bestBETs

A patient is brought into the emergency department with a severe acute head injury. You remember that there was recent trial in the hospital on the use of progesterone in head injury and wondered if it would be in the patients best interests?

A child attends the emergency department with a life threatening exacerbation of asthma. Despite the use of standard therapies the patient continues to deteriorate. You are aware of the bronchodilatory properties of ketamine and consider whether it may be of use as an additional therapy.

You are a paramedic assessing a patient with difficulty in breathing. On auscultation you think you hear a third heart sound. You wonder how accurate paramedics are at identifying abnormal heart sounds.

A 25 year old man is brought to the Emergency department following a gunshot wound to the abdomen. His BP is 70/50mmHg. He is tachycardic with cool extremities. You wonder about recent studies on permissive hypotension in hemorrhagic shock management. You wonder whether you should aggressively resuscitate the patient with crystalloid or restrict the fluid resuscitation before the patient is taken to the operating room.

A 64 year old patient with a history of epistaxis presents to the emergency department with a 3 hours history of spontaneous epistaxis. Simple first aid measures have been ineffective, and nor has the application of ice. You wonder whether there is any evidence base behind the use of topical vasoconstrictors or decongestants in the management of adult patients with epistaxis.

A 25 year old football player patient presents with a 24 hour history of delayed onset muscle soreness affecting his gluteal and hamstring region following an intense gym weight training session which included loaded squats, deadlifts, stiff leg deadlift and lunge exercises. He is due to train today and tomorrow before a game in three days’ time, although he feels he is too sore and stiff to be able to participate in training. You have heard from a colleague who works in sports medicine that application of localised laser therapy can help improve pain, function and the reduce recovery time, and therefore wonder if it should form part of your management plan to enable the player to return to training as soon as possible.

A parent of a 9 year old male suffering from myopia came to the clinic wondering if using contact lenses would slow the progression of myopia in her child as she read in the Internet.

A young woman presents to the emergency department (ED) with a number of vague, non-specific complaints. The team suspect she may be suffering domestic abuse. Upon enquiry, the patient discloses a recent history of abuse by her current partner. What ED-based interventions will be most effective in improving the management of such a patient to reduce her risk of further abuse?

An adult patient presents to your emergency department with a severe exacerbation of asthma. Despite multiple rounds of salbutamol and ipratropium with prednisolone and oxygen supplementation the patient continues to deteriorate and plans are made to intubate the patient for mechanical ventilation. You are aware ketamine is the induction agent of choice and wonder if a ketamine infusion may obviate the need for intubation and mechanical ventilation.

A 5 year old child attends the ED with an acute respiratory tract infection that requires admission. A colleague mentions zinc supplementation is used in many rural areas in Asia for the prevention of respiratory tract infections. But is there evidence that zinc as an adjunctive therapy has a therapeutic role in the management of acute respiratory tract infections?

A 25-year-old man presents to the emergency department (ED) with a fracture dislocation of his ankle. His ankle needs reducing, and you intend to use conscious sedation to facilitate this. You wonder whether bispectral index monitoring (BIS) would help achieve an appropriate level of sedation, thereby reducing the risk of respiratory depression while maintaining comfort. .

A70 year old man presents with pleuritic chest pain. A D-dimer taken at triage is mildly elevated from the standard positive threshold. You feel he is at low risk of pulmonary embolism based on his wells score, and proceed to CTPA. CTPA shows no evidence of pulmonary embolism. You wonder whether an age adjusted D-dimer level would have excluded PE in this gentleman without the need for further investigations.

An 89-year-old woman presents to your emergency department following a fall. She is complaining of severe pain in her right hip area. A plain radiograph shows a neck of femur fracture. A fascia iliaca nerve block with bupivacaine is the opioid sparing analgesia of choice in your department. You have heard that magnesium can prolong the duration of action and effectiveness of the local anaesthetic. You wonder if there is any evidence for this adjunct in fascia iliaca nerve blocks.

A 76 year old man presents to the Emergency Department with multiple rib fractures after falling down stairs. His pain is difficult to manage, despite intravenous opioids. You speak to the acute pain team for advice on how to manage his pain. They suggest using 5% lignocaine patches over the site of maximal pain.

As a new attending in a regional hospital, you constantly search for new indications to use your brand new ultrasound machine. You see a 23 years old man with facial trauma after a ski accident and suspect a nasal bone fracture. You ask yourself if an ultrasound would be as sensitive or even more than your standard CR to confirm a clinical diagnosis of nasal bone fracture in adults.