 year boy with coeliac disease has eaten a biscuit at a friends birthday party. His mother has brought him to A+E because she has read on a coelaic disease support forum that charcoal can reduce the risk abdominal pains and diarrhoea.

A busy emergency department has a long list of patients in the waiting area and several patients have recently arrived on trolleys from the ambulance service. There is pressure to get patients seen and either discharged or admitted as soon as possible. You wonder if asking the triage nurses to determine whether they think each patient will need admitted will speed the process along by allowing earlier booking of inpatient beds.

An 8 year old child is brought the emergency department following a high speed road traffic collision. He was unrestrained in the vehicle and has evidence of head trauma. He arrested at the scene and on arrival has undergone 15 minutes of CPR, has fixed pupils with no pulse and asystole on the cardiac monitor. Is it appropriate to stop resuscitation?

You are the most senior doctor in the Emergency Department when you receive an alert call from the pre-hospital medical team. They are bringing an 8 year old boy who was a pedestrian struck by a bus. He is displaying signs of hypovolaemia due to suspected ongoing internal bleeding, with tachycardia and hypotension despite fluid resuscitation. You are concerned that he is at risk of cardiac arrest, but are unsure of the optimal method of identifying cardiac arrest in such patients to help you decide when to start your traumatic cardiac arrest protocol.

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