bestBETs

A 55-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset of severe chest pain radiating to his left arm. On physical examination, he is diaphoretic and appears anxious. His initial electrocardiogram (ECG) appears normal. You wonder how accurate the ECG findings are to rule out acute coronary occlusion (ACO).

A 55-year-old female presents to the emergency department with shortness of breath and fever. She has no hemoptysis or signs of deep venous thrombosis (DVT). The D-dimer is 600 ng/mL. Can PE reliably be excluded using YEARS criteria?

A 10 year old child has been transferred to hospital after being involved in a pedestrian versus vehicle collision. They have sustained a lower limb injury which demonstrates significant soft tissue loss with a comminuted, open fracture of tibia/ fibula. Their pedal pulses are weak with dusky appearanes of the extremity of the affected lower limb

While working pre-hospital, you attend an adult patient with severe burns. You have treated the patients pain with IV morphine, IV paracetamol and Entonox. At handover the patient is given Penthrox. You wounder if Penthrox is superior to Entonox at reducing pain.

You are on scene with a patient who has been assaulted via a blow to the head with an unknown object. The patient has a GCS 8 giving a preliminary diagnosis of serious traumatic brain injury. You also remain suspicious that they may also have a fracture cervical spine which is the case in 5% of patients with TBI. You wonder if the application of cervical collar will increase intracranial pressure (ICP)

A 35 year old man presented to the emergency department 3 hours after ingesting 25 tablets of 200mg hydroxychloroquine sulfate in a suicide attempt. Should activated charcoal still be administered?

A 34-year-old female presents to the Emergency Department with abdominal pain and nausea that started 1 day ago and became more intense and moved to the right lower quadrant. She is taking an oral contraceptive pill and has no known drug allergies. Abdominal ultrasonography confirmed a diagnosis of appendicitis. She refuses laparoscopic surgery and is requesting to go home with antibiotics.

A 28 year old female attends the Emergency department with widespread red, itchy wheals covering her body. She is unsure of what has caused this and it has not happened before to this extent. She is haemodynamically stable and has no airway or respiratory involvement. She is visibly uncomfortable and you want to help the symptoms resolve as quickly as possible. You are unsure of the clinical evidence behind a course of oral steroids for acute urticaria and NICE CKS suggests it on expert advice.

A 45-year-old male with a past medical history of prior open appendectomy, presents to the Emergency Department (ED) with a chief complaint of abdominal pain with associated nausea, vomiting and inability to pass flatulence. Imaging of the abdomen demonstrates loops of bowel with a transition point, consistent with small bowel obstruction (SBO). The patient refuses insertion of the nasogastric tube (NGT).

A 48-year-old male with a history of type 2 diabetes presents to the emergency department with left knee pain. On examination, his left knee is erythematous with an effusion and tender to palpation. He is very painful with both passive and active range of motion. You would like to rule out a septic joint in the most reliable and least invasive way, and consider which laboratory tests to order.

A 65-year-old man presents with shortness of breath, was subsequently found on electrocardiogram to have acute onset rapid ventricular response to his chronic atrial fibrillation with a ventricular rate of 160. The patient’s blood pressure was 72/42 mm Hg. Anteroposterior transcutaneous pads were placed on the patient’s chest placement for electrical cardioversion. You wonder if anterolateral pad placement might be more effective for converting atrial fibrillation.

A two-year-old healthy male presents to the emergency department with his parents after a witnessed fall from a chair. Parents say he was initially irritable but mostly himself. An age-appropriate neurologic exam is reassuring but you notice he has a temporal hematoma. You are deciding whether to complete a head computed tomography (CT) in this child to rule out skull fracture and traumatic brain injury by reviewing decision making algorithms, such as the Pediatric Emergency Care Applied Research Network (PECARN) head injury algorithm. CT is unavailable at your hospital at this hour and the patient would need to be transported to a different center. While trying to decide, you wonder how sensitive and specific point of care ultrasound (POCUS) is in detecting skull fractures in children

A 32 year old gentleman presents to the Emergency Department after falling during his 5-a-side football match. He reports hearing a ‘pop’ and pain in his posterior ankle. His Simmonds-Thomson test is positive and you suspect an acute rupture of his achilles tendon. You wonder if this patient should be put in an equinus cast or heel-raised functional bracing prior to orthopaedic clinic review.

A 60-year-old male with noncontributory past medical history presents with two weeks of productive cough. His initial course of illness included additional upper respiratory tract infection symptoms, all of which improved within the first five days apart from the cough. He has an albuterol inhaler and Tessalon Perles available at home though has not perceived any significant benefit from these therapies. The patient has stable vitals, unremarkable exam apart from frequent productive cough, unremarkable basic labs (COVID negative), and chest x-ray negative for consolidation. He is diagnosed with uncomplicated acute bronchitis. He is frustrated with the frequent coughing and asks if there are any other available therapies. Oral steroids are considered.

A 65-year-old male with history of atrial fibrillation on apixaban presents to the emergency department with recurrent atrial fibrillation with a rapid ventricular rate. His vitals are stable and physical exam reveals irregularly irregular heart rate. He states medications to covert atrial fibrillation are usually ineffective and he requests cardioversion. However, he expresses concern about the side effects he experienced during his last procedural sedation with propofol.

A 45-year-old man presents to the emergency department after a motor vehicle accident. His only complaints are shortness of breath and abdominal pain. A focused assessment with sonography in trauma (FAST exam) is used to evaluate the patient's abdomen and chest. You wonder what is the accuracy of extending the FAST to detect pneumothorax.

A 34-year-old female comes to the emergency department due to acute episodes of dizziness. The history and physical exam are most consistent with diagnosis of posterior canal benign paroxysmal positional vertigo (BPPV). You wonder what is the most effective treatment at resolving her symptoms.