bestBETs

A 56 year old palliative care patient with transitional cell urothelial carcinoma presents with excruciating cancer related pain in the Emergency Department (ED). He is no longer responsive to opioids for moderate pain and now requires management of his severe cancer related pain. He has experienced constipation, nausea, vomiting and decreased cognition since being placed on morphine (70 mg/day) previously and would like to avoid significant side effects of his medication and focus on maintaining a good quality of life.

A 6 month old child is referred to Occupational Therapy (OT) from the consultant led clinic with camptodactyly. You want to try to correct the flexion deformity at the PIP joints and wonder if splinting may be a useful technique effective in improving PIP joint range of movement (ROM) and hand function.

A young person with autism comes to hospital for an intervention and the procedure is cancelled as a result of the patient’s challenging behaviour and distress. You wonder if an individualised care plan would have reduced patient anxiety and improved cooperation with the intervention.

You heard from a colleague that "if there is a radial pulse, then the SBP is at least 80mmHg", you wonder if this is actually true in the trauma patient.

A 78 year old lady is admitted on a saturday follwing a fall at home and acopia. She is then admitted to the acute medical unit. Physiotherapy and Occupation Therapy assessments only occur Monday to Friday between 08:15am and 16:15pm. We wonder whether a seven day therapy service on the acute medical unit would decrease her length of stay.

A 48-year-old, well-trained, long-distance runner collapsed at the finish of a half marathon. Against his usual practice, the athlete tried to accelerate on the last hundred meters towards the finish line. Immediately after the collapse, cardiopulmonary resuscitation with defibrillation of ventricular fibrillation was successfully carried out. After ROSC, the patient was arousable but not fully alert. We sought to understand the long term neurological outcomes for patients with out of hospital cardiac arrest from ventricular fibrillation?

A 60 year old male, brought in by ambulance crew,with the complaint of sudden onset severe right flank pain. He is also known to have cardiac problems and is on several medications. On examination his systolic blood pressure is 100 mm of Hg and the pulse rate of 65 per minute. The immediate concern is a ruptured AAA. Can ultrasonography by emergency physicians detect accurately the presence or absence of an abdominal aortic aneurysm,AAA and affect the immediate management strategy in this patient?

In the physiotherapy department you see two 50-year-old female patients who have both sustained ankle fractures 12 weeks ago and are mobilising with crutches. One has been conservatively managed and the other has had an open reduction–internal fixation. You wonder whether hydrotherapy would be a viable treatment option for either patient. A literature search is required in order to ascertain whether hydrotherapy is an appropriate intervention for either patient.

A child with suspected benign raised intracranial pressure requires a lumbar puncture and opening pressure readings. As you prepare for the procedure the consultant on call asks you to make sure the child’s legs are straightened out before you measure the opening pressure. You wonder whether measuring CSF pressure with the lower limbs in the flexed position truly does falsely elevates the reading, and whether you should take the reading with the lower limbs in the extended position?

A 4 year old child is brought to the Emergency Department by her parents. She presents with protracted seizures. It proves difficult to gain intravenous access for administration of IV Lorazepam, which is the standard of care. You wonder whether intranasal administration of Lorazepam may be an acceptable alternative.

A 37 year-old man, who is known to suffer from cluster headaches, presents to the Emergency Department with a severe unilateral headache associated with lacrimation, rhinorrhoea and restlessness. He has already taken his own triptan and has been put on oxygen therapy on arrival. You remember being told that intranasal lidocaine can help in cluster headaches and you wonder what the evidence is for this therapy.

A 65 year old male presents having returned from a two week holiday. Whilst on holiday he experienced a tearing pain between his shoulder blades, which has been slow to resolve. Examination reveals no abnormal findings. However, his blood pressure in both arms is measured at 135/80. An x-ray reveals a slightly enlarged mediastinal shadow; a CT aorta is performed which confirms the diagnosis of an uncomplicated type B aortic dissection.

A 56-year-old female presents to the emergency department complaining of intermittent nausea, she is now also experiencing angina, dyspnea, and diaphoresis. EKG shows signs concerning for myocardial ischemia. Interventional cardiology prepares to take the patient to the cardiac suite for coronary angiography.

A 45 year old man is brought to the ED in respiratory distress. He is HIV positive and has defaulted on both his anti retrovirals and follow up. From his chest X ray you suspect Pneumocystis jerovii pneumonia (PJP). After intubation he becomes increasingly difficult to ventilate and oxygenate. The team from Critical Care are talking about getting him onto the ICU to ventilate him in the prone position. Although this may improve his oxygenation you wonder whether it will affect his survival?

A 65 year old male has an out of hospital cardiac arrest that is witnessed by bystanders. EMS arrives and the patient needs an advanced airway. The airway kit has endotracheal tubes as well as supraglottic airways. The EMS responder must decide which airway will provide the best outcome for the patient.