bestBETs

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.

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.

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.

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.

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.

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?

An 11-year-old boy is struck by a car and sustains an acquired brain injury (ABI). He is admitted with a Glasgow Coma Scale score of 6/15. Cranial imaging reveals evidence of diffuse injury. Approximately 12 months later following discharge, the patient is seen for a planned review. The patient and his family report poor attention with hyperactive and impulsive behaviours. The school has reported to parents that there has been a change in his ability to concentrate at school and he is being disruptive in class. This represents a clear departure from the patient's preinjury behaviour. Parental and school management of this concerning conduct is structured and consistent. You have heard that stimulant medication may be of benefit in managing difficulties with attention, hyperactivity and impulsivity (attention deficit hyperactivity disorder (ADHD) type behaviours) following an ABI.

A 2-year-old child is acutely admitted at night to a district general hospital following a prolonged focal seizure. A CT scan of the head without sedation fails as the child is too active and distressed, and as the on-call paediatric registrar, you are requested by the radiographer to prescribe a sedative. The NICE guideline for sedation in children and young people advises that midazolam or chloral hydrate can be used to sedate for painless procedures. You wonder which of these drugs is the most effective and safe and which has the least side effects.

As a paediatric registrar you are presented with a 4-month-old baby in paediatric outpatients. His mum describes him as having large vomits up to 30 min after most feeds, and recently he has seemed reluctant to feed. He is exclusively breast fed, and is gaining weight appropriately and otherwise thriving. He has previously been investigated for his vomiting and you conclude that he has gastr­oeosphageal reflux without complications (GOR). In the first instance, positioning and thickened, small frequent feeds would be advised. The latter suggestion is not without difficulty for mothers exclusively breast feeding. As the mother is describing vomiting at least six times per day, but no signs suggestive of pain at present, could a pro-kinetic alone such as domperidone improve these symptoms?

A 28 year old man with Hodgkin’s lymphoma presents to the Emergency Department with increasing pain, swelling and erythema of the forearm following intravenous administration of doxorubicin a few hours ago at your local specialist cancer treatment centre. The pain was described as severe and constant with localised swelling, erythema, warmth and limited movement of the wrist. You suspect extravasation of anthracycline from the cannula site and as you initiate local measures of limb elevation and cooling, you wonder if emergency intravenous administration of dexrazoxane may be beneficial in reducing the risk of soft tissue necrosis and subsequent debridement.

A 30 year old patient attends your department 2 weeks following a lateral malleolar ankle fracture. They complain of increased pain and cramping up the calf. The toes are swollen but there are no clinical signs of compartment syndrome. You are concerned about the possibility of DVT and arrange an ultrasound scan to investigate further. A junior doctor asks you what the incidence /pretest probability of venous thromboembolism is within this cohort of immobilised ambulatory patients. You tell them that is an excellent question. And that you will give them one week to find out the answer for you.

A 40-year-old man who is having a haematemesis is brought into the emergency department. He has not attended the department before but admits to chronic alcohol dependency. It is not known if he has liver disease or varices. You resuscitate him and arrange an endoscopy. Being aware of the use of tranexamic acid in trauma patients you wonder if using it would reduce this man's bleeding and improve his chance of survival?