bestBETs

A 5 year old boy is brought into the Emergency Department by his mother. He complains ofconstipation. You consider ordering an AXR to rule out intra-abdominal pathology and guide management.

A 5-year-old female presents to the emergency department after a fall from playground equipment. Parents are concerned about significant head injury. You perform history and physical exam and would like to use a pediatric head injury algorithm to help guide your need for advanced imaging and you hope to avoid unneeded imaging. You wonder how accurate your exam is for pediatric skull fracture.

You are working in an Emergency Department during the Influenza season. You see a patient who has presented with typical symptoms of influenza. Their point of care influenza test is positive, but they don’t have ‘high risk’ clinical features making Oseltamivir (Tamiflu) an appropriate option. You wonder whether, for [patients with suspected or proven influenza], whether [products containing Echinacea Purpurea extract] might reduce the [clinical symptoms or duration of illness] compared to [placebo or Oseltamivir].

38-year-old female, 30 weeks of gestation with her 3rd child, had 1 miscarriage a year ago due to pre-eclampsia. At her last doctor's visit, she was placed on medication to keep her blood pressure under control. The patient is staying 4 hours away from the closest rural hospital. The patient was educated on hypertension and instructed to keep track of her blood pressure daily. The patient called one night and stated that she ran out of her blood pressure medications two days ago, and her blood pressure reading has been increasing since this morning and is now reading 170/116. The closest airport is 10 minutes away from her, and the flight time is 1 hour. The aircraft was activated immediately. Would oral nifedipine be better than labetalol in stabilizing this patient pre-hospital?

A 27 year old man presents with a 24 hour history of recurrent vomiting. You note he has had 5 previous presentations in the last 6 months. He has a history of daily cannabis use and it appears that his vomiting has been difficult to manage on his previous attendances. He states he often feels better after a hot shower. You have heard someone mention that there can be similar relief to hot shower by getting the patient to apply a capsicum based cream which causes a similar heating to the skin. You wonder if there is any evidence to back this up.

51 year-old man present to ICU with respiratory symptoms, increased oxygen requirement, SOB and increased WOB. He has a background of TIIDM. ABG revealed type one respiratory failure. Patient not weaning. Clinical examination reveals bilateral dull percussion, reduced basal expansion. Portable CXR bibasal consolidation/atelectasis ?infection. COVID -ve. Consultant perform lung ultrasound and revealed bilateral pleural effusion worse on right which was tapped. You wonder if doing ultrasound on everyone would change clinical management and impact on patients quality of care if done routinely.

The mother of a 3-year-old boy, who was in excruciating pain and distress, accompanied him to the emergency room. The mother recounts the sequence of events: The boy's goal was to get his cereal from the cupboard. In order to reach it, he stood on a chair, which unfortunately toppled over, causing him to strike the underside of his chin against the corner of a table. When medical staff entered the room, the child would cry out loud, and the mother said that the boy had a large, heavily bleeding cut under his chin. Out of two medications you may use to sedate the youngster before examination and therapy, which would you prefer: nasal ketamine or nasal fentanyl?

Paramedics often perform cardiopulmonary resuscitation in out-of-hospital setting. Dynamic yet stressful environment may hinder them to perform quality cardiopulmonary resuscitation.

A 64-year-old woman is brought to your Emergency Department with acute onset isolated lip and tongue swelling. Despite having no other symptoms of anaphylaxis, she quickly receives intramuscular epinephrine and intravenous methylprednisolone without any effect. Her history reveals that she has been taking ramipril for two years to treat her hypertension. You suspect a bradykinin-mediated ACE-inhibitor angioedema and have heard that icatibant may help this patient, but you’re not sure if there is convincing evidence for its use.

A 12-year-old child presents to the emergency department following a major trauma. Primary survey reveals signs of shock so you commence initial resuscitation for this. Tranexamic acid is widely used for adult trauma patients and you wonder if using it in this child would reduce the bleeding and improve outcomes.

As we are aware, trauma to elderly patients is significantly worse in terms of outcome compared to a younger adult. I wanted to investigate if the benefit would out weigh the risk for administering tranexamic acid to all 'silver trauma' patients.

A 39 year old man is experiencing acute on chronic non specific lower back pain, this is the second such episode he has had despite being active and a regular attendee at the gymnasium. His current employment requires a reasonable level of fitness and he is struggling without constant topical analgesia. A colleague suggests pilates, upon research he wonders if a certain style/type is more effective at reducing symptoms and preventing future episodes.

A 38y/o male presents with persistent shoulder pain, after manual clinical assessment and ultrasound it is confirmed he has a rotator cuff tear. The patient expresses concerns and wants to know what his long term treatment options are.

A 6 day old baby was seen in CEC with mild increase in WOB. The baby was saturating well and was feeding normally so parental education was given and they were advised to go home and return if things change. However, before discharge the parents mentioned they were worried about the yellow tinge to babys skin. The history revealed no risk factors for pathological jaundice, however, before discharge a serum bilirubin level (SBR) was done to ensure normal bilirubin levels and put the parents mind at ease. The results showed serum bilirubin was well below the treatment line (122umol/L). Was it necessary to bleed this baby or would a transcutaneous bilirubin measurement have been an effective method to rule out significant hyperbilirubinemia?

A family have concerns over their 56 year old family member who has presented with sudden on-set coordination/gait problems, who has also vomited twice. An ambulance is called and the patient has been assessed as FAST neg. Despite this, the gentleman was transported to the local emergency department. When in the emergency department he was further assessed and found to also have ataxia and problems with vision. CT head revealed the patient was suffering with an ischemic stroke effecting a posterior artery.