bestBETs

70 year old male presenting to the emergency department with a 2 day history of fever and rigors with dysuria and increased urinary frequency. Could a point-of-care capillary lactate measurement be used to predict illness severity and prognosis?

A 56-year-old man who presented to the ED with acute upper GI bleed was enlisted for urgent endoscopy after assessment by a senior registrar. You knew that patient would have better outcome if they receive early endoscopy but wonder if there was any difference in outcome between 12 hours and 24 hours.

A 40-year-old man came in to ED with suspected upper GI bleed. He was prescribed erythromycin before going for endoscopy. You wonder what was the role of erythromycin pre-endoscopy

You are asked to attend to an 87 year old female patient who fell at home. She has no acute injuries, but is quite distressed at having been brought to hospital. The ambulance crew state that she did not fulfill their criteria for home management. You wonder if all pre-hospital screening tools for frailty are equally effective at deciding which patients can be safely left at home.

An 80-year-old man presents to ED with a mechanical fall. He has sustained a minor head injury and complains of left hip pain. On further questioning, he had three recent falls in the past week. He mentions that he is not coping at home. Investigations reveal no evidence of intracranial injury or bony injury to the hip. You wonder if the service has met with his expectations, and dealt with the underlying problems he presented with.

A 42-year-old woman presents to the emergency department stating she has suicidal ideation. She denies any overdose or intoxication. She states in the past few days she has been planning to end her life.

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.