bestBETs

Current practice for patients after routine primary total hip replacement is to have unsupervised physiotherapy in the home-based setting followed by one hospital-based out-patient appointment check at 6 weeks post-op. A colleague feels that physiotherapy out-patient services should manage all post-op THR more frequently. You are concerned about the pressure on your out-patient service, particularly in view of the current COVID-19 pandemic limiting face-to face appointments. You want to establish what is the current evidence for physiotherapy in the home-based compared to the hospital-based settings.

An African American 19-year-old male presents to the emergency department with coryza, audible wheeze, and cough. He is afebrile, well hydrated, in mild respiratory distress with an oxygen-saturation (SaO2) 93% on room air. During the COVID-19 pandemic, you recall some concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation.

A 25-year-old male presents to the emergency department after burning his hand on a torch at work. He suffered a superficial burn with a large blister to his dorsal hand. You consider the best evidence-based management of the blister.

A 14-year-old presents to the ED with acute flank pain and is found to have a 5 mm distal left ureteral calculus. There is no concern for significant hydronephrosis, renal insufficiency, or infected stone. Should tamsulosin be prescribed to help facilitate stone passage in this pediatric patient?

A 40-year-old police officer is exposed to a white powder after apprehending a suspect. He is concerned that he was exposed to fentanyl so he self-dosed with Naloxone and came to the Emergency Department. He is observed for 1 hour and discharged home.

An otherwise healthy 28-year-old male presents to the emergency department following a motor vehicle collision. The patient, brought in wearing a cervical collar, is obtunded upon arrival and intubated for airway protection. CT imaging shows a multifocal subarachnoid hemorrhage. The patient has signs of increased intracranial pressure (ICP) and despite maximal medical therapy continues to be severely hypertensive and bradycardic. CT of the cervical spine was negative, and you wonder if the patient’s cervical collar is contributing to the elevated intracranial pressure.

A 55-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset of severe chest pain radiating to his left arm. On physical examination, he is diaphoretic and appears anxious. His initial electrocardiogram (ECG) appears normal. You wonder how accurate the ECG findings are to rule out acute coronary occlusion (ACO).

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 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 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

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 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 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.

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?

While working pre-hospital, you attend an adult patient with severe burns. You have treated the patients pain with IV morphine, IV paracetamol and Entonox. At handover the patient is given Penthrox. You wounder if Penthrox is superior to Entonox at reducing pain.

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.