bestBETs

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

A 30 year old male presents with 24 hours of right ankle pain, swelling and fever. You decide to perform needle aspiration of the ankle joint to diagnose a suspected septic arthritis.

A 36 year old motorcyclist sustained an isolated cervical spinal cord injury at C5/6 level discovered on MRI after falling off his motorcycle in a road traffic collision. You wondered whether hyperbaric oxygen therapy may be a useful treatment to improve his neurological outcome.

You are a neonatal Registrar and called by the nurse to review a 10 days old preterm baby born at 27weeks gestation for vomiting. Baby is otherwise well in self with normal systemic examination. Baby is receiving expressed breast milk with thickener. You planned to commence the baby on Ranitidine for suspected gastro oesophageal reflux. You wonder whether ranitidine can increase the risk of necrotising enterocolitis (NEC) in this baby.

A 30 year old man is admitted to the Emergency Department with a history of an unknown drug ingestion. He is stuporous and unable to give a coherent history. His observations are abnormal and he undergoes emergency tracheal intubation to protect his airway due to a decreasing level of consciousness.

65 yrs old gentleman comes with SOB for last 12 hrs, has got previous history of COPD and IHD, would Ultrasound be helpful to differentiate between Pulmonary edema and COPD?

A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient.

A 68 yrs old female presents with Fracture neck of femur in ED after a fall and now in severe pain 10/10 and we couldn't get a line so IV morphine can be given, so would intranasal diamorphine be a suitable alternative?

A 65 yrs old gentleman presented to the ED with Acute SOB and high temperature with previous history of LVF. Will IVC diameter help decide whether we need to give or restrict fluids to treat him?

A 46 year old man presents with a painful erection lasting approximately 4 hours. Your attending physician recommends giving oral terbutaline to the patient, but cannot recall the effectiveness of this drug in the treatment of acute priapism.

A 55-year-old female patient is brought into the Emergency Department in cardiac arrest. She is intubated but you cannot get peripheral or central venous access. You wonder if intraosseous access is worth a try to deliver drugs and if this will improve outcome.

A 65-year-old man is brought to the Emergency Department with no recordable blood pressure and a temperature of 39°C. You attempt unsuccessfully to insert a peripheral line several times and you decide to cannulate a central vein. Your colleague asks you if it would not be wiser to wait for the patient’s blood coagulation profile to avoid potential bleeding complication.