bestBETs

An adult patient with a mixed background of asthma and chronic obstructive pulmonary disease (COPD) presents to the ED with worsening shortness of breath and wheeze. They report using their salbutamol inhaler multiple times at home, with little improvement. At present, they are not able to speak in full sentences, but their oxygen saturations are normal, and they show no signs of fatigue. You consider prescribing nebulised salbutamol but wonder if there is any evidence to support instead the use of a metered-dose inhaler with spacer.

You are at a fireworks party with your young family. You wonder whether inserting a sparkler into a carrot may be safer and reduce the risk of injury.

An elderly patient presents to the emergency department (ED) with hip pain after a fall from standing. They are unable to weight bear. You notice extensive bruising around their left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve their outcome when they later undergo surgery.

A 32 year old patient presents with severe loin to groin pain. He is otherwise fit and well. CT KUB shows a 5 mm stone at the vesico-ureteric junction. You have read about intradermal sterile water injections being used in the context of labour pain and musculoskeletal injuries and wonder whether they may also provide benefit in renal colic.

A 33-year-old patient presents to the emergency department with right-sided flank pain and haematuria. The pain is described initially as 10/10 in severity. CT imaging demonstrates a 4mm non-obstructive stone in the right ureter. Despite intravenous ketorolac and morphine, the pain remains 9/10 in severity. The patient is otherwise well, and you wonder if an erector spinae plane block (ESPB) would be an effective alternative for analgesia.

A 44-year-old patient presents to the emergency department (ED) with a deformed and painful right shoulder after a hard tackle playing rugby. An X-ray confirms right anterior glenohumeral dislocation with no associated fracture. You would like to attempt a closed reduction. Unfortunately, your department is too busy for a full procedural sedation. You wonder what your likelihood of success would be using only inhaled methoxyflurane (Penthrox®) and whether this would facilitate a quicker discharge from ED.

A 19-year-old male presents to your ED after a generalised tonic-clonic seizure. He has never had a seizure before and is otherwise fit and well. You conduct a full neurological examination and request several bedside investigations. You wonder whether you should also request a CT head scan. More broadly, you wonder whether your department should be scanning all patients who present with a first seizure.

Current practice for patients after routine primary total hip replacement is to have unsupervised physiotherapy in the home-based setting followed by one hospital-based out-patient appointment check at 6 weeks post-op. A colleague feels that physiotherapy out-patient services should manage all post-op THR more frequently. You are concerned about the pressure on your out-patient service, particularly in view of the current COVID-19 pandemic limiting face-to face appointments. You want to establish what is the current evidence for physiotherapy in the home-based compared to the hospital-based settings.

An African American 19-year-old male presents to the emergency department with coryza, audible wheeze, and cough. He is afebrile, well hydrated, in mild respiratory distress with an oxygen-saturation (SaO2) 93% on room air. During the COVID-19 pandemic, you recall some concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation.

A 25-year-old male presents to the emergency department after burning his hand on a torch at work. He suffered a superficial burn with a large blister to his dorsal hand. You consider the best evidence-based management of the blister.

A 40-year-old police officer is exposed to a white powder after apprehending a suspect. He is concerned that he was exposed to fentanyl so he self-dosed with Naloxone and came to the Emergency Department. He is observed for 1 hour and discharged home.

A 14-year-old presents to the ED with acute flank pain and is found to have a 5 mm distal left ureteral calculus. There is no concern for significant hydronephrosis, renal insufficiency, or infected stone. Should tamsulosin be prescribed to help facilitate stone passage in this pediatric patient?

An otherwise healthy 28-year-old male presents to the emergency department following a motor vehicle collision. The patient, brought in wearing a cervical collar, is obtunded upon arrival and intubated for airway protection. CT imaging shows a multifocal subarachnoid hemorrhage. The patient has signs of increased intracranial pressure (ICP) and despite maximal medical therapy continues to be severely hypertensive and bradycardic. CT of the cervical spine was negative, and you wonder if the patient’s cervical collar is contributing to the elevated intracranial pressure.

A 7-year-old female with a history of atopic dermatitis presents to a pediatric emergency department for wheezing and increased work of breathing. The department is full with many hall beds currently occupied by patients. You put in orders to administer 4 puffs of albuterol and a dose of dexamethasone. You notice that 45 minutes later the medications have not been given and when you reassess the patient she is in more respiratory distress. Crowding in the emergency department seemed to play a role in the adverse turn of events for the patient.

A 64-year-male presents to the emergency department in cardiac arrest. While undergoing cardiopulmonary resuscitation, chest compressions are paused every two minutes to evaluate for the presence of a pulse. As a knowledgeable resuscitationist, you know that minimizing pauses in chest compressions provides the best opportunity for a positive patient outcome. You wonder if using point-of-care ultrasound (POCUS) to evaluate for the presence of a pulse reduces pulse check times.

A 55-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset of severe chest pain radiating to his left arm. On physical examination, he is diaphoretic and appears anxious. His initial electrocardiogram (ECG) appears normal. You wonder how accurate the ECG findings are to rule out acute coronary occlusion (ACO).

An ambulance crew calls the local trauma unit with an 85 year old female they suspect of being major trauma. They want to know if she should be brought to the trauma unit or taken to the major trauma centre?

A 4 year old girl attends your accident and emergency department crying and unable to move her left elbow after a fall on outstretched hand at school. You identify a Gartland Type IIa fracture on the plain radiograph. You wonder if admission is necessary for her angulated fracture.

A 10 year old child has been transferred to hospital after being involved in a pedestrian versus vehicle collision. They have sustained a lower limb injury which demonstrates significant soft tissue loss with a comminuted, open fracture of tibia/ fibula. Their pedal pulses are weak with dusky appearanes of the extremity of the affected lower limb