bestBETs

An 18 years old gentleman presents to the Emergency department with a two hours history of an acute onset of severe left testicular pain. On examination, the left testicle is tender with absent ipsilateral cremasteric reflex.

A 72-year-old man is seen in the prehospital setting following an out-of-hospital cardiac arrest with successful return of spontaneous circulation. He has received prehospital emergency anaesthesia (PHEA) for the indication of ventilatory failure / inadequate oxygenation. You wonder whether bispectral index (BIS) monitoring would reduce the risk of inadequate depth of anaesthesia in prehospital care.

You are discharging a 52-year-old man who tested positive for COVID-19 recently from the emergency department. He lives in a remote area and asks you if there’s anything else you can give him to help “stay away from the hospital”. You vaguely remember some reports on inhaled budesonide and wonder whether prescribing an inhaler would help.

A 78 year old man with chest pain presents to the ED accompanied by his daughter. He is recluctant to wear his hearing aid and is reliant on his daughter to communicate. You wish to be confident in assessing his level of chest pain and wonder if there were tools to get a more accurate pain score direct from the patient

EMS brings in a 65-year-old female who was found weak and confused at home after being found on the ground by her spouse. You complete a general assessment and rule out any major injuries. Unfortunately, you find that the patient cannot give you a useful history due to her confusion and decide to call her spouse for more information. As you are calling her spouse, the patient's nurse alerts you that she suddenly lost her pulse. Chest compressions are on-going as you enter the room and find she has PEA at the next pulse and rhythm check. You perform POCUS and find there is evidence of cardiac activity. You wonder what the likelihood of obtaining ROSC will be.

A 2 year old boy presents to the Emergency Department with pain to the lower leg and inability to walk after jumping from a low wall. His initial x-ray of the tibia and fibula shows no fracture. You suspect a possible toddler's fracture and wonder if point of care ultrasound (POCUS) would be useful to make a diagnosis.

A 40 year old male patient is brought to the hospital after being lost while snowmobiling for 3 days where the average temperature was -32 Celsius. After ensuring he is stable, you noticed he has frostbite on his feet. Despite appropriate rewarming, his toes and portions of his feet look very dark and you're worried about possible amputation. You wonder whether thrombolytic therapy could salvage his toes and feet.

25 year old Male presenting with a 2 day history of central abdominal pain associated with nausea, vomiting and poor appetite. On examination he is restless with pain, dehydrated and diffusely tender with guarding in his lower abdomen. CRP has not been done on admission bloods, and the specialty team want a CRP done before they will see him.

A young man attends the emergency department having sustained an acute anterior shoulder dislocation in a rugby tackle. Peripheral venous access has not yet been obtained. You wonder if inhaled methoxyflurane (MF) could be as effective as procedural sedation and analgesia (PSA) in facilitating successful shoulder reduction whilst reducing length of departmental stay.

A patient with a history of asthma presents to your Emergency Department with a severe exacerbation. Despite treatment with standard therapies, the patient continues to deteriorate, and you begin to prepare for intubation. You are aware of the reported potential bronchodilatory properties of ketamine and wonder if treatment with nebulized ketamine may avoid the need for intubation and mechanical ventilation.

A 63 year old male, presents with a 4 month history of a painful adhesive capsulitis or frozen shoulder. He is non-diabetic. He has restriction in motion in the capsular pattern of the shoulder. He experiences, a deep throbbing ache/ pain in his mid-upper arm, which is worse at night, affecting his sleep hygiene. A referral to physiotherapy for management of his range and pain made by his GP. If offered an injection, is there a significance of the dosage of CS (triamcinolone acetonide) on his pain reduction?

A 62-year-old gentleman attends thoracic outpatients with end-stage emphysema for consideration for lung volume reduction surgery. Imaging has identified heterogenous emphysematous areas in both upper lobes with minimal perfusion, and the patient is keen to discuss surgical options. You wonder what surgical approach would be most beneficial to the patient, bilateral or unilateral LVRS. You decide to undertake a review to investigate post-operative improvement following each procedure