bestBETs

While working the night shift, a patient is admitted for thunderclap headache 12 hours ago. After a negative head CT, you decide to do a lumbar puncture to rule out subarachnoid haemorrhage. You specifically need a non-traumatic LP and you wonder if localizing the right lumbar space with an ultrasound would reduce the rate of traumatic LP.

A 24 year old male presents with chronic low back pain. Investigations have ruled out any serious disc, joint or bony pathology. Current opinion advocates core stability as the ‘go to’ treatment for this non-specific pain scenario. You wonder if it would be more effective than a conventional exercise programme?

You are a senior doctor working in the Emergency department when a patient presents with a red painful eye. You suspect orbital compartment syndrome and know the patient could lose their sight if you don't act. You know how to do a lateral canthotomy as well as the risks but wonder if it is reasonable to do this within the emergency department?

13 year old, previously healthy male presents with non-specific chest pain for last 3 hours. After a thorough history and physical, no abnormalities are found and diagnostic testing is debated. Knowing that adult patients with similar symptoms cause concern for ACS, you question whether pediatric patients have similar concerns with ACS and whether a full cardiac workup is warranted.

67yo female with past a medical history of chronic kidney failure presents with chest pain and fatigue. EKG shows wide QRS complex and peaked T waves. iStat shows potassium of 8.3mEq/L. While starting hyperkalemia treatment with Calcium Gluconate, Insulin + Dextrose, nebulized Salbutamol, and Kayexalate, you question whether nebulization or intravenous administration of Salbutamol is more effective in decreasing plasma potassium levels.

You have reviewed a 45 year old woman complaining of vertigo on head movement with no other concerning features. She has a positive Dix-Hallpike test and you diagnose BPPV. In teaching today you were shown the Semont manoeuvre, you wonder if this manoeuver or the Epley manoeuvre would be more effective in treating her.

A 50 years old man with good past health presents to A&E with a 10/7 history of paroxysmal palpitation. His hear rate is around 80 bpm, and 12 leads ECG shows one PVC over 10 seconds with symptom. Repeat long lead ECG showed no PVC over 60 seconds at time of symptom free. TnI and CBC LRFT are normal. Private echocardiogram and Holter were performed a few days ago for previous episodes, and revealed pvc but no structural abnormalities. Blood tests including TFT in private were all within normal range. A clinical diagnosis of PVC is made. The patient is asking whether there is any drug to reduce his symptom.

A 28 year old male presents to the emergency department with a 2-week history of cough and progressive shortness of breath. An outside chest x-ray was non-diagnostic. Chest CT here demonstrates bilateral interstitial infiltrates, consistent with pneumonia. You wonder how often CT scan is necessary to diagnose a pneumonia after an equivocal chest x-ray.

In the middle of the night, a 48 years old male is brought to your emergency department after a car accident. His seatbelt was fastened and he complains of moderate to severe sternal pain. He is alert, has no shortness of breath, his vital signs are normal and your secondary survey is otherwise negative for any other injury. You suspect your patient has an isolated sternal fracture. After ordering an electrocardiogram, cardiac enzymes and administering medication to relieve your patient, you wonder if bedside ultrasound would perform better at diagnosing sternal fracture than standard chest and sternal x-rays.

A 74-year-old woman presents to the emergency department with significant primary epistaxis. She struggles to tolerate nasal packing. A passing orthopaedic registrar suggests that tranexamic acid may be beneficial since it works in other haemorrhage scenarios. You wonder if he is correct and whether there is any evidence for a role for intravenous tranexamic acid in the management of her epistaxis.

A 40 year old pedestrian is stuck by a car travelling at 40mph. On primary survey she is shocked and hypotensive with signs of significant pelvic and intra-abdominal injury. FAST shows large volumes of peritoneal fluid and pelvic radiograph shows marked disruption of the pelvic ring. Despite four units of pRBCs and FFP you are unable to obtain a radial pulse. You wonder whether Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) might be helpful.

A 57-year-old man attends the Emergency Department with bilateral ptosis. You only have a short time in order to ascertain the cause of the ptosis and therefore refer appropriately. The ED SHO wonders if there is a simple bedside test to distinguish whether Myasthenia Gravis is the cause of this presentation.

After an international conference on the management of patients in cardiac arrest and watching a lecture on this subject, I felt that this was a novel approach and wanted to explore the evidence surrounding this approach and the feasibility of this being introduced into our ED.

A 52 year old male presents to the orthopaedic knee service with gradual onset of knee pain and effusion. He finds walking is now limited to 2 hrs and he struggles to play a full round of golf. Knee X-ray findings confirm moderate signs of degenerative joint disease. He is not yet at the stage to consider a joint replacement. He has tried physiotherapy and relative rest but now is keen for an ‘injection’. Should he be offered a corticosteroid or hyaluronic acid injection?