bestBETs

Gaining vascular access in the prehospital environment is often challenging. In the circumstance where an intravenous (IV) insertion is delayed or unobtainable, intraosseous (IO) insertion should be attempted. The manual intraosseous infusion device and the semi-automatic intraosseous infusion device are both available, so you question which device offers the best rate of success, accuracy and user satisfaction in the prehospital setting.

A 32 year old un-helmeted cycle courier is brought to the ED after a collision with a car. He has an isolated severe head injury (GCS=7) and is intubated before transfer to the CT scanner. You wonder if the severity of his injury, or his outcome, would be improved had he been wearing a helmet.

An emergency medicine trainee is called to a 66-year-old man in the Emergency Department (ED), who has just had a cardiac arrest. Advanced life support (ALS) has started. The trainee knows the guidelines have recently been updated, but is not familiar with the changes. The resuscitation attempt is unsuccessful and the patient dies. Later she wonders whether using a checklist (e.g. from her smart phone or on a poster) would have been useful during the arrest to ensure that current guidelines were followed and whether this would have improved the patients chances of survival.

A 32 year old male presents to the Emergency Department with a laceration on his right forearm. He accidentally cut his forearm with the sharp edge of a metal can 14 hours ago. The wound appears clean and there is no evidence of any foreign body. Neuro-vascular and tendon examination are normal. The wound is irrigated with saline and repaired with nylon sutures. You wonder whether this wound is at a higher risk for infection because of the time lapse from injury to repair.

A 32 year old woman presents to the emergecny department with vaginal bleeding. You want to know if she is pregnant, and wonder if a urinary pregnancy test is sensitive enough to detect an ectopic pregnancy?

A 25 year old female presents to your department having fallen off her bike and is diagnosed with an undisplaced midshaft humeral fracture by a junior collegue. Plaster immobilisation and fracture clinic follow up in one week is arranged. It is likely that the arm will be immobilised for at least four weeks. There is no relevant medical history of note, however there is a family history of thromboembolic events, and the patient is on the oral contraceptive pill. You wonder if upper limb immobilisation carries similar risks to lower regarding venous thromboembolic disease.

Your patient in the Emergency Department is diagnosed with Community Acquired Pneumonia and requires antibiotic treatment. You are advised by the Medical team to give a stat dose of oral Clarithromycin as research shows oral Clarithromycin is as effective as an intravenous Clarithromycin for treatment of Community Acquired Pneumonia, and provides a cost effective treatment

A 30 year old man presents to the ED with a painful knee due to a traumatic sporting injury. You suspect a soft tissue injury and wonder if he needs an x-ray?

A 30 year old woman has been bitten by a venomous snake. In anticipation of emergency medical care, a bystander tied a compression bandage and a splint. You wonder if a compression bandage combined with immobilisation is a safe and effective first aid measure to reduce the effect of envenomation.

It is rare for Alzheimer’s disease patient to present with brain tumor. You are working in a Radiation Oncology Clinic when the nurse informs you that a patient with CNS Lymphoma and Alzheimer’s disease has arrived. You wonder the safety of cranial irradiation in an Alzheimer’s disease patient and the management of this clinical challenge.

It is not uncommon for non-insulin dependent diabetes mellitus patients having the co-morbidity of cardiovascular disease. You are working in a busy Intensive Care Unit when the nurse informs you that a congestive cardiac failure patient with Hyperosmolar non-ketotic diabetes mellitus has just arrived. You wonder the management, as treatment of one condition is contraindication for the other. Cardiovascular disease complicating Hyperosmolar Nonketotic diabetes mellitus is not a rare phenomenon and lethal if not treated properly. Both diseases are treatable individually. Treatment of one condition being the contraindication to the other, clinical judgment on management is difficult, when one complicates the other.