bestBETs

A 5 year old child presents to ED 5 days after tonsillectomy with bleeding from the tonsilar bed. You wonder if nebulised TXA plays an evidence based role in his management to minimise his bleeding and particularly his need for other intervention.

A 32 year old woman presents to the Emergency Department with epistaxis which she cannot stop herself. First aid measures in triage cause haemostasis. She is haemodynamically stable, her observations are within normal limits and she is not taking any anti-coagulation or anti-platelet medications. This is her first episode of epistaxis. The Ear, Nose and Throat specialist advises you to prescribe anti-septic nasal cream for one week “to prevent recurrence or complications.” You are unsure whether this treatment will reduce the risk of recurrent epistaxis or infective complications.

A 60 year old man presented to the A&E with a ~4cm dog bite laceration on the posterior thigh. He has already received all 3 doses of tetanus vaccine. It has been confirmed that the dog is up to date on rabies vaccination. The laceration is deep and requires sutures. Should you do primary closure of the wound?

A 46-year-old female patient presents to the emergency department with a warm to touch, painful, and erythematous rash on their right leg. No previous methicillin-resistant staphylococcus aureus colonization documented in the past. You are considering which outpatient oral antibiotic strategy would be most appropriate for this patient for suspected cellulitis.

A 25-year-old athlete suffers a first-time anterior shoulder dislocation. After reduction in the emergency department, you wonder whether immobilizing the shoulder in external rotation instead of internal rotation could better prevent recurrent dislocations.

A 40-year-old patient presents to the ED with epistaxis. They are otherwise fit and well with no signs of bleeding elsewhere. You wonder if a nasal clip will deliver more effective first aid than manual compression.

A 25 y/o male has sustained a femur fracture and is attended by Paramedics. I know IV Morphine will reduce pain and distress to facilitate the application of a Kendrick Traction Device, but will analgesic doses of IV Ketamine achieve this quicker?

An adult patient with a mixed background of asthma and chronic obstructive pulmonary disease (COPD) presents to the ED with worsening shortness of breath and wheeze. They report using their salbutamol inhaler multiple times at home, with little improvement. At present, they are not able to speak in full sentences, but their oxygen saturations are normal, and they show no signs of fatigue. You consider prescribing nebulised salbutamol but wonder if there is any evidence to support instead the use of a metered-dose inhaler with spacer.

You are at a fireworks party with your young family. You wonder whether inserting a sparkler into a carrot may be safer and reduce the risk of injury.

An elderly patient presents to the emergency department (ED) with hip pain after a fall from standing. They are unable to weight bear. You notice extensive bruising around their left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve their outcome when they later undergo surgery.

A 33-year-old patient presents to the emergency department with right-sided flank pain and haematuria. The pain is described initially as 10/10 in severity. CT imaging demonstrates a 4mm non-obstructive stone in the right ureter. Despite intravenous ketorolac and morphine, the pain remains 9/10 in severity. The patient is otherwise well, and you wonder if an erector spinae plane block (ESPB) would be an effective alternative for analgesia.

A 32 year old patient presents with severe loin to groin pain. He is otherwise fit and well. CT KUB shows a 5 mm stone at the vesico-ureteric junction. You have read about intradermal sterile water injections being used in the context of labour pain and musculoskeletal injuries and wonder whether they may also provide benefit in renal colic.

A 19-year-old male presents to your ED after a generalised tonic-clonic seizure. He has never had a seizure before and is otherwise fit and well. You conduct a full neurological examination and request several bedside investigations. You wonder whether you should also request a CT head scan. More broadly, you wonder whether your department should be scanning all patients who present with a first seizure.

A 44-year-old patient presents to the emergency department (ED) with a deformed and painful right shoulder after a hard tackle playing rugby. An X-ray confirms right anterior glenohumeral dislocation with no associated fracture. You would like to attempt a closed reduction. Unfortunately, your department is too busy for a full procedural sedation. You wonder what your likelihood of success would be using only inhaled methoxyflurane (Penthrox®) and whether this would facilitate a quicker discharge from ED.