bestBETs

A 12 year old boy came into the ED brought by his parents who were concern that an enlarged lymph node in the boy's neck has not subsided since it was present about 3 months ago. Initial history and clinical investigations were done. Should the boy undergo ultrasound to further assess the lymphadenopathy?

A 2 year old girl is brought in to the ED by her mother who is worried about the fever she has been having for the past 5 days. The little girl was also noted to have an enlarged lymph node on her neck which was not tender. She didn't have any history of sore throat or a previous URTI. The doctor treating her suspects Kawasaki Disease. Will a CRP level help confirm this diagnosis?

A 65 year-old man is referred to the ED by his GP with a serum potassium concentration of 6.5mmol/L. Repeat tests confirm hyperkalaemia. You order an ECG which shows characteristic hyperkalaemic changes. ............

A 78 year old man on warfarin for AF presents to the ED with a head injury following a mechanical fall. There was no LOC, nausea or vomiting, amnesia or visual disturbances and neurological examination was normal. He did however sustain a laceration to his occiput, which required suturing. Despite not fulfilling NICE criteria he underwent a CT head, which was unremarkable besides an old infarct. The gentleman was admitted for observation and 10hrs later dropped his GCS to 4/15. Repeat CT demonstrated a large subdural haematoma. He subsequently died 14hrs later. In hindsight, should his INR have been reversed regardless of its value to help prevent delayed bleeding?

An otherwise healthy 25 year old woman presents to the ER with 3 days of runny nose, sneezing, and nonproductive cough. She reports it feels like a common cold and usually she recovers without intervention. She has never received relief from over the counter cold medications. She is seeking care because she has a job interview in two days and wants to know if there is anything she can take to recover faster. You have heard that some providers use second generation antihistamines for upper respiratory infections, and wonder if there is any evidence behind the practice.

A 24 year old man attends the Emergency Department having suffered an injury to his right shoulder whilst playing rugby. He has severely restricted movement. Plain x-ray shows no fracture. MR scan shows rotator cuff disruption. He is referred and subsequently undergoes operative repair. He is sent for rehabilitation post operatively. You wonder whether hydrotherapy will benefit him.

A 64 year old male presents with epistaxis. Your usual approach is to attain haemostasis, check for hypertension and coagulopathy. As you prepare to gain IV access and take blood you wonder whether there is any evidence to show that checking the clotting is warranted.

You're having a bad day! You've just seen your third neonate in 2 hours with a sticky eye and the senior nurse informs you that you dispensed the final bottle of chloramphenicol eye drops in the Emergency Department to the last child. In a rapidly deteriorating mood, you ring pharmacy, who suggest fucidic acid (Fucithalmic) eye drops. You wonder if it is comparable to the standard treatment with chloramphenicol.

A sixteen year old patient presents to the emergency department following a crush injury, with an acute traumatic subungual haematoma of the finger. The nail margin and nail are intact. There is an undisplaced fracture of the distal phalanx present.

The local ambulance service bring in a 22 year old male who was witnessed by shoppers to have a seizure in the town centre, but there are no longer any eye-witnesses available to give a collateral history. You wonder whether a prolactin level will help you to differentiate between an epileptic seizure and a pseudoseizure.

on friday night in a busy ED, a 22 year old single female law student presents with lower abdominal discomfort and per vaginal spotting for 12 hours. She is primigravida, with unplanned pregnancy which happened while she was on oral contraceptive pills. She does not have any other significant medical history. She is afebrile. Pulse of 75/min, B.P is 126/79 with postural drop of 15mm(Hg). Abdominal examination is completely normal. Urine dip shows positive B HCG and blood test are completely normal. The timeliest appointment in early pregnancy unit is not available till Monday. You are concerned about sending this patient home. You have an ultrasound machine available in department. Can this ultrasound be used as a screening tool to risk-stratify this patient with any degree of certainty during first consultation in ED? What does the evidence say?

A four year old attends the emergency department with a head laceration that requires suturing. You have heard of ketamine/propofol mixtures being used for sedation and wonder if you should consider using it for procedural sedation