bestBETs

A 67 year old female attends the Emergency department after a fall onto outstretched hand. X-rays identify a Colles fracture with dorsal angulation and shortening of the distal radius which requires manipulation. With experience of reducing Colles fractures you wonder if bupivacaine will give better analgesia improving patient comfort during and after the procedure than lignocaine.

You are called to the emergency department to see a 35 years old man who presented with severe left loin to groin pain and vomitting. On examination you find him rolling in the bed, tachycardic and has a left renal angle tenderness. You control his pain and decide to run a urine test to confirm the diagnosis of renal colic. The urine dipstick comes back as normal, and leaves you with this question: How sensitive is the lack of hematuria in rule out the diagnosis of acute renal colic?

Whilst on duty in the ED, a young man is brought into the resuscitation room with a stab wound to his abdomen. A trauma call is put out and resuscitative measures started. Primary survey includes a positive FAST scan. The bleeding is severe and the Trauma Lead initiates the massive transfusion protocol. Packed red cells, platelets and FFP are transfused in a 1:1:1 ratio, as per protocol. The patient is taken to theatre to control the bleeding. As he is leaving, the Trauma Lead asks you to take a further clotting sample to measure PT, APTT and INR so that 'we’ll know how many more products to give him’. You follow up this patient and find that he survived and is currently on ITU. The Intensivist tells you he is suffering from ARDS, likely to be a Transfusion Associated Lung Injury (TRALI). The Intensivist believes the patient received far too many blood products during his resuscitation and in theatre. You wonder if there is a way of guiding blood product replacement in trauma situations which may supersede rigid transfusion protocols. You are aware that TEG machines are used to guide blood product replacement for open cardiac surgery patients and wonder if the same technique could be used to guide transfusion for trauma patients.

A 28-year-old female presents to the emergency department with fever, influenza-like symptoms and diarrhea. History reveals she recently returned from a two week trip to rural Kenya. You consider malaria in your differential and wonder if using the Binax NOW malaria rapid diagnostic test (RDT) has sufficient accuracy to guide your treatment decision and hasten disposition.

A 29-year-old man presents to the emergency department after sustaining a mid-shaft spiral closed tibial fracture in a motorcycling crash. You know he is at high risk of developing compartment syndrome and requires compartment monitoring. You wonder whether the distance of the compartment monitoring device from the fracture site affects the pressure reading and therefore the accuracy of the diagnosis of compartment syndrome.

A 30-year-old woman had swallowed an overdose of pills. Her husband asks you what he could have done to help his wife while waiting for the emergency medical services to arrive. You wonder whether he could have laid her in a particular position to ensure that the poisoning would have less detrimental effects.

A 30-year-old man falls from a third storey window on to concrete. He complains of pain around his pelvis. You know that a vertical shear injury is more likely than an open book pelvic injury with this mechanism, and wonder whether you should apply a pelvic splint before he reaches hospital, when he arrives, or not at all.