bestBETs

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 22 year old woman with a history of hypoparathyroidism presents to the emergency department with recurrent grand mal seizures. Her ionized calcium level is 0.7 mmol/L (2.8 mg/dL). You prefer to administer intravenous calcium gluconate over calcium chloride because it causes less tissue necrosis if extravasated. Also, calcium gluconate is better tolerated through a peripheral IV. However, you recall that calcium gluconate might possess a slower onset of action because it requires hepatic metabolism to release the elemental and active form of calcium.

A 61-year-old lady presents to the ED with redness and swelling around a varicose vein that extends from the lateral aspect of the left knee to the mid-portion of the lateral aspect of the left leg. She has a 25-year history of asymptomatic lower extremity varicosities which appeared after the birth of her first child. A duplex ultrasound confirms your clinical diagnosis of "superficial thrombophlebitis". You begin treatment with a nonsteroidal anti-inflammatory drug (NSAID), compression stockings and arrange follow-up in 2-3 days. Although she has no risk factors for hypercoagulability or deep venous thrombosis, you wonder if anticoagulants might reduce complications.

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.

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 12 year old girl with autism was admitted for elective orthopaedic surgery, requiring a 4 week inpatient stay for post-op physiotherapy. She required significant dietetic and psychiatric input, and had lost weight at successive outpatient appointments prior to hospital admission. She was diagnosed with anorexia during her admission. This case, is one of many, that highlighted the need for dietetic and psychiatric input intervention early in children with autism. Patient group: Children aged 5-15 years old with Autism Intervention: Eating Disorders (Anorexia AND/ OR Bulimia) Control group: Children aged 5-15 years old without Autism Outcome: Data on the prevalence of Eating Disorders in children with Autism compared to children without Autism

A patient is brought into ED with airway difficulty and stridor and requires intubation. Rapid sequence induction for anaesthesia is performed. On laryngoscopy the view is Cormack Grade 2 and the anaesthetist says they don’t need a bougie to pass the endotracheal tube and intubate the patient. You wonder if the endotracheal tube will be passed first time.

A 35 yrs old girl comes to the Emergency department with acute shortness of breath for last 6 hrs. The working diagnosis of pulmonary embolism is made. The D dimer was sent but will take 2-3 hrs for the results to be available. You wonder if arterial blood gas analysis can be used to diagnose the PE.

A 55 year old man has presents to the emergency department with severe hypoxia secondary to an exacerbation of congestive heart failure. His initial saturation is 83% with a reservoir oxygen mask; he is tachypneic with a respiratory rate of 35. You decide to intubate this patient and want to optimize his oxygen saturation before induction. You place a standard reservoir face mask with a flow rate of oxygen set as high as possible. After 3 minutes the saturation has improved to 95%. One of your colleagues suggests using high-flow nasal cannula oxygen during the intubation procedure to reducing desaturation (apneic oxygenation).