bestBETs

You are taking care of a 36 year-old female with confirmed pulmonary embolism (PE) on CT angiography. She complains of a moderate pleuretic chest pain and is slightly short of breath. Her vitals signs and her ECG are normal. She is hemodynamically stable since her arrival in the ED. You know that right ventricular strain in patients with PE is associated with significant mortality and morbidity and that high-sensitivity troponin and BNP could help identify these patients. While planning to potentially discharge the patient after appropriate PE treatment, you wonder if high sensitivity troponin would better perform than BNP to identify individuals with high-risk of complications or serious adverse events.

A 79 year old patient attends the ED for a minor medical problem. While taking the history it becomes apparent that this patient lives alone, with no relatives nearby and no social support. You wonder if this finding alone increases the risk of re-attendance and the length of stay for this patient.

You are asked to attend to an 82 year old foreign language speaking female patient presenting with a 3 hour history of chest pain. She has multiple comorbidities and is quite distressed at having been brought to the hospital. She speaks very limited English, making it almost impossible to take a detailed history. You wonder if this language barrier might influence her management and outcome.

A child suffers major trauma, resulting in cardiac arrest.

You are asked to see a patient in the ED who is not fluent in English and requires an interpreter. You find that the telephone translation service is a bit difficult and you wonder if video conferencing or translation services using novel technologies may lead to better outcomes than the telephone service.

You are a newly appointed Emergency Medicine Consultant at a large inner-city hospital, and you notice a high incidence of assault victims attending your department, and you wonder which interventions might be helpful in reducing this.

A 35 year old, male, recreational basketball player, attends the physiotherapy department with a diagnosis of right sided patella tendinopathy. He wants to know what the best exercise regime is to allow him to return to pain free basketball

A 39 year-old patient presents to the emergency department with a displaced angulated limb fracture that requires reduction under conscious sedation. It is decided that intravenous Ketamine is the best agent to use but doctors in the department recommend different dosage regimens. Some believe that administration of a bolus of 0.5mg/kg Ketamine and then topping up by 10mg boluses is safe, effective and reduces the risk of adverse events, especially emergence phenomenon. Others feel that giving small titrated boluses of 10mg from the beginning is safer. You wonder which is the most effective method?

A two year old boy presents to the emergency department with a 4 hour history of barking cough, rhinorrhoea, stridor on exertion. A diagnosis of croup is made. What does of dexamethasone should be given?

A 30-year-old motorcyclist is brought to a major trauma centre following a road traffic collision. He has multiple injuries with clinical evidence of haemorrhagic shock. You activate the major haemorrhage protocol, and wonder whether early cryoprecipitate would be beneficial in this patient.

A three year old child is brought to the emergency department with pyrexia and dehydration, requiring cannulation. Routinely topical anaesthetic Ametop would be applied prior to this procedure. However a paediatrician has come to see the patient and requested giving the child sucrose. When questioned, the paediatric doctor explains it provides comfort and settles children during procedures such as cannulation. Despite years of Accident and Emergency experience using this technique for comfort in neonates you wonder whether this will be of similar effective use in older children.

A 45 years old female teacher presents to the Emergency Department with severe hoarseness and a mild cough for three days. She hasn’t been able to work since then. Her vital signs and physical examination reveal nothing particular except an important dysphonia. You tell her that she has an acute laryngitis, a self-limited condition that will resolve with voice rest. You wonder if a brief course of corticosteroids can reduce her dysphonia and speed her recovery.

in patients wirh acute severe asthma, does NIV improve outcome?

A 23-year old man presents to the emergency department because of pain and swelling of the left knee after a motorcycle accident that occurred the day before. Clnical examination suggested the presence of joint effusion in the suprapatellar pouch with sever pain in the affected knee. A radiograph of the knee showed no signs of fracture. Computed tomography (CT) of the left knee revealed an oblique fracture of the tibial plateau. As the treating clinician, you question the sensitivity of plain x-rays to identify fractures in the knee.

During a night shift, you receive in your resuscitation room your classical 6am pulmonary oedema patient. You start nitrates, furosemide and you initiate positive pressure ventilation, but you are asking yourself if you should still use the M of your LMNOP treatment mnemonic.