A 25 years old woman presents to the ER with a chief complaint of first trimester vaginal bleeding. Her vitals are unremarkable. You perform a transvaginal ultrasonography using a condom on the probe and confirm the presence of an intrauterine pregnancy. Once the exam is completed, you clean the probe. You wonder if probe sheaths and low level decontamination were studied regarding microbial contamination.
A 4 year old girl with DKA on fluid and insulin therapy in children's ward developed altered sensorium & unequal pupils. The registrar advised to commence her on mannitol (20%) to treat cerebral oedema. Intensivist from the transport team insisted on hypertonic (3%) saline. You wonder whether hypertonic saline is better than mannitol in treating cerebral oedema in children with DKA.
In the emergency department, you saw a young woman with severe symptoms of urinary urgency and burning. After your thorough evaluation, your diagnosis is a urinary tract infection. Before leaving, she asked you if you could give her something to relieve her symptoms while waiting the antibiotics to kick in ? You heard about phenazopyridine before but you wonder if it will really be helpful?
Can paediatric early warning scores predict serious illness in paediatric inpatients?
A three year old boy presents to his local district general hospital with a one day history of fever and shortness of breath. He is admitted to the paediatric ward for on-going observation and management. The nursing staff calculate a paediatric early warning score, based on physiological parameters, with each set of nursing observations. The student nurse on the ward notices that your chart is different to the one used by the paediatric ward on her last placement. She asks you how accurately paediatric early warning systems predict serious clinical deterioration, particularly cardiopulmonary arrest, paediatric intensive care admission or paediatric high dependency care admission.
Do hot drinks have any effect on the severity or duration of epistaxis?
A 46 year old lady attends the Emergency Department with significant epistaxis from the right nostril - this started spontaneously. Her nose is packed using a Rapid Rhino. She feels better and would like a hot cup of tea - you know the policy is to avoid hot food and drink for 24 hours to prevent further bleeding, however you would if there is any evidence to support this?
In community paediatric clinic you review a 4 year old boy with Down’s syndrome with attention difficulties. Parents report no concern with his sleep. At a recent meeting you remember a respiratory physician discussing screening for OSA in children with Down’s syndrome. Polysomnography is difficult to access in your area, you wonder whether overnight pulse oximetry would be an appropriate alternative. You realise you require three main questions answered: 1.tWhat is the baseline prevalence of OSA in children with Down’s syndrome? 2.tHow accurate is pulse oximetry in diagnosing OSA in children with Down’s syndrome? 3.tWhat is the post-test probability of OSA using pulse oximetry in my patient with Down’s syndrome?
A patient who works as a model, presents to the A&E with dog bite lacerations to the hand and arms. You check tetanus status and clean and irrigate the wounds. Having recently read the Cochrane review on not providing prophylactic antibiotics in dog bites, you wonder whether this also means you can primarily close the wounds.
Transtracheal ultrasound to confirm tracheal intubation in cardiopulmonary arrest
A 40-year-old man is brought into the emergency department in cardiopulmonary arrest. It is agreed by the cardiac arrest team that endotracheal intubation is now appropriate to manage the airway. You usually use end-tidal CO2 (ETCO2) waveform analysis to confirm tube placement—but are aware that it is not so reliable during cardiac arrest. You wonder if transtracheal ultrasonography is a good tool to confirm endotracheal intubation in this situation.
Do patients with an asymptomatic sub-segmental pulmonary embolism need anticoagulation therapy?
A 49 year old male, who was previously fit and well, attended the Emergency Department as a trauma patient after being involved in a road traffic collision. He underwent whole-body computed tomography (CT) scanning and was found to have an incidental, sub-segmental pulmonary embolism (PE). You wonder whether this finding warrants anti-coagulation treatment as is protocol for larger, symptomatic pulmonary emboli, or whether the patient would have a similar outcome if they were to be discharged without treatment.
Ultrasound for the diagnosis and drainage of suspected peritonsillar abscess
A 30-year-old woman comes to the emergency department presenting with sore throat and low-grade fever. Physical examination reveals a non-toxic-appearing woman with mild trismus and uvular deviation. As you consider whether the symptoms represent cellulitis or a true abscess, you wonder if using intraoral ultrasound could help establish a definitive diagnosis and assist in needle aspiration.
The use of local anaesthetic lubrication for the catheterisation of males
A male patient presents to the emergency department with acute urinary retention requiring urethral catheterisation. You ask the nursing staff where the local anaesthetic gel is and they tell you that it has been removed following a safety alert as it contains chlorhexidine, which may cause anaphylaxis. You catheterise the gentleman who appears to suffer a lot of pain with the procedure. Following this you decide to look at the evidence for the use of local anaesthetic lubrication in catheterisation.
Emergency Physician Performed 2-point Bedside Compression Ultrasound for Deep Venous Thrombosis.
A 62-year-old man presents with an acutely swollen left calf. You suspect that he may have a deep vein thrombosis (DVT). Can a 2-point bedside compression ultrasound, performed at the bedside by an Emergency Physician confirm or refute this diagnosis accurately?
Oropharyngeal Exercise to Reduce Obstructive Sleep Apnea Symptoms
A 40 year old male presents with moderate obstructive sleep apnea. He is frustrated and non-compliant with his continuous positive airway pressure (CPAP) and does not want to have surgery. There are no complicating factors.
A patient is referred for voice therapy with dysphonia. There are many exercises available which will facilitate efficient phonation. Is the use of semi-occluded vocal tract exercises using a straw likely to lead to improvements in the quality of the person’s voice?
Factors attributing to hip dislocations in adults who have sustained a # NOF
Therapists assess and treat patients following surgery for fractured neck of femur (NOF). Hip precautions (no hip flexion above 90 degrees, no adduction beyond midline and no rotation of the operated leg) are routinely adhered to in those having undergone hemiarthroplasty and total hip replacement. This has time and cost implication for example waiting for equipment delivery for discharge can increase length of stay. To ensure that following hip precautions is evidenced based practice, the orthopaedic therapy team wanted to conduct a BestBETs.