bestBETs

A 45 years old man came to emergency department with sever epigastric pain and vomiting, he was tachycardic and hypotensive, immediate fluid resuscitation stabilized his hemodynamic status. Labs revealed high lipase and amylase suggesting acute pancreatitis; he was kept NPO on intravenous fluid and was treated with analgesics and anti-emetics. The case was referred to gastroenterologist for admission who on further discussion, was enquiring why antibiotic was not started in ED for a better outcomes? This stimulated my thought, if starting prophylactic antibiotics in case of acute pancreatitis improve the outcome in term of morbidity and mortality.

A five year old girl presents with mild vincristine neuropathy (peripheral neuropathy of common peroneal nerve) affecting bilateral Tibialis Anterior muscles. She is able to actively dorsiflex but walks with an affected gait. You wonder whether kinesiotaping would be of benefit to facilitate these muscles and retrain gait.

A 64 years old woman is suddenly unresponsive and pulseless. A few minutes after prompt cardiopulmonary resuscitation initiation by her husband, the paramedics arrive on site. Defibrillation is performed twice with an external defibrillator. Return of spontaneous circulation is achieved but she stays unconscious. On emergency department arrival, her vital signs are stable and she is normothermic. The electrocardiogram is not showing any ST-elevation. You decide to put this patient on therapeutic hypothermia. You ask yourself if a coronary angiography with or without percutaneous coronary intervention could improve her chances of survival.

A 4-week-old term baby is brought into your DGH ED by his mother. He is crying inconsolably, and examination reveals a swollen and deformed right femur. Xrays confirm a midshaft fracture. You want to alleviate his pain and discuss strong analgesia. The ED nurses tell you that opiates are unsafe in his age group and state that paracetamol is the only option. You wonder about the evidence for this.

A 34 years old man presents to the emergency department at 11:00PM with severe left flank pain and vomiting which began abruptly 4 hours ago. The patient is not known for any health problem nor does he take any medication. He denies fever of chills. You suspect obstructing renal colic. His creatinine level is normal. You administer him NSAIDs and opioid medication, which relieves his pain. You wonder if this patient can safely be discharged at home if your bedside ultrasound is reassuring, with outpatient imaging and follow-up.

Ward 32 is an acute rehabilitation ward. Many patients that come across for further rehabilitation have had hip surgery following a fractured neck of femur. It had been observed that several patients had a leg length discrepancy following their surgery and so an audit on the prevalence of post-surgical leg length discrepancy demonstrated that 50% of patients transferred to ward 32 post hip fracture had a LLD and these patients were routinely referred to orthotics for correction. On discussion with both Podiatrist and Orthotist it was established that common practice would be to correct half the LLD. The physiotherapists delivering rehabilitation on the ward felt that clinically patient’s functional improvements were greater following LLD correction.

A 45 year old female with a diagnosis of Rheumatoid Arthritis (RA) presents to the physiotherapy department requesting the current best physiotherapy treatment and advice for her chronic, multiple joint pains and stiffness.

A 75 years old man presents with acute onset of central abdominal pain. He has never had this pain before. Abdominal examination revealed central abdominal tenderness but no guarding or masses. The general examination was unremarkable. Routine blood tests came back as normal. You request a CT scan of the patient’s abdomen as he continues to be in pain with no obvious pathology but wonder if the CT scan is a sensitive predictor of significant underlying pathology and if it will help you in clinical decision making.

A 65 year old gentleman presents with his wife after collapsing at home. He is FAST positive with a clear onset time of 1 hour. On examination in the emergency department he has a dense right hemiplegia and expressive dysphagia. CT shows no bleed. Stroke thrombolysis is considered however the patient is unable to tell you how much he weights and his wife is unsure. The doctor and nurses looking after him think he is around 70kg. Is this an accurate enough estimation for drug dosing?

A 40- year-old woman presents at the ED with complaint of severe lower back pain of 2 days duration after carrying a heavy load. She is able to ambulate with no sciatica but reports having urinary incontinence. Physical examination is unremarkable with no neurological deficits in limbs and intact perianal sensation with good anal tone. You wonder whether her urinary symptoms are indicative of cauda equina syndrome.

A 78 years old man presents to the Emergency Department with central abdominal and back pain for 2 hours. He is smoker, overweight, hypertensive and is on bisoprolol and amlodepine 5 mg each daily. Clinical examination reveals tenderness and pulsation in the epigastrium and around the umbilicus his pulse is 78 beat per minute and systolic blood pressure is 85mm Hg. You wonder if you can rely on your examination to rule out a leaking AAA.