bestBETs

A 24 year old man attends the Emergency Department having suffered an injury to his right shoulder whilst playing rugby. He has severely restricted movement. Plain x-ray shows no fracture. MR scan shows rotator cuff disruption. He is referred and subsequently undergoes operative repair. He is sent for rehabilitation post operatively. You wonder whether hydrotherapy will benefit him.

A 64 year old male presents with epistaxis. Your usual approach is to attain haemostasis, check for hypertension and coagulopathy. As you prepare to gain IV access and take blood you wonder whether there is any evidence to show that checking the clotting is warranted.

You're having a bad day! You've just seen your third neonate in 2 hours with a sticky eye and the senior nurse informs you that you dispensed the final bottle of chloramphenicol eye drops in the Emergency Department to the last child. In a rapidly deteriorating mood, you ring pharmacy, who suggest fucidic acid (Fucithalmic) eye drops. You wonder if it is comparable to the standard treatment with chloramphenicol.

A sixteen year old patient presents to the emergency department following a crush injury, with an acute traumatic subungual haematoma of the finger. The nail margin and nail are intact. There is an undisplaced fracture of the distal phalanx present.

on friday night in a busy ED, a 22 year old single female law student presents with lower abdominal discomfort and per vaginal spotting for 12 hours. She is primigravida, with unplanned pregnancy which happened while she was on oral contraceptive pills. She does not have any other significant medical history. She is afebrile. Pulse of 75/min, B.P is 126/79 with postural drop of 15mm(Hg). Abdominal examination is completely normal. Urine dip shows positive B HCG and blood test are completely normal. The timeliest appointment in early pregnancy unit is not available till Monday. You are concerned about sending this patient home. You have an ultrasound machine available in department. Can this ultrasound be used as a screening tool to risk-stratify this patient with any degree of certainty during first consultation in ED? What does the evidence say?

The local ambulance service bring in a 22 year old male who was witnessed by shoppers to have a seizure in the town centre, but there are no longer any eye-witnesses available to give a collateral history. You wonder whether a prolactin level will help you to differentiate between an epileptic seizure and a pseudoseizure.

A four year old attends the emergency department with a head laceration that requires suturing. You have heard of ketamine/propofol mixtures being used for sedation and wonder if you should consider using it for procedural sedation

A 30 year old male presents with 24 hours of right ankle pain, swelling and fever. You decide to perform needle aspiration of the ankle joint to diagnose a suspected septic arthritis.

A 36 year old motorcyclist sustained an isolated cervical spinal cord injury at C5/6 level discovered on MRI after falling off his motorcycle in a road traffic collision. You wondered whether hyperbaric oxygen therapy may be a useful treatment to improve his neurological outcome.

You are a neonatal Registrar and called by the nurse to review a 10 days old preterm baby born at 27weeks gestation for vomiting. Baby is otherwise well in self with normal systemic examination. Baby is receiving expressed breast milk with thickener. You planned to commence the baby on Ranitidine for suspected gastro oesophageal reflux. You wonder whether ranitidine can increase the risk of necrotising enterocolitis (NEC) in this baby.

A 30 year old man is admitted to the Emergency Department with a history of an unknown drug ingestion. He is stuporous and unable to give a coherent history. His observations are abnormal and he undergoes emergency tracheal intubation to protect his airway due to a decreasing level of consciousness.

65 yrs old gentleman comes with SOB for last 12 hrs, has got previous history of COPD and IHD, would Ultrasound be helpful to differentiate between Pulmonary edema and COPD?

A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient.