bestBETs

You are about to perform a rapid sequence intubation on a 26 year old man. You’ve heard rocuronium may provide similar intubating conditions to succinylcholine with fewer side effects, and wonder which should be your muscle relaxant of choice.

A 62-year-old man comes in with a new vesicular rash on his abdomen that has been present for 24 h. He complains of intense pain and tenderness in the same area as the rash. You diagnose herpes zoster. You start an antiviral medication right away, but you wonder what medication you could use to try to alleviate the patient's pain and reduce the incidence of post-herpetic neuralgia. You have seen your colleagues use pregabalin for that purpose, but wonder if there is good evidence to support this practice.

A 72 year old man is admitted to the Stroke Unit following collapse and a suspected CVA. He presents with dysarthria and a CT scan confirms an acute stroke. You wonder whether oro-motor exercises will help to improve the intelligibility of his speech.

A 35 year old man has a dislocated shoulder that will need to be reduced. He will require sedation and will be monitored with standard monitoring (ECG, BP, SpO2). You wonder if addition of capnography would be beneficial for the patient?

A 9-year-old boy presents to the Emergency Department (ED) following a motor vehicle collision. He was a restrained rear seated passenger involved in a head on crash at approximately 45 mph. His physical examination is unremarkable, except for the presence of bruising on the lower abdomen in the distribution of his lap belt, consistent with a ‘seat belt sign,’ (SBS). The boy otherwise looks well. You wonder whether there is evidence to help you decide to discharge the patient, pursue additional imaging, or admit the child for observation/further intervention.

A 25 year old male attends the emergency department after he slipped on some ice and onto his outstretched right hand. He has attended complaining of tenderness in his wrist and a lack of function. There is also marked swelling around his right wrist.

A 73-year-old male with known chronic obstructive pulmonary disease (COPD) presents to the emergency department with dyspnoea. He is diagnosed with an acute exacerbation of COPD. Despite optimal medical management he fails to improve, his arterial blood gases demonstrate type II respiratory failure with worsening respiratory acidosis. He is offered a trial of non-invasive ventilation but refuses as. A decision is taken that invasive ventilation is not in the best interests of the patient. You wonder if the respiratory stimulant doxapram may improve the patient's respiratory failure.

A 30 year old male gym enthusiast presents with a 3 week history of sudden onset of back pain, after lifting heavy weight, His pain radiates from the lumbar spine to the right posterior thigh lateral calf and foot and has associated mild paraesthesia. He has had treatment with Ultrasound (U/S) before for a different condition and he is asking if U/S could be useful in this case.

A 30-year-old man presents to the emergency department (ED) after twisting his knee. You suspect a soft tissue injury and are aware that the Ottawa knee rule could be used to help determine whether radiography is necessary. A colleague suggests that you should use the Pittsburgh rule instead. You wonder which rule has greater sensitivity (thus missing fewer fractures) and greater specificity (thus reducing the need for unnecessary radiography).

A 36 year old female patient is admitted to the ICU following a significant burn injury, with more than 50% of the body surface area involved, sustained in gas exploding accident. She is being managed in accordance with Burn injury guidelines but in addition, since she had an high risk factor for stress-related UGI bleeding, she was prescribed Esomeprazole 40 mg i.v od, for stress-related upper gastrointestinal bleeding prophylaxis. However, this was changed to Ranitidine 50 mg i.v tid, two days later on the advice of the Gastroenterologist. Is there is any difference in benefit between the two drugs for the prevention of stress-related upper gastrointestinal bleeding?

A 30 yr old man who has been involved in a car crash has been brought to your ED. His GCS is 7 and he was intubated in ED and underwent trauma series CT. His CT cervical spine has been reported as normal. He is about to be transferred to ICU and you are wondering whether CT cervical spine alone can exclude unstable ligamentous injury?

A 35 year old triathelete presents to the emergency department following a long distance event. He feels dizzy, nauseated, fatigued and has some degree of confusion. A clinical diagnosis of symptomatic hyponatraemia is made when his arterial blood gas sample shows a sodium level of 120 mmol/L.