bestBETs

A 32 year old gentleman presents to the Emergency Department after falling during his 5-a-side football match. He reports hearing a ‘pop’ and pain in his posterior ankle. His Simmonds-Thomson test is positive and you suspect an acute rupture of his achilles tendon. You wonder if this patient should be put in an equinus cast or heel-raised functional bracing prior to orthopaedic clinic review.

A 35-year-old man was sent to the emergency department after being hit by an electric car. He complained of right chest pain, no tenderness in the ribs and normal chest X-ray, but the patient still unwell consider sending him for a chest CT but your colleague told you that you could first scan the chest ultrasound for diagnose occult pneumothorax. You want to know whether patients with negative chest X-ray can diagnose the presence of occult pneumothorax by ultrasound.

Following a failed extubation on day 3 of life on a neonate born at 25 weeks gestation, an echocardiogram was performed that showed a hemodynamically significant patent ductus arteriosus (PDA). A clinical decision was made to treat the PDA with intravenous paracetamol. A recent review article showed an association between prenatal and neonatal use of paracetamol with adverse neurodevelopmental outcomes. Can this be true for paracetamol use for PDA closure?

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.