bestBETs

An elderly man attends the emergency department with a clinical fracture dislocation of the ankle after a fall. He has got significant co morbidities and a history of recent myocardial infection. You have read that ankle fracture-dislocations can be reduced with intra-articular lidocaine (IAL). You wonder if IAL is as effective as intravenous analgesia and sedation (IVAS) in facilitating reduction and providing adequate analgesia.

A 3 year old with croup presents to A&E with inspiratory stridor. You want to treat with a steroid, and know dexamethasone is commonly used. Having recently used prednisolone in asthma, you wonder if this would be as effective as dexamethasone.

A patient presents with a fingertip injury that includes a laceration to the nail bed. The X-ray demonstrates a fracture of the distal phalanx. Should the patient receive antibiotics to prevent osteomyelitis, after appropriate wound toilet and closure?

A 73yr old man with COPD is seen in the Emergency Department. You give him salbutamol and atrovent nebulisers but he remains breathless. You wonder whether giving intravenous or oral steroids would reduce length of hospital stay and his risk of death.

A patient is bought to the Emergency department with pelvic trauma. One of the members of the trauma team mentions that the new T-pod pelvic binder is better than the traditional wrapped sheet. You wander if there is any evidence to support this

47year old gentleman presents to physiotherapy with a 6 month history of right heel pain, worse in the morning, particularly the first few steps. Previous conservative management failed. Physiotherapy including calf stretches, taping, activity modification and soft tissue techniques was unsuccessful. Insoles provided by podiatry were not effective. This patient has been told about shockwave therapy by a friend and would like to try it.

Adult trauma patient presenting with hemorrhage or at significant risk of hemorrhage. Can early administration of a 1 g loading dose of Tranexamic acid infused over 10 minutes followed by a transfusion of 1 g over 8 hours decrease rates of adverse events including further hemorrhage, blood transfusion and death?

An 18 year girl went hiking for the first time. Unfortunately she had to interrupt the trip because she suffered from several friction blisters on her feet. When arriving at the emergency department with an infected blister, she asks you whether she could use antiperspirants in order to prevent blisters the next time.

A nine year old child is brought to the emergency department with a tender, red swelling on her eyelid. You diagnose hordeolum (stye) and recommend treatment with warm compresses four times a day. A colleague later challenges your advice and asks what evidence there is for it.

A 30 year old patient presents to her general practitioner, she has been suffering from postprandial dyspeptic symptoms after dinner regularly. You have heard that a walk after dinner offers some benefit in such cases and wonder if there is evidence to support this.

Whilst working in the Emergency Department you assess a 44 year old male patient with a large intracerebral haemorrhage. He only scores 2 on his early warning score due to his decreased level of consciousness, his other physiological variables being normal. Based on clinical indications, he is intubated and ventilated and taken to intensive care but dies two days later. Whilst reflecting on this case you wonder whether early warning scores are sensitive and specific enough to predict mortality in ED patients.

A premature infant (30 weeks) weighing 1050g was recently admitted to the NICU after an uncomplicated delivery. You have spoken to 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 adequate intake of macro 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.

Blood gas analysers are typically preset to assume a patient’s temperature is normothermic at 37 degrees centigrade. In clinical practice the temperature of the patient is infrequently taken at the time of sample or entered into the analyser. With emergency departments exposed to patients presenting with temperature extremes, you wonder whether the temperature entered into the gas analyser has a significant effect on results and subsequent clinical management.