bestBETs

A 27-year-old female presents to the emergency department with shortness of breath. She is 26 weeks pregnant. The lower limbs Doppler ultrasound is negative. You must perform another diagnostic test to eliminate a pulmonary embolism. You wonder which test is the most appropriate for this patient: a Computed-Tomographic pulmonary angiography or a ventilation-perfusion scintigraphy.

A 44 year old female attends the Emergency Department with a two day history of worsening dysuria and urinary frequency. She is systemically well, but urinary dipstick testing confirms the presence of a urinary tract infection. The patient states that she does not want to take antibiotics and you wonder whether NSAIDs will provide adequate relief to the patient?

You are about to perform a rapid sequence intubation on a 26 year old man with a severe head injury. You have been told that the gentleman has consumed a significant amount of alcohol in the last 3 hours. The nurse asks you whether the application of Cricoid pressure will stop him aspirating.

A 50 year old gentleman attends the Emergency Department following a collapse. After initial resuscitation you obtain a CT scan of his brain, which shows a spontaneous intracerebral bleed. You want to know if rFVIIa will improve your patients survival rate / functional outcome.

You have been treating a 30 year old woman in the ED for classic migraine. Her symptoms have improved and she is keen to go home. She was given steroids to reduce recurrence when she last visited the ED with migraine and she asks you if you are going to do the same.

A 7 year old presents to the emergency department following a minor head injury with repeated vomiting. He is GCS 15 on assessment with no focal neurological deficit. Cranial CT scan is normal. You would like to know if he can be safely discharged to a capable parent.

An 18-year-old male is brought to your Emergency Department by his mother with a chief complaint of \"acting odd\". The patient has been intermittently unresponsive to verbal stimuli, laughing uncontrollably, and appears to hallucinating. In his front pocket, you find a crude pipe and a foil package labeled \"Saliva 10x\" (sic). You begin to wonder what clinical suprises this patient may have in store for you.

A 51 year old presents to A&E with loin pain and macroscopic haematuria and a diagnosis of renal calculi is made. The patient’s pain is adequately controlled and the decision is discharge with Medical Expulsive Therapy (MET) – but you don’t know whether to prescribe alpha-adrenergic antagonists or calcium channel blockers.

A 3-year-old boy comes in with intermittent bouts of severe abdominal pain. You are thinking of intussusception as the most likely diagnosis. It is night time and in your institution, the access to a formal ultrasound is limited at this time of day. You have heard of case reports of intussusception diagnosed by emergency physicians using bedside ultrasound. You wonder if there is any good evidence at diagnosing intussusceptions with this modality and you decide to search the available literature.

A 16 year old girl presents to her general practitioner, monthly she suffers from dysmenorrhea. Her dysmenorrhea is often associated with vomiting and therefore her mother does want to know if a non-pharmaceutical therapy can reduce the pain as well. You wonder if applied heat is as effective in providing menstrual pain relief and reduction of abdominal cramping as pain killers.

A 50 year old male is brought in by ambulance after a collapse. It is a hot day and the patient had been playing 5-aside football when he collapsed. In the Emergency Department he is a assessed, having a rectal temperature of 41.5C and a GCS of 4. The patient is hot and not sweating. A diagnosis of heatstroke is made. You have heard contradictory evidence as to the most effective cooling modality available and wonder if whole body ice-water immersion might be the best option.

A 10-year-old girl presents to the emergency department (ED) with pain in her right lower quadrant. She states that the pain started 2 days ago when it was diffuse across her lower abdomen. She has had a decreased appetite but no nausea or vomiting. On examination, her abdomen is soft, non-distended, with no guarding and no rebound tenderness. Rovsing\'s sign is negative, but she has positive obturator and psoas signs. Murphy\'s sign is negative. Bowel sounds are heard throughout her abdomen. She is afebrile and her basic laboratory tests show a leucocytosis of 11 000 white blood cells/µl with a left shift. You wonder how likely it is that this patient has appendicitis and how best to manage this individual. You wonder if the Alvarado scoring system used for this purpose in adults is supported by evidence in paediatrics.

As you prepare one of your patients for conscious sedation in the emergency department she tells you that she has been allergic to eggs since childhood. Your colleague states that a documented egg allergy is a contraindication for the use of propofol but you have your doubts. You wonder if there is any published evidence or whether this is another medical myth.

A 35 year old builder presents to the emergency department having dropped a paving slab on his toes. He has swollen painful great toe on the right foot. An x-ray shows he has sustained a closed fracture of the distal phalanx of the great toe. No other injuries have been sustained.

A 70-year-old man encountered several episodes of hypotension when standing after bending over to tie his shoes. Last time, he lost consciousness transiently. He asks you for an easy way to prevent passing out, as he lives alone. You once heard about the effect of leg crossing and you wonder if leg crossing actually prevents syncope caused by orthostatic hypotension.

A 47-year-old man attends the emergency department with a 12-h history of palpitations and slight chest tightness. On examination he is found to be in atrial fibrillation with fast ventricular response. He is haemodynamically stable. You decide to cardiovert the patient as he is symptomatic. After successful cardioversion he is feeling well and remains stable. His cardiac markers and electrolytes are also normal. You wonder whether he can go home immediately or if he needs to stay in hospital for a further period of observation.

A 13-year-old boy presents to the emergency department after sustaining 30% burns. Fluid resuscitation is commenced and he is intubated and ventilated for transfer to the burns unit. The burns team ask you to commence a vitamin C infusion. You wonder whether vitamin C will make any difference to the patient\'s outcome.

A 45 year old man presents with acute renal colic, with no signs of infection or renal failure. You consider discharging the patient with analgesia and an out-patient urology appointment but remain concerned about the safety of this approach.

A 12-year-old girl requires a lumbar puncture (LP) for possible meningitis/encephalitis. She has a postdural puncture headache (PDPH). While discussing her treatment options with the anaesthetic team they ask why a cutting point needle was used. You wonder if there is any evidence to back up their claim that cutting needles are associated with a higher incidence of post-puncture headache.