bestBETs

A premature infant (30 weeks) weighing 1050g was recently admitted to the neonatal intensive care unit after an uncomplicated delivery. You have spoken to the mother regarding the benefits of expressed breast milk (EBM) compared to premature formula milk, including the decreased risk of necrotising enterocolitis (NEC), and this is being administered via a nasogastric tube. At the ward round the consultant suggests the addition of EBM fortifier to ensure the baby has an adequate intake of macronutrients and micronutrients and to maximise extra-uterine growth. You wonder if the addition of a cow's milk-based fortifier to EBM will confer an increased risk of NEC and decide to find out more.

A 3-week-old baby presents with cough and episodes of apnoea. Nasopharyngeal aspirate is negative for common respiratory viruses. You consider the diagnosis of pertussis and take a full blood count to assess the lymphocyte count. You wonder what the sensitivity and specificity of the lymphocyte count is for pertussis in infants.

A 2 year old boy is brought to your emergency department after a motor vehicle crash. He was wearing a seatbelt and the parents do not think he lost consciousness. No one else in the car was injured. On exam, the child is quite upset and you are unable to determine whether there is cervical tenderness. You do notice some bruising over his torso. There are no neurologic deficits on exam and he is able to ambulate. Should you obtain cervical spine imaging to rule-out injury?

My FY1 who had just seen a patient with a TIA was told by the stroke specialist nurse to prescribe clopidogrel. The FY1 had already given the patient aspirin and asked me whether clopidogrel was better for secondary prevention in this group of patients, and also should she give the clopidogrel as well as the aspirin?

A 3-year-old child presents to the emergency department with High fever and pain in his right knee. You perform a diagnostic arthrocentesis and the stat gram is positive. You start the IV antibiotic treatment and you wonder if the addition of a corticosteroid would be appropriate.

A patient attends A&E with a painful sickle crisis. They have taken oral anlgesia including rescue oramorph with limited effect. You are unable to obtain IV access and wonder if there are any inhaled therapies (apart from oxygen) which could help the patient. You ask your registrar who is uncertain so you decide to check BestBETS

A 30-year-old man attends your emergency department after a deliberate overdose of his father's atenolol tablets. He is bradycardic, hypotensive and has had seizures. Despite fluids, atropine and a glucagon infusion, he remains hypotensive and you start treatment with inotropes. He remains unresponsive to treatment and very hypotensive and you wonder if an intravenous lipid infusion would help.

A 62 year old male emergency patient arrives in cardiac arrest. During resuscitation he is found to have pulseless electrical activity (PEA). Several rounds of ACLS are performed with no improvement in the patient's condition. You wonder if a rapid bedside cardiac ultrasound (echocardiography) would be of any prognostic or diagnostic utility.

An eight-year-old female patient arrives at the Emergency Department with her mother after being struck by a car while riding her bicycle. Her respirations are strained and she has an obvious deformity of the right shoulder. She is evaluated immediately by the trauma service. Possible interventions include the placement of a chest tube. Should her mother be removed from the room?

A 6 month-old-female is brought to the emergency department by their parents after what they describe as a fall from a bed to the floor. The child has several bruises that appear to be in various stages of healing and the parents seem very tense. I suspect non-accidental injury. How likely am I to see occult fractures on a standard skeletal survey?

A 22-year-old woman, who is currently 12 weeks pregnant, presents to the emergency department complaining of a four week history of severe nausea and vomiting. She appears to be clinically dehydrated and urinalysis confirms she is ketotic. Immediate management includes intravenous fluids and standard anti-emetics. Unfortunately she gets minimal relief and continues to vomit. You recall from your recent oncology placement, the beneficial effect of steroid therapy on chemotherapy induced vomiting, and wonder if a trial of steroids might be useful to control the symptoms of severe hyperemesis gravidarum (HG)

A 28-year-old man is brought to the emergency department by ambulance. He was thrown out from a club following an argument with a bouncer. As he tried to escape from the bouncer he was sprayed in the eyes by another doorman. At the scene the paramedics tell you that the bouncer had a can of CS spray with him that had been confiscated by the police. He has watery and painful eyes with a foreign body sensation. You ask one of the senior nurses to perform an eye washout but she suggests that he would be better off standing in front of a fan and letting the air blow the CS particles off. You wonder how on earth they know this but remember that sister Milly Terry is a weekend warrior with the Territorial Army and that they use CS gas for Chemical, biological, radiological and nuclear (CBRN) training.

A 70-year-old woman presents to the emergency department (ED) with confusion and collapse. You find her serum creatinine is 180 μmol/l and wonder which classification system you should use to determine her renal function and prognosis.

A patient requires a thoracotomy for resection of a lobe of their lung is worried about pain relief post-operatively. You wonder whether it might be pertinent to provide them with an spinal block rather than prescribe IV analgesia for the immediate post-operative period.

A 4 year old boy presenting to Emergency department with high pyrexia of 39.5C and on going generalised clonic tonic seizure. No IV access is immediately obtainable. You have identified that the child requires urgent first line treatment for initial seizure control.