bestBETs

An adult patient attends the ED with a simple traumatic laceration to the pinna after fighting. You have heard that we should give prophylactic antibiotics to these patients after suturing the wound as they have a high risk of developing perichondritis. You wonder whether there is any evidence for this.

You are a paediatric registrar carrying out your shift in paediatric Accident and Emergency. You see a 12 year old girl presenting with an acute onset of right sided stroke. She was admitted to the Children’s ward and on further investigation she was found to have an ischemic stroke involving the left middle cerebral artery territory. Her cardiac evaluation was normal. The Paediatric Neurologist advised commencing her on Aspirin. The family are anxious about the efficacy and safety of Aspirin. You have heard that Aspirin has been proven to be beneficial in strokes in adults with arterial ischemic infarcts. However, you are not sure if there is enough evidence to justify its use in paediatric age group. You decide to find out the evidence

A 31-year-old man was working in a local chemical factory when he splashed himself with hydrofluoric acid to the eye. He attends the emergency department and you arrange for copious water irrigation and oral pain relief. You have the heard about the Hexafluorine antidote solution and wonder whether there is any evidence for its use.

A 12 year old female post motor vehicle collision is admitted to the pediatric ICU with a grade 3 liver laceration, pelvic bone fractures, and a humerus fracture. She has a central line that was started for treatment of hypotension. Your institution typically does not provide deep vein thrombosis (DVT) prophylaxis in children, but you wonder what the incidence and risk factors of venous thromboembolism (VTE) are in children who are critically ill after trauma.

A 35 year old male patient attends the emergency department with acute onset pain in left flank that is constant and radiating anteriorly. You speak to the radiologist to request a non-contrast CT scan to identify the cause of his pain, but the request is declined on grounds that the radiation dose is high and not justified and other imaging is advised. You wonder whether the dose reduction is possible and propose a bet to methodically examine the literature.

A 9 month old infant is brought to the Emergency Department by his mother with a 3 day history of coryzal symptoms and increasing difficulty breathing. Ausculation reveals widespread wheeze and crepitations, and you make a clinical diagnosis of bronchiolitis. You wonder whether a chest xray is indicated to confirm this diagnosis and assess its severity.

You are the middle grade doctor attending a patient with an isolated head injury in the Emergency Department. The GCS on arrival is now E2V2M4 (8/15). There is a history of vomiting en route to the hospital. The anaesthetist present agrees that the patient should be intubated following rapid sequence induction for CT scan; while you are pre-oxygenating another middle grade appears and helpfully reminds you that "suxamethonium will only increase this patient's intracranial pressure." You wonder whether the evidence is compelling enough to avoid suxamethonium altogether in patients with head injury.

You are seeing a 3yr old girl in the ED. She has fever, red tongue and conjunctivitis. Her mother mentions her BCG scar looks more red than usual. You wonder if this is significant.

A 5 year old boy presented after being struck by a car while riding his bicycle without a helmet. He had a GCS of 5, and was found to have a right frontal skull fracture and a left sided subdural hematoma on CT imaging studies. He was intubated while in the emergency department and admitted to the Pediatric Intensive Care Unit. Does treatment with hypothermia have improved clinical outcomes?

A 42-year-old man presented to the emergency department with unilateral parasternal chest pain of recent onset. Examination revealed reproducible tenderness overlying the 2nd to 4th right sided costochondral junctions. Significant differentials were excluded subsequent to clinical examination and normal investigations, and a diagnosis of costochondritis was made. You prescribe ibuprofen, however he states he is intolerant to all non-steroidal anti-inflammatory drugs and asks whether there are any alternative treatments. Your registrar suggests giving either a local corticosteroid injection or oral soluble format prednisolone. You wonder what evidence exists to support this.

A 12-year-old boy presents to the Emergency Department (ED), with pain and swelling around his left clavicle which occurred during a game of rugby. You explain his clavicle might be broken and an x-ray is required to confirm the diagnosis. His father points out that he has multiple x-rays in the past for other sporting related injuries and asks if the x-rays are necessary? You wonder whether Ultrasound (US) would be an alternative means for diagnosing a fracture of this bone.

A young adult was paddling on a sandy shoreline during their summer holiday; they think they may have been stung by something in the water. They are showing local signs of envenomation including erythema and swelling. Ambulance crews have given no treatment as they were unclear as to what action to take. You wonder if warm water immersion will be an effective therapy for reducing the symptoms.

There is new emerging technology designed to electrically stimulate key muscles involved in swallowing for treating people with dysphagia. This is more commonly used in the United States but it is now being provided in the UK by independent practitioners. The Royal College of speech and language therapists do not endorse this treatment due to lack of a robust evidence base so we do not know if this type of therapy is effective and for which client group it is most effective for. Patients are beginning to ask therapists about this kind of treatment so a search of the available evidence is useful to inform patients of the most up to date evidence.

A 25yrs old gentleman presents to the ED after punching into a wall, xrays show boxer fracture with 60degrees volar angulation. Can he be managed conservatively with neighbour strapping or he needs surgery?

A 23 year old female with a diagnosis of Joint Hypermobility Syndrome is assessed by a Physiotherapist in an out-patient department. The patient is presenting with pain, which is decreasing her function. You wonder whether acupuncture is an effective treatment adjunction to use with this patient to decrease pain and increase her function.

A fifty year male attends Emergency Department (ED) with cardiac sounding chest pain 2 hours ago and the pain lasted for 30 minutes. Now he is pain free and there is no history of previous IHD. He is ex smoker but has no other risk factors for IHD. His ECG is completely normal. You wonder if Point of Care (POC) triple markers can be requested 2-3 hours after the onset of pain in such cases and ACS can be realibly ruled out to allow safe discharge from ED.