bestBETs

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

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 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 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 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.