bestBETs

A 72-year-old gentleman presents to ED with symptoms of a Stroke arisen within the last hour. His wife rushed him to ED. A middle cerebral artery infarction is confirmed on diffusion weighted MR scan. The Stroke Team Consultant is called to consider thrombolysis. On noting that the patient has a high blood pressure, he wants the patient started on a Labetalol infusion prior to administration of thrombolytic agent. Amongst other things the question of evidence on the best anti hypertensive drug to be used in such a situation arises

A patient presents with a few days history of pleuritic chest pain. All clinical findings and investigations are normal except for a raised d-dimer. A high probability V/Q scan confirms the diagnosis of pulmonary embolism. The patient is very keen to be discharged. You are aware that right ventricular strain is associated with a poor outcome in pulmonary embolism and you also know that B natriuretic peptides are raised in the presence of ventricular strain. You wonder if a low B natriuretic peptide level could be used to confirm the absence of ventricular stain and low risk of death or serious complications, therefore suggesting suitability for outpatient management.

A 78 year old female presents to your emergency department reporting increased wheezing over the last 24 hours. She reports a mildly productive cough and denies fever. A chest x-ray reveals no clear evidence of pneumonia. In addition to therapy for what you believe is a COPD exacerbation, you consider the possibility of bacterial infection. A colleague mentions that they are using procalcitonin as a biomarker to guide antibiotic therapy for patients with potential respiratory infection on the intensive care unit. You wonder if there is any evidence assessing the utility of procalcitonin for this indication in the emergency department.

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.

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.

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 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 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?

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.

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 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. .