bestBETs

A previously healthy 8-year-old boy, with a three-day history of flu-like symptoms presents to your emergency department. He was admitted with dehydration and hypothermia in the context of persistent vomiting. The following day he developed heart failure secondary to viral myocarditis.

A 43 years old man presents to the emergency department with a moderate cellulitis with lymphangitis of the forearm following a trivial skin trauma in the previous days. The patient is not known for any health problem nor does he have any risk factor for CA-MRSA. You wonder if daily intravenous cefazolin following oral probenecid is as effective as two or three times a day intravenous cefazolin treatment.

A 42-year-old previously healthy woman presented to the emergency department with chest pain and was found to have an ST elevation myocardial infarction. Cardiac catheterization revealed a dissection in her left anterior descending artery. You wonder what is the prevalence of spontaneous coronary artery dissection (SCAD) in patients with acute coronary syndromes.

A 20 year old patient presents to the ED with low mood and suicidal ideation. The patient has been assessed and is for admission by the psychiatric team once medically cleared. You wonder whether the use of mandatory screening studies in the ED actually affects morbidity and mortality in such patients.

20 year old student radiographer is brought to emergency department by ambulance after being involved in a RTC a few hours earlier. It’s a busy Friday afternoon and she’s been sat in waiting room. You call her through to be seen and you notice she obviously has difficulty walking; her concerned looking mother helps her in to a nearby wheelchair and brings her through. She is complaining of lumbar back pain. On examination you are concerned by your neurological findings in her lower limbs: clonus, 4/5 power throughout and some subtle paraesthesia. You explain you would initially like to perform an x-ray and that she may require a CT. She asks her mum to go and get her a drink of water and quietly reveals to you she’s 8 weeks pregnant. You think that MRI is likely to be safer but are not sure if there any significant risks?

“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.

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 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.

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?

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).

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.