bestBETs

“He needs stitches? Will they dissolve? We're going to Disneyland tomorrow!” asks the anxious mother of a 3-year old who presents to your ED with a 2cm vertical forehead laceration. You ask yourself if you can use absorbable instead of non-absorbable sutures for closure for the same results.

A 62 year old male emergency department patient presents with an acute pulmonary embolism. Patient is tachycardic and requiring supplemental oxygen. You debate over where to place the patient (ICU, progressive, general floor). You consider whether elevated plasma lactate (greater than or equal to 2 mmol/L) might be a good prognostic indicator of death or clinical deterioration.

A four year old girl is brought to the Paediatric Emergency Department by her family with her second episode of spontaneous epistaxis in a month. The bleeding resolves within 30 minutes and she is otherwise fit and well. Her parents are requesting blood tests to look for an underlying cause but you are uncertain as to whether this is justified.

A 35 year old female known to suffer with severe depression and suicidal tendencies goes missing from her home address. Search teams are deployed and following a 3 day search the missing person is found alive but very cold and in a remote area of woodland inaccessible to other emergency services. Further medical support is requested to aid with rewarming the MISPER (missing person) and evacuate her to hospital.

29 month old boy had a representation with severe hives and vomiting 14 hrs from initial presentation with severe anaphylactic reaction to the Emergency department, you just wonder this child should be observed longer.

A 44 year old male presents to the ED with primary epistaxis. It has spontaneously resolved. Should Naseptin cream be given on discharge to prevent recurrence?

A 68-year-old female presents to your emergency department with chest pain and dyspnea. Her ECG reveals sinus tachycardia and slight ST elevation in leads I and aVF with reciprocal ST depression in leads I and aVL. Before activating the cardiac catheterization laboratory, you consider the other causes of ST-segment elevation.

An 80 year old man with a history of atrial fibrillation on warfarin presents to the emergency department after a ground level fall. He reports hitting his head, but denies loss of consciousness. Vital signs are stable and within normal limits at presentation, GSC is 14. Physical exam is unremarkable. Initial head CT scan is read as negative for acute abnormality without evidence of intracranial hemorrhage. Can the patient safely be discharged home?

An adult patient presents to the emergency department with acute renal colic ('loin-to-groin' pain). You would like to give Tamsulosin 'off-label' to facilitate stone passage.

A 69 year old woman presents to the emergency department patient with acute onset of chest pain and dyspnea. Symptoms began while she was attending her son’s funeral service. Her electrocardiogram shows characteristic ST-segment elevation over the anterior precordial leads with a small elevation in troponin T. While paging the cardiologist, you wonder is this patient has a myocardial infarction or stress induced cardiomyopathy (apical ballooning syndrome or Takotsubo cardiomyopathy).

A 12 year old girl who has been brought with inversion injury to the left ankle while playing football. She was unable to bear weight. On examination there was swelling and tenderness over the lateral malleolus and anterior joint line. Left ankle X-ray showed Salter Harris Type 3 fracture of the distal tibia. You discussed with the orthopedic Specialty registrar on call; who was very kind to accept the patient and requested to carry out CT scan of the left ankle in order to rule out Triplane fracture. You wonder what is the sensitivity and specificity of x-ray to rule out Triplane fractures against CT scan being the gold standard.

You are training a number of prehospital care providers airway management skills. You want to know how many times they will need to insert a supraglottic airway device before gaining competence in this skill.

A 4-year-old boy presents in A&E with sudden onset facial paralysis and hemiplegia. CT scan followed by MR angiogram diagnose stroke as a result of thrombosis to Middle Cerebral Artery (MCA). The GP trainee who has worked in Medicine has seen thrombolysis being used in adult patients with stroke. He wonders whether thrombolysis should be carried out for this child.

A 32 year old patient reports having a persistent headache during his most recent mountaineering trip to Colorado. He notes the headache occurred just prior to reaching the summit of Pikes Peak (14,115 ft)and persisted until his decent. He wants to know if there are any safe and effective medications he can take to help alleviate his symptoms during future high altitude climbs.

A 30 year-old male is brought in by paramedics with ongoing generalised tonic/clonic seizures that have been ongoing for 25 minutes. The paramedics have given 15mg of Midazalam IM with no effect, and couldn't gain IV access due to extensive track marks over the patient’s veins from extensive IV drug use. Vascular access is urgently needed to terminate this state of status epilepticus and to prevent further neurological sequelae. A central line would take too long to place, and would be extremely difficult in this patient. You decide to use an IO access kit to gain rapid access in this patient, so that benzodiazepines can be administered.