bestBETs

A 26-year-old woman presents to the Emergency Department with pelvic pain and purulent vaginal discharge is diagnosed with pelvic inflammatory disease (PID). She had an intrauterine device (IUD) placed six months ago after the birth of her third child. She is afebrile, able to tolerate oral intake, and can be managed as an outpatient. As you discharge her with antibiotics, you wonder if you should have removed the IUD or arrange to have it removed by her gynecologist.

A 25 year-old man presents with a fever and cough productive of yellowish sputum. You take a history and examine the patient. You wonder whether it is possible to rule in or rule out pneumonia without the need for a chest x-ray, to save time, money and radiation.

A 1-year-old boy presented to emergency department with fever. History and Physical examination suggested upper respiratory tract infection. You want to prescribe paracetamol(acetaminophen) for the fever, but the boy kept on crying and oral route was not possible. You wonder if oral route is more effective than rectal administration.

A 6-year-old boy weighing 23 kg is repatriated to your unit from a Dutch hospital after appendectomy complicating a short holiday trip abroad. He is still on parenteral hydration. You notice that the prescribed intravenous solution of 1600 ml a day is hypotonic: dextrose 5%, NaCl 0.45% with 2 mmol potassium/kg/day added. His serum electrolytes and glucose are within the normal range. You wonder why your colleagues abroad did not prescribe isotonic maintenance solution so you decide to contact them. You are informed by the referral hospital that it is common practice to prescribe hypotonic fluids as maintenance solution, and you wonder whether your routine of prescribing isotonic fluids as maintenance is be preferred.

A short, obese female with pneumonia enters the emergency department. She is tachypnoeic, febrile, and labouring intensely to breath. She has an oxygen saturation of 76% on room air and becomes decreasingly responsive in front of you. You believe her declining respiratory condition merits intubation. You anticipate a difficult intubation and wonder if any simple manoeuvres might be of some help. You have heard that elevating the head and flexing the neck (sniffing the air position) gives you a better view of the vocal cords.

A 3-year-old girl is brought to the emergency department by her parents. She has vomited multiple times and has been feverish and lethargic over the last 24 h. On examination, she is feverish, she has a stiff neck and Kernig's sign is positive. You are concerned about the possibility of meningitis but do not want to put a child through an unnecessary lumbar puncture. You wonder how accurate the above signs of meningeal irritation are in detecting bacterial meningitis in children.

An 83-year-old restrained female passenger involved in a head-on collision is brought to the ED via helicopter. The ED evaluation reveals an unidentified esophageal intubation. On questioning the helicopter paramedic crew, it is found that a carbon dioxide indicator was not used in the field.

A 17-year-old male presents to the Emergency Department with a unilateral loss of vision and orbital swelling a day after an altercation outside a community college with weapons-carrying students. The patient is not forthcoming with details. The pupils are equal and reactive to light. You want to establish the extent of orbital/ocular damage. There is a wait for a CT scan so you wonder if using the bedside ultrasound scanner (USS) for a focused ocular ultrasound would provide useful imaging for either safely reviewing the patient later or making an informed prioritisation for CT.

A 55-year-old man presented to the emergency department due to nausea, jaundice, and mild abdominal pain over the right-upper quadrant that had persisted for three days. Lab data showed hyperbilirubinemia and abdominal CT revealed multiple stones in the common bile duct (CBD). ERCP was performed for removal of CBD stones. Both amylase and lipase were elevated the day following ERCP and post-ERCP pancreatitis was diagnosed. As it is a feasible route for a patient treated without oral intake, you wonder if the use of rectal indomethacin would have lowered the occurrence of post-ERCP pancreatitis?

A 12 year old male involved in a motor vehicle crash is brought in by EMS. His vitals are within normal limits, however on exam you do note moderate left upper quadrant tenderness. Before sending the patient to the CT scanner you wonder if a negative read will be sensitive enough to rule out significant intra-abdominal injury (IAI).

A 29 year old female presents to the physiotherapy department for treatment of recurrent giving way of her right ankle, present since a severe ankle sprain in her late teens. The ankle gives way into the inversion direction when walking on uneven surfaces such as cobble stones; this occurs approximately twice per week. Any possible underlying structural cause for the instability has been ruled out by a Consultant Orthopaedic Foot and Ankle Surgeon assessment, X-rays and a MRI. A diagnosis of “Functional Instability” has been made and she has been referred to physiotherapy for rehabilitation.

A 7 yr old boy presents to the trauma bay in the emergency department after a high speed motor vehicle collision. He is alert, talking, and moving all extremities. During his secondary survey, you wonder if a digital rectal exam would be of any prognostic or diagnostic utility.

A 4-month-old girl with respiratory distress presents at the emergency room in January. On physical examination the child has a fever, nasal discharge and a dry wheezy cough with tachypnoea and dyspnoea. On auscultation you find inspiratory crackles and expiratory wheezing. You know that there is no evidence for the use of bronchodilators or corticosteroids in bronchiolitis, but you wonder whether the combination of dexamethasone and epinephrine could help your patient to recover more quickly.