bestBETs

A 52-year-old woman presents to your emergency department with a severe gastroenteritis. She is moderately dehydrated and is nauseated. While you prescribe intravenous rehydration and metoclopramide as antiemetic medication, one of your colleagues comes in and suggests that you add prophylactic diphenhydramine to prevent metoclopramide-induced akathisia. You wonder if this should be done routinely and perform a thorough search of the literature.

An infant under 3 months with Erb’s Palsy is referred to occupational therapy for hand splints. You wonder if splinting is a useful intervention to improve joint range of movement (ROM) for this client group.

Clinical Scenario Your musculoskeletal physiotherapy service is considering developing a supervised gym class for post-operative shoulder patients. Many patients experience post operative pain which impacts on their ability to perform exercises. Would the use of TENS machines during the class be beneficial in decreasing pain?

A 3-year-old boy is brought to your ED after falling top to bottom of stairs at home. Parents witnessed his landing and he did not lose consciousness. The child is distressed, and only his mother is able to have a reasonable rapport with him. Would having Clinical Decision Rule (CDR) help in clearing C-spine clinically, to avoid imaging?

Evidence for the effectiveness of circuit class therapy (CCT) in patients post stroke has concentrated on lower limb parameters, walking tasks and balance. There is some research emerging on the effects of participation in CCT on upper limb recovery post stroke. This BET will help to inform class structure and content.

You are at the scene of a car crash with a medical team. The driver is showing signs of hypovolaemic shock, and the limited access and poor light make vascular access difficult. You elect to insert an intraosseous needle, but while preparing the proximal tibial site a paramedic suggests that using the humerus will allow for faster fluid infusion. You wonder if there is any evidence for this?

A 49 year old man with acute lumbodynia for more than 2 weeks for which he received 2 non-steroidal anti-inflammatory drug tablets daily, but with no other health relating conditions, comes to the emergency department referring meleana dejections. In the laboratory tests haematocrit is discovered to be 27%, thus a transfusion is obligatory. You wonder whether the premedicasion transfusion could prevent the appearance of any allergic or febrile non-haemolytic transfusion reactions.

You are called to resus to see an adult with known epilepsy who has been brought in by ambulance in status epilepticus. The seizure is ongoing despite IM and IV midazolam boluses. A phenytoin infusion is the widely accepted second line treatment for benzodiazepine-resistant seizures, however you are aware of draft guidelines suggesting the use of newer anticonvulsants such as valproate or levetiracetam.

A 20-year-old man presents to the emergency department with police officers after he was witnessed swallowing a bag of methamphetamine. He denies ingestion of any other substances and has no specific complaints at this time. The time of ingestion is 30 min before evaluation. His vital signs are: blood pressure 134/86, pulse 94, heart rate 18, temperature 37.6°. You wonder whether to attempt actively to expedite the passage of the toxin or if conservative management is acceptable.

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.