bestBETs

A 12-year-old boy was admitted to our department as part of our epilepsy surgery protocol. He was admitted for video EEG and for ultimate consideration for vagal nerve stimulator (VNS) insertion. He had a background of intractable epilepsy which had not responded to multiple antiepileptic medications.

A 57 year old woman attends the Emergency Department with palpitations of uncertain duration. A diagnosis of recent onset atrial fibrillation with a ventricular rate of 160bpm is made. You decide to treat her by ventricular rate limitation and wonder whether you should use digoxin or a calcium channel blocker.

A 45 year old male presents to the emergency department after feeling a wrenching sensation in his shoulder when lifting a box onto an overhead shelf. He cannot actively elevate his arm and radiographs reveal no fracture. You suspect he has a full rotator cuff tear, but wonder what is the best clinical test to confirm your suspicions.

A 23 year old male is brought to the ED after an alleged assault. He sustained a gunshot wound to his neck, is haemodynamically stable, and currently there is no bleeding from the wound. Your secondary survey does not reveal any neurological deficit. The ambulance crew has not immobilised his cervical spine, and you wonder if you should apply cervical spine immobilisation.

A 25 year old factory worker presents to the ED with a history of painful red right eye following chemical exposure at work , the eye ph was checked with the litmus paper which gave reading of ph 7.8, the eye was irrigated thoroughly then the eye ph checked again - which was 7.2. You want to know accuracy of the litmus paper before discharging the patient

An eighteen month old boy presents with flu-like symptoms for one day. Other than shortening the length of symptoms, does antiviral therapy prevent risks of secondary pneumonia?

A 40 year old male, with a history of IV drug use, comes to the emergency department with five days of back pain. He has no history of trauma, fevers, or neurologic complaints. As an IV drug user, he has a risk factor for a BSEA, but is afebrile and is neurologic exam is non-focal. Does he need an MRI?

A pediatric patient presents to the ED in acute respiratory distress, with increased work of breathing and reduced oxygen saturation. The patient is treated with multiple rounds of nebulized albuterol, ipratropium, oxygen supplementation, and parental steroids, with none to minimal improvement in clinical and objective evidence of respiratory distress. You have heard that ketamine is the anesthesia of choice in pediatric and adult patients with bronchospasm of history of reactive airway disease. However, you wonder if ketamine’s bronchodilatory effects can reduce patient’s airway distress, prior to the need for intubation or admission, when added to standard therapies.

A 56 yr old man presents to the emergency department one week after an initial blunt left sided chest injury. Initial investigations showed no haemothorax and he had been discharged with analgesia. On his representation he was complaining of new chest pain and shortness of breath on exertion. His repeat Chest x-ray showed a haemothorax. The question was posed as to whether the correct treatment should be drainage or not.

A patient presents with a known abdominal aortic aneurysm presents to your hospital with symptoms indicating rupture. The patient is haemodynamically stable enough to have a CT scan, which confirms this diagnosis. The patient is treated by traditional open surgery, though it is noted that the anatomy of the aneurysm is suitable for endovascular repair (EVAR) using a stent graft. Subsequently the case prompts discussion about establishing a service for the treatment of ruptured abdominal aortic aneurysms (rAAA) preferentially by EVAR. You decide to search for the evidence for this in order to investigate whether such a service would be beneficial to patients.

A 71 year old pleasant man presented to the Emergency Department complaining of dark urine, urgency, occasional dysuria, suprapubic pain and foul-smelling urine for 1 month. No frequency, haematuria or flank pain was reported. He has a past medical history of diverticulitis with lower gastro-intestinal bleeding in the past. You wonder whether all cases of colovesical fistula have to be managed surgically.

It's 6 a.m. The standby phone goes and the ambulance service tell you there bringing in a chap with severe heart failure, low sats and a low BP. You attempt to stabilise him in resus. BIPAP is instituted to compensate for the respiratory failure; a small dose of IV nitrates is infused and a catheter is passed. Despite your best efforts, he remains dyspnoeic and hypotensive. You call up to ICU looking to steal some enoximone or milrinone, having previously used these agents with success, but a consultant intensivist suggests using dobutamine instead as "it does the same job". After initiating dobutamine therapy and successful transfer to CCU, you resolve to go home and find out if he's right or not.

A 32 year old patient with a history of HIV attends the emergency department with acute onset of shortness of breath. A chest X-ray reveals a right sided large pneumothorax. You wonder whether prophylactic antibiotics will improve his survival rate.