bestBETs

A two year old has a witnessed cardiopulmonary arrest whilst in your Emergency Department. You are able to ventilate the child using a bag valve mask (BVM) and oral pharyngeal airway, but notice his stomach is becoming inflated. In cardiac arrest in adults you know that a LMA or iGel is now the advised airway to use (ALS guidelines 2011), but you wonder if this could apply to children as well.

A 67-year-old man known for alcoholic cirrhosis comes in with an upper GI bleed. While you order the appropriate management therapies to control the bleed, one of your colleagues comes in and suggests that you add prophylactic antibiotic coverage to prevent an infectious complication. You have not heard of such a practice and wonder if this should be done routinely in cirrhotic patients presenting with an upper GI bleed. You perform a thorough search of the available literature.

A 43 years old man presents to the emergency department with a moderate cellulitis with lymphangitis of the forearm following a trivial skin trauma in the previous days. The patient is not known for any health problem nor does he have any risk factor for CA-MRSA. You wonder if daily intravenous cefazolin following oral probenecid is as effective as two or three times a day intravenous cefazolin treatment.

An unconscious 67-year-old male involved in a motor vehicle accident is brought to the emergency departmentby paramedics. The head CT shows a frontal contusion. The patient is on Clopidogrel. You wonder if the antiplatelet therapy reversal with platelet transfusion would improve patient’s survival.

A patient is brought to the Emergency Department with pelvic trauma. One of the members of the trauma team mentions that the new T-POD pelvic binder is better at controlling internal haemorrhage than the traditional wrapped sheet. You wonder if there is any evidence to support this?

A 50 year old male presents to the emergency department with signs of head injury, a GCS of 14 and heavily intoxicated with alcohol. He had similar presentations in the past needing a head CT scan repeatedly. His GCS is 14 after 2 hours. A CT scan is indicated and is normal. Could this CT scan have been avoided by using a serum S-100B blood biomarker test?

You are part of a mountain rescue team that has been called to a 22 year old climber who fell from a rockface at a height of 8metres. He landed injuring his left leg. His thigh is deformed, swollen and painful and he is unable to weightbear. You suspect a femoral fracture. Are you able to splint the leg in a box leg splint or do you need to call other team members to bring up a traction splint?

A 45 year old woman in brought into the emergency department following a house fire, during which she was trapped in a smoke-filled room for a period before being extricated by the fire service. She has no thermal burns and is fully conscious and orientated but is complaining of a headache and dizziness. You are concerned about possible toxicity secondary to carbon monoxide inhalation. The department has invested in a non-invasive fingertip carbon monoxide saturation meter, and you wonder whether this is sufficiently sensitive to rule out significant carbon monoxide toxicity and is sufficiently accurate to guide treatment.

A 26 year old man attends the emergency department with a first-time headache of moderate to severe intensity, with no clinical course of vomiting. It is however of a sudden onset. Neurological examination was unremarkable. He has no history of trauma and has no relevant previous medical history. You wonder if it would be safe to rule out sub-arachnoid hemorrhage without an emergent CT scan.