bestBETs

A baby is brought in to ED, by concerned parents, with high fever and history of generally being unwell with no clear history pointing towards any clear diagnosis or focus of infection. You wonder whether you need to proceed with a full septic screen, or whether a positive diagnosis of influenza on rapid bedside testing would be sufficient to allow safe discharge directly from the ED.

A 60 year old man presents to the Emergency Department (ED) with chest pain. The ECG shows an ST elevation MI. You give him oxygen, nitrates, aspirin and morphine and also start thrombolysis. You wonder whether giving him clopidogrel as well would be beneficial.

A young 23 year old fit healthy male patient is brought in by ambulance with agitation to emergency department.His friends give a history of cocaine use whilst he was out partying.while you are examining he has a generalised tonic clonic seizure

An elderly lady presented in severe pain with shorted and externally rotated leg in keeping with a NOF fracture. You are worried about giving her iv Morphine. In your anaesthetic secondment you observed a Fascia iliaca Block being used for post operative pain control and you wonder whether you can do the same.

A 45 year old man presents with a painful swollen ankle. No fractures are seen on X-ray and he is diagnosed with an ankle sprain. He has a history of duodenal ulcers and gastrointestinal bleeding treated with proton pump inhibitors for the last 5 years. You wonder whether the topical non-steroidal anti-inflammatory drug (NSAID) patch, diclofenac epolamine topical patch (DETP) 1.3% (FLECTOR® Patch, King Pharmaceuticals® Inc., Bridgewater, NJ, USA), can be prescribed to manage pain instead of an oral NSAID formulation.

A 2-year-old girl presented with 1-day history of temperature, off food and “not herself”. Clinical examination showed a slightly irritable child with a temperature of 38.8°C, mildly congested throat and doubtful neck stiffness, with no other apparent focus of infection. Urine was clear. A full septic screen was performed including lumbar puncture. C reactive protein was 38; cerebrospinal fluid (CSF) showed glucose 3.6 mmol (blood glucose 4.8 mmol), protein 0.6 g/l, white blood cell count 4 with no bacteria on Gram staining. The child was observed with a diagnosis of viral illness without any antibiotics. We wondered: can meningitis occur with initial normal CSF?

A 45 years old man with known history of peptic ulcer disease is admitted with haematemesis and malaena. The is no history or stigmata of chronic liver disease to suspect varices. You want to know whether giving proton pump inhibitors (PPI) as intermittent intravenous (IV) bolus dose is as effective as as a continuous IV infusion pre endoscopy.

An elderly Patient with the history of BPH presented in A/E department with acute retention. He was successfully catheterised; he has no signs of UTI or acute renal impairment. Some hospitals discharge these patients and arrange Trial without Catheter as OP. I wonder if early TWOC is more successful than delayed in this group of patients.

A 60-year-old man comes to the emergency room with his right knee swollen and has experienced pain for two days. He has concomitant fever and history of gouty arthritis. Laboratory studies do not demonstrate specific findings except a slightly higher serum level of uric acid. You wonder whether or not serum procalcitonin could be helpful in the differentiation between septic and nonseptic arthritis.

A 4-month old child is presented at the emergency department with coryza,cough and wheeze. You see an alert, well hydrated wheezing infant with mild respiratory distress and oxygen-saturation 93%. You wonder wether it is safe to send this child with bronchiolitis home.

It's the end of a particularly eye-rending nightshift. You're looking forward to bed but are called to minor injuries where one of the ENP's friends' feet are on display with either leprosy or athlete's foot, you can't decide. He tells you he's tried over-the-counter (OTC) daktarin (miconazole 2%). When asked for advice, instead of inwardly screaming and recommending a trip to see his GP or pharmacist, you admit you don't know, recommend OTC terbinafine and shuffle off to a warm and comfy bed (mmmm, bed!). For some reason you can't sleep that night and eventually get up at 2 am (perhaps it's that itch between your own toes) to find the answer to the question.

A 28 year old female presents with a four month history of ‘tennis elbow’ (lateral epicondylitis). You want to treat her with a form of electrotherapy and you wonder if one form is better than another.

A 54 year old female smoker with a history of hypertension presents to the emergency department with a complaint of heart fluttering and shortness of breath. Her vital signs reveal a blood pressure of 145/80, a pulse rate of 207, a respiratory rate of 18, and a pulse oximetry of 100% on room air. Her exam revealed tachycardia but it was otherwise within normal limits. An ECG was obtained and it revealed supraventricular tachycardia (SVT). While you treat the patient’s heart rate, you wonder if a troponin level would be useful in evaluating the presence of coronary artery disease.

A 33 year old office clerk presents with a painful wrist swelling which he noticed a few months ago. The lump is interfering with his daily activities at work. Clinically it is a soft cystic mobile lump on the anterior aspect of the wrist. You wonder whether to aspirate the cyst in the department or refer him for surgical excision.

The standard practice to increase the likelihood of yielding a positive blood culture is to obtain blood specimens at or around the time of a temperature spike. This is based on the principle that the presence of organisms in the intravascular space leads to the elaboration of cytokines, causing body temperatures to rise. In clinical practice this is not always possible, so I want to determine whether it is necessary to obtain blood sample for culture when a patient is febrile.