bestBETs

Term baby with moderate HIE being re-warmed after 72 hours of cooling developes seizures.

You see a baby on the neontal unit. There are no contraindications to feeding and you would like to start feeds. Mum is not available for feeding but is keen to breast feed. The nurse suggests that the baby should be cup fed as bottle feeding will interfere with successful breast feeding You wonder if this is based on evidence..

A 36-week 3550 g neonate is admitted to the intensive care unit and commenced on intensive phototherapy for known Rhesus haemolytic disease. In spite of intensive phototherapy, the bilirubin level approaches the exchange transfusion threshold by hour 16 of life. The specialist registrar orders a crossmatch of blood and arranges for central line insertion in preparation for an exchange transfusion. The new registrar queries why intravenous immunoglobulin is not being used first in an attempt to avoid exchange transfusion.

A 6-year-old girl presents for a routine asthma follow-up appointment. She takes 200 µg per day of inhaled budesonide and uses her salbutamol 3–4 times per week. She has been in hospital three times in the last 2 years. The medical student in clinic asks whether you intend to offer a written management plan as these are used widely in adult practice.

You are the paediatric senior house office running the prolonged jaundice clinic. A urine sample from a baby was collected via the "clean catch" method and has a mixed (contaminated) growth on culture. You need to recall the baby for repeat urine culture and wonder whether it is best to perform a suprapubic aspiration to minimise the chance of another contaminated sample or whether an in–out urethral catheter sample would be as good.

A healthy 14-year-old boy involved in an altercation with another boy sustains injury to his jaw and two of his incisor teeth are avulsed. He attends the Emergency Department with his teeth wrapped in tissue paper. The nurse at the triage asks whether we need to put the teeth in milk immediately. You wonder whether this is 'Nanny advice' or evidence-based?

A 33 year school teacher arrives in the Emergency Department following a trip to the local botanical gardens. She has breathing difficulty with extensive expiratory wheeze and a florrid urticarial rash. She was given salbutamol by nebulizer in the ambulance. She continued to wheeze in the Emergency Department and was given intra-muscular adrenaline. You wonder whether nebulised adrenaline would have worked for her wheeze as this was an acute allergic reaction/anaphylaxis and not asthma.

A 34 year Jamaican man attended the Emergency Department after having his back tattooed. He had gross urticaria and swelling to his lips and face. His tongue was large and inflamed. You looked at the tongue and wondered if you could put a tablet of adrenaline under it and whether it would work as well as an intramuscular injection. You remember from your student days that sublingual and rectal absorption of tablets is much faster than intramuscular injection.

Your consultant is about to operate on an urgent in-patient referral with left main stem disease who has long-standing diabetes and hypertension with atheromatous changes in the aorta. You ask him if he will use the single cross-clamp (SC) technique for coronary artery bypass grafting (CABG). He replies that he has not seen any convincing papers that prove that this will protect the patient from stroke and he is concerned that this technique may unnecessarily increase the myocardial ischaemic cross-clamp time. You decide to look up the evidence for his statement.

A 30 year-old female is brought to the emergency department with extensive burns after having been trapped in a burning car. After initial resuscitation of the patient you attempt to assess the surface area of skin affected by the burn in order to guide the volume of fluid required for resuscitation. You wonder which method of surface area assessment is the best tool for assessing the surface area of her burns.

A 25 year old patient is subdued by law enforcement with the use of a Taser device. He is brought to your Emergency Department for further evaluation. You would like to know what type of cardiac monitoring is necessary (and for how long).

A 40-year-old female presents to the emergency department with epigastric abdominal pain and nausea. Her WBC count and transaminases are within normal limits and her symptoms improve with pain medication and antiemetics. You wonder if performing bedside ultrasound (US) will be sufficient to rule-out cholelithiasis and hasten her disposition.

You are the Oncology registrar on call. A 38 year-old man with relapsed Acute Myelogenous Leukemia (AML) who is receiving induction chemotherapy presents to hospital with fever. On clinical assessment he has a temperature of 101°F (38.3°C) and a neutropenia (absolute neutrophil count(ANC) is 150 cells/mm³). He also has a mucositis, hypotension and pallor. He is classed as a high risk febrile neutropenic patient and admitted in isolation on the wards. He is commneced on Timantin and Amikin antibiotic therapy. Your inquisitive medical student asks you about the role of colony stimulating factors in febrile neutropenia and you send her off to search for the evidence...

60 Lady presents with headaches < 72 hours in duration and vague neurological signs. you are not sure what the diagnosis might be and think of cavernous Sinus thrombosis . You get a CT head which is normal . You think if a D-dimer levels were low could you exlude Cavernous sinus thrombosis a dangerous cause of Headaches.