bestBETs

Following a failed extubation on day 3 of life on a neonate born at 25 weeks gestation, an echocardiogram was performed that showed a hemodynamically significant patent ductus arteriosus (PDA). A clinical decision was made to treat the PDA with intravenous paracetamol. A recent review article showed an association between prenatal and neonatal use of paracetamol with adverse neurodevelopmental outcomes. Can this be true for paracetamol use for PDA closure?

A 72-year-old woman presents to the emergency department (ED) with hip pain after a fall from standing. She is unable to weight bear. You notice extensive bruising around her left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve her outcome when she later undergoes surgery.

A 70 year-old gentleman has presented to the Emergency Department (ED) for the 3rd time in 7 months. Your SHO insists that he should be admitted or he will just come back again. What factors in his assessment suggest that he is more likely to re-attend?

A 42 year old male presents to the ED with opioid withdrawal symptoms of moderate severity. He is hoping to be prescribed opioid agonist therapy treatment with buprenorphine. He has no other complaints.

A 65 year old man who has a history of AF on apixaban presents to the emergency department with a minor head injury (GCS 15, no loss of consciousness, no neurological deficits) after a trip and fall on the street. He does not have a headache, did not vomit, there were no haematoma or laceration wounds on his head. Does he need to be admitted for 24 hours neuro-observation?

A 5 year old boy is brought into the Emergency Department by his mother. He complains ofconstipation. You consider ordering an AXR to rule out intra-abdominal pathology and guide management.

A 5-year-old female presents to the emergency department after a fall from playground equipment. Parents are concerned about significant head injury. You perform history and physical exam and would like to use a pediatric head injury algorithm to help guide your need for advanced imaging and you hope to avoid unneeded imaging. You wonder how accurate your exam is for pediatric skull fracture.

You are working in an Emergency Department during the Influenza season. You see a patient who has presented with typical symptoms of influenza. Their point of care influenza test is positive, but they don’t have ‘high risk’ clinical features making Oseltamivir (Tamiflu) an appropriate option. You wonder whether, for [patients with suspected or proven influenza], whether [products containing Echinacea Purpurea extract] might reduce the [clinical symptoms or duration of illness] compared to [placebo or Oseltamivir].