bestBETs

A 68 yrs old female presents with Fracture neck of femur in ED after a fall and now in severe pain 10/10 and we couldn't get a line so IV morphine can be given, so would intranasal diamorphine be a suitable alternative?

A 65 yrs old gentleman presented to the ED with Acute SOB and high temperature with previous history of LVF. Will IVC diameter help decide whether we need to give or restrict fluids to treat him?

A 65-year-old man is brought to the Emergency Department with no recordable blood pressure and a temperature of 39°C. You attempt unsuccessfully to insert a peripheral line several times and you decide to cannulate a central vein. Your colleague asks you if it would not be wiser to wait for the patient’s blood coagulation profile to avoid potential bleeding complication.

A 46 year old man presents with a painful erection lasting approximately 4 hours. Your attending physician recommends giving oral terbutaline to the patient, but cannot recall the effectiveness of this drug in the treatment of acute priapism.

A 55-year-old female patient is brought into the Emergency Department in cardiac arrest. She is intubated but you cannot get peripheral or central venous access. You wonder if intraosseous access is worth a try to deliver drugs and if this will improve outcome.

A 3 year old with croup presents to A&E with inspiratory stridor. You want to treat with a steroid, and know dexamethasone is commonly used. Having recently used prednisolone in asthma, you wonder if this would be as effective as dexamethasone.

A patient presents with a fingertip injury that includes a laceration to the nail bed. The X-ray demonstrates a fracture of the distal phalanx. Should the patient receive antibiotics to prevent osteomyelitis, after appropriate wound toilet and closure?

A 73yr old man with COPD is seen in the Emergency Department. You give him salbutamol and atrovent nebulisers but he remains breathless. You wonder whether giving intravenous or oral steroids would reduce length of hospital stay and his risk of death.

An elderly man attends the emergency department with a clinical fracture dislocation of the ankle after a fall. He has got significant co morbidities and a history of recent myocardial infection. You have read that ankle fracture-dislocations can be reduced with intra-articular lidocaine (IAL). You wonder if IAL is as effective as intravenous analgesia and sedation (IVAS) in facilitating reduction and providing adequate analgesia.

A patient is bought to the Emergency department with pelvic trauma. One of the members of the trauma team mentions that the new T-pod pelvic binder is better than the traditional wrapped sheet. You wander if there is any evidence to support this

47year old gentleman presents to physiotherapy with a 6 month history of right heel pain, worse in the morning, particularly the first few steps. Previous conservative management failed. Physiotherapy including calf stretches, taping, activity modification and soft tissue techniques was unsuccessful. Insoles provided by podiatry were not effective. This patient has been told about shockwave therapy by a friend and would like to try it.

Adult trauma patient presenting with hemorrhage or at significant risk of hemorrhage. Can early administration of a 1 g loading dose of Tranexamic acid infused over 10 minutes followed by a transfusion of 1 g over 8 hours decrease rates of adverse events including further hemorrhage, blood transfusion and death?

An 18 year girl went hiking for the first time. Unfortunately she had to interrupt the trip because she suffered from several friction blisters on her feet. When arriving at the emergency department with an infected blister, she asks you whether she could use antiperspirants in order to prevent blisters the next time.

A nine year old child is brought to the emergency department with a tender, red swelling on her eyelid. You diagnose hordeolum (stye) and recommend treatment with warm compresses four times a day. A colleague later challenges your advice and asks what evidence there is for it.

A 30 year old patient presents to her general practitioner, she has been suffering from postprandial dyspeptic symptoms after dinner regularly. You have heard that a walk after dinner offers some benefit in such cases and wonder if there is evidence to support this.

Whilst working in the Emergency Department you assess a 44 year old male patient with a large intracerebral haemorrhage. He only scores 2 on his early warning score due to his decreased level of consciousness, his other physiological variables being normal. Based on clinical indications, he is intubated and ventilated and taken to intensive care but dies two days later. Whilst reflecting on this case you wonder whether early warning scores are sensitive and specific enough to predict mortality in ED patients.