bestBETs

An ambulance crew calls the local trauma unit with an 85 year old female they suspect of being major trauma. They want to know if she should be brought to the trauma unit or taken to the major trauma centre?

A 40-year-old male presents to the emergency department with low back pain after lifting and moving a heavy piece of furniture. After your history and physical exam, you conclude that the patient’s pain is musculoskeletal in nature secondary to using poor form while performing heavy lifting. You contemplate whether an oral or intramuscular NSAID would provide more effective pain relief.

A 64-year-male presents to the emergency department in cardiac arrest. While undergoing cardiopulmonary resuscitation, chest compressions are paused every two minutes to evaluate for the presence of a pulse. As a knowledgeable resuscitationist, you know that minimizing pauses in chest compressions provides the best opportunity for a positive patient outcome. You wonder if using point-of-care ultrasound (POCUS) to evaluate for the presence of a pulse reduces pulse check times.

You are expecting an 80 year old major trauma patient into the resuscitation room of the emergency department. You wonder what early interventions might improve her outcomes.

A 7-year-old female with a history of atopic dermatitis presents to a pediatric emergency department for wheezing and increased work of breathing. The department is full with many hall beds currently occupied by patients. You put in orders to administer 4 puffs of albuterol and a dose of dexamethasone. You notice that 45 minutes later the medications have not been given and when you reassess the patient she is in more respiratory distress. Crowding in the emergency department seemed to play a role in the adverse turn of events for the patient.

A 4 year old girl attends your accident and emergency department crying and unable to move her left elbow after a fall on outstretched hand at school. You identify a Gartland Type IIa fracture on the plain radiograph. You wonder if admission is necessary for her angulated fracture.

A 55-year-old female presents to the emergency department with shortness of breath and fever. She has no hemoptysis or signs of deep venous thrombosis (DVT). The D-dimer is 600 ng/mL. Can PE reliably be excluded using YEARS criteria?

A 10 year old child has been transferred to hospital after being involved in a pedestrian versus vehicle collision. They have sustained a lower limb injury which demonstrates significant soft tissue loss with a comminuted, open fracture of tibia/ fibula. Their pedal pulses are weak with dusky appearanes of the extremity of the affected lower limb

You are on scene with a patient who has been assaulted via a blow to the head with an unknown object. The patient has a GCS 8 giving a preliminary diagnosis of serious traumatic brain injury. You also remain suspicious that they may also have a fracture cervical spine which is the case in 5% of patients with TBI. You wonder if the application of cervical collar will increase intracranial pressure (ICP)

A 35 year old man presented to the emergency department 3 hours after ingesting 25 tablets of 200mg hydroxychloroquine sulfate in a suicide attempt. Should activated charcoal still be administered?

A 34-year-old female presents to the Emergency Department with abdominal pain and nausea that started 1 day ago and became more intense and moved to the right lower quadrant. She is taking an oral contraceptive pill and has no known drug allergies. Abdominal ultrasonography confirmed a diagnosis of appendicitis. She refuses laparoscopic surgery and is requesting to go home with antibiotics.

A 48-year-old male with a history of type 2 diabetes presents to the emergency department with left knee pain. On examination, his left knee is erythematous with an effusion and tender to palpation. He is very painful with both passive and active range of motion. You would like to rule out a septic joint in the most reliable and least invasive way, and consider which laboratory tests to order.

A 45-year-old male with a past medical history of prior open appendectomy, presents to the Emergency Department (ED) with a chief complaint of abdominal pain with associated nausea, vomiting and inability to pass flatulence. Imaging of the abdomen demonstrates loops of bowel with a transition point, consistent with small bowel obstruction (SBO). The patient refuses insertion of the nasogastric tube (NGT).

A 28 year old female attends the Emergency department with widespread red, itchy wheals covering her body. She is unsure of what has caused this and it has not happened before to this extent. She is haemodynamically stable and has no airway or respiratory involvement. She is visibly uncomfortable and you want to help the symptoms resolve as quickly as possible. You are unsure of the clinical evidence behind a course of oral steroids for acute urticaria and NICE CKS suggests it on expert advice.

A 45-year-old man presents to the emergency department after a motor vehicle accident. His only complaints are shortness of breath and abdominal pain. A focused assessment with sonography in trauma (FAST exam) is used to evaluate the patient's abdomen and chest. You wonder what is the accuracy of extending the FAST to detect pneumothorax.

A 32 year old gentleman presents to the Emergency Department after falling during his 5-a-side football match. He reports hearing a ‘pop’ and pain in his posterior ankle. His Simmonds-Thomson test is positive and you suspect an acute rupture of his achilles tendon. You wonder if this patient should be put in an equinus cast or heel-raised functional bracing prior to orthopaedic clinic review.

A 34-year-old female comes to the emergency department due to acute episodes of dizziness. The history and physical exam are most consistent with diagnosis of posterior canal benign paroxysmal positional vertigo (BPPV). You wonder what is the most effective treatment at resolving her symptoms.

A two-year-old healthy male presents to the emergency department with his parents after a witnessed fall from a chair. Parents say he was initially irritable but mostly himself. An age-appropriate neurologic exam is reassuring but you notice he has a temporal hematoma. You are deciding whether to complete a head computed tomography (CT) in this child to rule out skull fracture and traumatic brain injury by reviewing decision making algorithms, such as the Pediatric Emergency Care Applied Research Network (PECARN) head injury algorithm. CT is unavailable at your hospital at this hour and the patient would need to be transported to a different center. While trying to decide, you wonder how sensitive and specific point of care ultrasound (POCUS) is in detecting skull fractures in children