bestBETs

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.

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

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.

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.

A 22-year-old female patient arrives to your emergency department with severe left-sided non-pulsating headache that began 3 days ago. She had been discharged from your ED a few hours earlier with a diagnosis of new onset migraines after partial resolution of her symptoms with analgesia and rest. She complains of progressive unilateral headache and mild nausea, which appears to be different from the occasional headaches she experienced in the past. She is healthy and takes only an oral contraceptive pill without any previous thromboembolic complications. Her neurological exam is once again unremarkable and you decide to order a non-contrast head CT which is completely normal. Once again, her symptoms partially resolve and you consider migraine headache to be the most likely diagnosis. However, the persistence and severity of her symptoms makes you wonder if cerebral venous thrombosis could be the cause of her headaches. Instead of repeating an imaging exam with venous contrast (magnetic resonance or computed tomography), you wonder if D-dimers, a laboratory assay frequently used in the exclusion of venous thromboembolism, could safely exclude cerebral venous thrombosis in this case.

An 8 year-old known asthmatic patient presents to the Emergency Department with a typical exacerbation of asthma. He is partially improved after one bronchodilator treatment and oral steroids. You wonder if inhaled corticosteroids (ICS) would benefit the systemic steroids you are already prescribing.

You work in a resource poor country and cooling of infants with Hypoxic Ischaemic Encephalopathy (HIE) is not available. A term baby is born with low Apgar scores and admitted to the neonatal unit, where you confirm moderate to severe HIE. As cooling is not available you wonder if starting phenobarbital (PB) would reduce mortality or disability.

10 month old girl seen in PICU, approx 12 hours after developing toxic shock syndrome secondary to a thigh myositis. Had been resusitated agressively in resus before transfer to PICU with fluids, antibiotics and commenced on inotropes. It was decided to give her IVIG. throughout the day the patient improved clinically, I noticed her ABG had dramatically improved, and she required less inotropic support. I wondered whether her dramatic improvement could have been sooner if we had administered IVIG in resus.