bestBETs

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.

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.

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 ).