bestBETs

A patient presents to the emergency department following an isolated chest injury. He is not dyspnoeic and recorded observations are normal but chest xray demonstrates a simple pneumothorax. You wonder does this patient require formal chest drain insertion or can he be treated conservatively?

A 4 year old boy is brought to the emergency department having fallen over at home. He has sustained a 3 cm deep laceration to the forehead. He was never unconcious and you have no concerns of an underlying brain injury. The wound clearly needs closure and cleaning but he is upset and would not be able to cooperate without sedation. You suggest this but his mother states that he ate 3 hours ago. You phone the anaesthetist on call who tells you that you should wait a further 3 hours to ensure that he is fasted. You wonder if this is really necessary.

A 32-year-old healthy man attends the emergency department with a right shoulder injury he sustained during a hockey game. Clinical examination reveals a defect in his glenohumeral joint, an anterior shoulder dislocation and no neurovascular deficits. x Rays reveal an anterior shoulder dislocation and no fracture. You are aware of endless discussion about the "best" technique for reduction and see no reason why you should not join in. In this light you wonder whether the scapular manipulation technique or Milch’s technique is the best at achieving the most successful reduction?

A 53 year old male is brought in by ambulance from a nearby building site after a collapse, on an uncharacteristically hot day. In the resuscitation room he has a GCS of 3. He is found to be warm and dry and to have a temperature of 42.3°C. You diagnose heat stroke and wonder if Dantrolene would be useful in this scenario.

You are working in a very busy Accident and Emergency Department and the Triage Nurse informs you that, a patient with "Amphetamine induced chest pain" has just arrived. you wonder , what his chances are, to develop Acute Myocardial Infarction.

A 4 year old patient presents to the ED with a lip laceration, you decide to repair it under ketamine sedation and prepare an appropriate dose of ketamine and atropine. However, before administration your colleague (who has recently returned from Australia) tells you that it is a waste of time and that the Antipodeans never use it. You wonder if this is true.

In [adults with displaced nasal fractures] does [ digital manipulation under local anaesthesia] produce [cosmetic appearance and airway patency comparable to manipulation under general anaesthesia, at acceptable pain levels for the patient

A 60-year-old man with fever for 5 days is brought to the emergency department by his family. He has no other somatic symptoms except for fever. The results of the physical examination are within normal limits except for a moderately enlarged prostate. Laboratory studies including chest film and urine analysis show no specific findings. You wonder whether serum prostate specific antigen level would assist in the diagnosis of acute prostatitis.

A patient is brought to the emergency department following a motor vehicle accident. He is tachycardic, hypotensive, with decreased breath sounds on the left. The airway is patent. You place a chest tube and there is a sudden rush of air. Vital signs improve. CT of thorax revealed tube postioned in the lung fissure and a small hemothorax. The chest tube has drained 300 ml. You wonder if a chest tube placed in the fissure is adequate for drainage of a hemopneumothorax.

A 25 year old male arrives to the emergency department following Tricyclic antidperessant overdose. He is drowsy upon arrives and soon after develops a grand mal seizure that lasts over five minutes. You wonder whether benzodiazepines are a safe and effective treatment for the seizures in the specific situation of tricyclic antidepressant overdose.

A healthy 25 year-old male presents to the emergency department with acute conjunctivitis. You suspect that it is likely viral in etiology, but you cannot rule out a bacterial source. You wonder if he should be started on antibiotics.

A burly thirty year-old man presents to the Emergency Department having taken a significant overdose of tricyclic antidepressant drugs. He is agitated and confused and it is not possible to treat him effectively. You wonder whether it will be safe to sedate him, given that you will depress his conscious level and the tricyclic antidepressants will delay gastric emptying, increasing the risk of pulmonary aspiration.

A 25 year old man attends A&E in the early hours with a deep knife wound to his forearm. The plastic surgeon wants to take him to theatre for exploration the following morning and asks for a betadine (povidone-iodine) dressing to be applied. The wound looks clean and you wonder if this is likely to alter the likelihood of the wound becoming infected.

You are the Head of Emergency Department (ED) and are currently facing the problem of overcrowding at the ED. Many Emergency Departments (EDs) also face the problem of overcrowding.1-3 According to the Joint Commission on Accreditation of Healthcare Organisations (JACHO) in the United States, ED overcrowding was a contributing factor for 31% of cases of mortality or permanent injury from delayed treatment.2 Many measures have been taken to reduce waiting time in the ED, including increased staffing of doctors and nurses, increased trolleys and beds for short stay.4 Some studies have even explored the effect of "fast-track"5-6 or rapid assessment clinics7 on reduction of ED overcrowding. Triage has traditionally been performed by nurses.8 Putting a doctor at the triage area may potentially relieve congestion in the EDs as the doctor can promptly assess the patients and initiate treatment, especially for those with minor injuries and illnesses. The objective of this study is to review the evidence for putting a doctor at the triage area of an Emergency Department.

A 52 year old man who has been diagnosed with gastrointestinal obstruction requires a NGT to be inserted. Is nebulised lidocaine the most clinically efficacious and safe agent to reduce pain and discomfort associated with the procedure?

A patient presents to the emergency department with history of recurrent daily 4 grams of acetaminophen use. Blood work shows elevated liver function tests. Can his daily acetaminophen account for this abnormality?