bestBETs

A previously well, term 20 day year old male is brought into the emergency department one evening. His mother reports that he is hot, irritable and not feeding. Examination does not find a source of infection but his observations show that he is febrile with a temperature of 38.1 degrees and his heart rate is raised at 190 bpm (normal range 120-160 bpm). You wonder if his raised heart rate increases the likelihood that this neonate has a serious illness?

A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using rectal thermometry.

A previously well, term 4 day old female neonate presents to the emergency department. On examination she is febrile with a temperature of 39.1 oC, tachycardic, tachypnoeic and has no focus for her fever. You decide to do a full septic screen and one of the things you need is a urine sample. You wonder whether a supra-pubic aspiration would be the best method for obtaining a sample in this neonate?

A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using tympanic thermometry.

You wonder why some hospitals splint buckle fractures and others plaster them. Is there any need to plaster these fractures? Only 1 study for futura splints (currently a 2nd trial in recruitment stage in Washinton USA). So looked for papers that compared plaster cast with alternatives including wool and crepe and tubigrip, 1 trial comparing splint with no treatment at all.

An 8 month old boy with atopic dermatitis attends the Paediatric Emergency Department. His mother's main concern is his itching which is causing him to become distressed and areas of skin to become broken down despite the use of emollients. You know that in older children the use of sedating antihistamines is recommended. You wonder if there is anything available to treat this infant's pruritus.

A five year old child presents to the Paediatric Emergency Department with a moderate exacerbation of atopic eczema. They have leukaemia and are likely to be immunocompromised. Usually you would give a mid-potency hydrocortisone cream but know they are only recommended by NICE in non-immunocompromised patients. You wonder whether any complications such as herpetic infection are increased when using potentially immunosuppressing drugs in immunocompromised children.

You are attending a paediatric patient in the Emergency Department. You note from the triage observations that the patient, a normally healthy 6-year-old, has a blood pressure of 80/40mmHg. You wonder if this is a little low, but cannot recall what the normal blood pressure for a child should be. You ask your registrar, who insists that you should use reference tables, while an eavesdropping consultant suggests using the formula from the APLS course - though he can't remember what it is. You wonder how best to ascertain the normal value.

A 60 year old gentleman presents to the emergency department with a spontaneous epistaxis. The bleed is anterior, from one nostril and stops with simple pressure application The patient is extremely concerned about this happening again asks what can be done to stop it? You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?

2 years old boy presented to A&E after a fall and was not weight bearing since. The clinical examintation revealed some tenderness at the junction of middle and lower 1/3 of anterior aspect of tibia. xrays did not reveal any fracture of tibia or fibula. Would you treat him in above-knee or below-knee cast for presumed toddler's fracture?

An 8 year old child has a 5cm laceration that requires closure with sutures. You wonder if TAC or LAT would be more effective in reducing the pain of suturing.

A 28 year old male is referred to physiotherapy with a 18 month history of right patella tendinopathy. You plan to use a eccentric exercise programme and wish to know what the efficiency of this treatment is against other non-invasive treatments is.

A 19 year-old girl was brought in having fallen off her horse at a canter and kicked in the abdomen. An ED trauma call was initiated. She was alert, orientated, stable but tachycardic. She had external bruising to her abdomen and it was tender on palpation, a training FAST scan was negative. Analgesia was given and the tachycardia remained. A CT abdo was requested. The consultant radiologist insisted that oral contrast was given. I wondered whether giving oral contrast improved images and diagnosis enough to outweigh the delay to scan as well as the hazards of giving oral contrast.

A 30 year old female presents to the emergency department with a swollen, bruised and painful wrist following a hyperextension injury. After examination and appropriate investigation you diagnose a wrist sprain. She asks you if she can have a splint to wear. You are unsure whether a period of immobilisation in a splint or early mobilisation is the best option.

The mother of a 5-year-old boy with athetoid cerebral palsy complains of difficulties putting his Lycra suit on each day. She is keen to know if it actually helps improve his function and movement.

A five year boy is presented to the Emergency department by his mother. His mother complains that he has constipation. After examining the boy's abdomen you wonder whether in order to confirm the diagnosis you should perform a digital rectal exam (DRE).