bestBETs

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 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.

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.

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 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.

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 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?

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 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 23 year old women started a graduated training programme for 10 weeks since she set her goal to run 5 km nonstop. While running, she encounters stabbing pain under the lower edge of the ribcage that is inconvenient to continue her training. Therefore, she asks you if exercise-related transient abdominal pain (or stitch) is preventable e.g. by not drinking fluids before and during the run.

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 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 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 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.