A 28 year old female attends the Emergency department with widespread red, itchy wheals covering her body. She is unsure of what has caused this and it has not happened before to this extent. She is haemodynamically stable and has no airway or respiratory involvement. She is visibly uncomfortable and you want to help the symptoms resolve as quickly as possible. You are unsure of the clinical evidence behind a course of oral steroids for acute urticaria and NICE CKS suggests it on expert advice.
Archives: BETs
A 31-year-old woman presents at the Emergency Department by ambulance following a heroin overdose. She requires naloxone for opioid-reversal. She has made a full recovery and is ready for discharge.
Capsaicin cream for cannabinoid hyperemesis syndrome: a peppered body of evidence?
A 27 year old man presents with a 24 hour history of recurrent vomiting. You note he has had 5 previous presentations in the last 6 months. He has a history of daily cannabis use and it appears that his vomiting has been difficult to manage on his previous attendances. He states he often feels better after a hot shower. You have heard someone mention that there can be similar relief to hot shower by getting the patient to apply a capsicum based cream which causes a similar heating to the skin. You wonder if there is any evidence to back this up.
A 53-year-old patient presents to the Emergency Department with an altered level of consciousness from a suspected respiratory failure. The decision was made to intubate him. As you are preparing to intubate the patient, you wonder whether pre-intubation IVF bolus administration in your normotensive patient will reduce the risk of peri-intubation complications.
A 68 year old patient, mechanically ventilated in the ICU has failed at multiple attempts at conventional weaning to a state of ventilator liberation, becoming dyspneic and desaturating. You wonder if there is a treatment adjunct you could use to increase her respiratory strength prior to further weaning attempts.
A fit and well 30-year-old male presents to the emergency department (ED) with central lower chest pain that came on at rest today and lasted 4 hours. He describes a “heavy ache” that radiated to his neck and made him feel sick, but denies vomiting or diaphoresis. He has had indigestion in the past but this felt higher and more severe than previous episodes. His observations, examination, and ECG are normal. He has no risk factors for coronary artery disease, but is worried about the possibility of a heart attack. You clinically suspect indigestion but feel a cardiac cause might be possible. He hasn’t had bloods sent and has been in the ED for 3 hours already. His HEAR score is 1 (due to a moderately suspicious history) and you wonder whether you really need to send a troponin in order to complete the HEART score and exclude an acute coronary syndrome (ACS).
Jefferson’s Burst Fracture treated with nPosterior C1 Lateral Mass Screw nApproximation
A 20-Year-old female front seat passenger with the seat belt on sustained a neck injury from a frontal collision car Accident that left her with a fronto-parietal scalp laceration; presented to the Emergency Room with cervical spine precautions. Primary survey demonstrated a non-disabling local neck pain and tenderness. The neurologic examination was normal with no disabilities, and no cranial nerve involvement. Glasgow coma scale was 15/15. Past medical history is unremarkable with no previous incident. An X-Ray, Computed Tomography (CT) scan and MRI of the neck revealed only a Jefferson fracture with a 12 mm widening of the lateral mass of C1. The Anterior Atlanto-Dens Interval (ADI) was normal (2mm) and the Space Available for the Cord was 17mm.
A 66-year-old man came to the emergency department by ambulance for cough and viral illness. His chest X-ray revealed bilateral infiltrates concerning for viral pneumonia. RT-PCR test confirmed the diagnosis of COVID-19 infection. You wonder if monoclonal antibody therapy would provide any benefits to mortality, length of stay, requirement for ventilation.
A 12-year-old child presents to the emergency department following a major trauma. Primary survey reveals signs of shock so you commence initial resuscitation for this. Tranexamic acid is widely used for adult trauma patients and you wonder if using it in this child would reduce the bleeding and improve outcomes.