bestBETs

A 72-year-old woman presents to the emergency department (ED) with hip pain after a fall from standing. She is unable to weight bear. You notice extensive bruising around her left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve her outcome when she later undergoes surgery.

A 70 year-old gentleman has presented to the Emergency Department (ED) for the 3rd time in 7 months. Your SHO insists that he should be admitted or he will just come back again. What factors in his assessment suggest that he is more likely to re-attend?

A 42 year old male presents to the ED with opioid withdrawal symptoms of moderate severity. He is hoping to be prescribed opioid agonist therapy treatment with buprenorphine. He has no other complaints.

A 65 year old man who has a history of AF on apixaban presents to the emergency department with a minor head injury (GCS 15, no loss of consciousness, no neurological deficits) after a trip and fall on the street. He does not have a headache, did not vomit, there were no haematoma or laceration wounds on his head. Does he need to be admitted for 24 hours neuro-observation?

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.

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].

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.

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.

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.