bestBETs

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.

A 12-month old child is admitted into the pediatric ward requiring peripheral venous access for the administration of fluids and medications. The parents are fretful of the procedure and has refused further attempts as multiple junior medical staff have failed on previous occasions. How do you minimize the number of attempts and time required, thereby improving patient confidence and satisfaction.

79 year old patient with Parkinson’s disease and a history of falls. You wonder if an exercise programme would reduce the rate and risk of falls.

You see a 12 year old girl with Graves’ hyperthyroidism in the clinic. She has relapsed on titration of her carbimazole. Hence, the Consultant changes her treatment regimen to block and replace ( combination of high dose carbimazole and thyroxine ) . You wonder whether block and replace regimen (combination of high dose anti thyroid drug with thyroxine replacement ) is better than dose titration regimen ( low dose anti thyroid drug ) at reducing relapses and achieving long term remission ( greater than 2 years ).

A 22 year old male had a right elbow ORIF following a fall on an outstretched hand whilst skateboarding. There were no complications with his surgery, however he has significant restriction in active range of movement at the elbow on initial assessment. tYou are aware of the possible complications of heterotopic ossification, so you refer back to previous research conducted in 2007 that highlighted no available relevant evidence to support the development of this complication. You wonder if there are any recent developments in the literature to a support this notion.

There are 65-80 lower limb amputations in our trust annually. It is considered good practice that amputees remain in a wheelchair until fitted with prosthesis. However, this practice has little evidence base. A wheelchair poses problems for accessing all areas of property. May be easier if patient could hop a few steps. Recurring patient question from unilateral amputees; can I have crutches or a zimmer frame and hop around my home?

The aim of the bet was to establish whether Graded Motor Imagery was a useful tool in managing Phantom Limb Pain in amputees. In addition, to established and moderately successful modalities such as medication, hypnosis and accupuncture.

A 6-year-old girl presents to the emergency department with a teacher. She was missing at the end of the lunch break and was found dazed at the base of a climbing frame, and can’t remember what happened. Her examination is normal other than a scalp haematoma, with no evidence of an underlying skull fracture. You are aware of the adverse effects of radiation on the developing brain, but wonder if the history and clinical findings warrant performing a head CT despite the potential risks.