Archives: BETs

A 57 year old woman attends the Emergency Department with newly diagnosed atrial fibrillation of uncertain duration. You decide to treat her by ventricular rate limitation and wonder whether you should use digoxin.

A 57 year old woman attends the Emergency Department with newly diagnosed atrial fibrillation of uncertain duration. You decide to treat her by ventricular rate limitation and wonder whether you should use digoxin or a calcium channel blocker.

A 60 year old female patient has treatment for widespread generalised OA. Her friend peruses the shopping channel and wants to buy a magnetic bracelet as a gift. Your patient wonders if this is a waste of money or may help her pain. You investigate further.

A patient arrives in the Emergency Department after suffering thoracic trauma. A member of the team suggests using ultrasound to search for the presence of haemothorax, as an extension of the usual FAST assessment. You wonder how accurate the ultrasound would be compared to either the usual initial supine chest x-ray or to a computed tomography which could be performed later in the patients assessment.

A 4 year old child presents to the Emergency Department with a history of fever and symptoms of a viral upper respiratory tract infection. On examination the child is well and apyrexial. However you notice a non-blanching rash over the child's hip. You wonder whether the child will need further investigations or a period of observation to exclude meningococcal disease.

A 40-year-old man who is having a haematemesis is brought into the emergency department. He has not attended the department before but admits to chronic alcohol dependency. It is not known if he has liver disease or varices. You resuscitate him and arrange an endoscopy. Being aware of the use of tranexamic acid in trauma patients you wonder if using it would reduce this man's bleeding and improve his chance of survival?

A 12 year old girl with primary generalised epilepsy comes to clinic for review. She has been seizure free for two years on sodium valproate 600 mg twice daily. Following discussion with her and her mother, an agreement is reached to withdraw the medication. You advise that the medication should be tapered off over a six week period. At this point the mother informs you that when she had her own anticonvulsant medication withdrawn, this was reduced over a six month period. She questioned whether it was appropriate to reduce the medication so quickly and requested evidence to support the recommendation, raising concerns about the possibility of a higher risk of seizure recurrence.

A 4 year old child presents to the paediatric accident and emergency department with a history of fever for 12 hours and clinical signs of an upper respiratory tract infection. The temperature on assessment is 39.5°C. There is a past medical history of asthma. The attending emergency doctor prescribes ibuprofen. The mother is not willing to give ibuprofen to her child, as she was told in the past that it is contraindicated in children with asthma.

An eight year old girl presents to the Emergency Department with a painful knee having fallen at gymnastics. She is not able to bend it to 90 degrees and says she cannot walk. The knee is not particularly swollen and there are no skin wounds present. You wonder whether the Ottawa Knee Rule would help you decide whether or not to x-ray her knee, which is what her mother wants.

The orthopaedic department has listed several patients for total hip or knee arthroplasty which is putting demand on bed turnover. It is hypothesised that a pre-operative education session would reduce length of stay post-operatively as an in-patient.

A 56 year-old male patient attends review clinic with recurrent olecranon bursitis. The bursitis was aspirated one week previously, and the resulting culture is negative. You wonder whether re-aspiration and bursal steroid injection will prevent recurrence.

An obese forty year old woman is brought in to the resuscitation room following a closed head injury, Her GCS is 6/15 and you need to urgently secure a definitive airway. The anaesthetist is busy so you have to proceed with the RSI alone and while drawing up the drugs the Nurse asks you what dose of Suxamethonium you would like. Her husband says she weighs 140kg. You wonder how best to calculate the dose of Suxamethonium to give optimal intubation conditions with shortest time to return of breathing should a failed intubation and ventilation scenario develop.

You are looking after a 45-year old bricklayer with severe triple vessel disease who underwent urgent CABG using bilateral internal mammary arteries and a radial artery graft. He has progressed well and is awaiting discharge. He was on no medication on admission and asks you why he needs to have 6 weeks of Diltiazem three times per day as prescribed by your consultant. You have some difficulty justifying this medication and thus resolve to look up the literature that night.

A 50 year-old lady presents with a fever and cough. Physical examination of her chest reveals crackles in the left base. You wonder whether this means that you can be confident of a diagnosis of pneumonia before the results of further investigations are obtained.

A 7 year old boy attends the emergency department following a fall in school. Clinically he has sustained closed fracture of his distal radius and ulna. The patient definitely needed manipulation under anaesthesia for reducing the fractures. You wonder whether below arm cast is as effective as above arm cast for these fractures.

You are treating a middle-aged man with severe pancreatitis. It is apparent that he is hypoxic, deteriorating, and will need to be ventilated. A chest X ray shows bilateral shadowing. There is no clinical indication to suggest either infection or pulmonary oedema. Your colleague from Intensive Care decides that the patient has Adult Respiratory Distress Syndrome and should be given high dose steroids. You wonder what evidence there is to support this treatment.

A 25 year old man presents to the emergency department with pharyngeal bleeding post tonsillectomy. You wonder whether haemostasis can be achieved by using nebulised adrenaline.

A 25 week gestation neonate is ventilated for RDS, he develops a haemodynamically significant persistent ductus arteriosus (hsPDA) on day ten of life. The PDA is treated with an initial course of Indometacin and despite initial improvement he remains ventilator dependent. On day seventeen a hsPDA is diagnosed again. How effective is a second course of Indometacin (Indo) at closing the PDA?

A 24 year old man presents to the emergency eye centre with a uniocular red eye. He has a mucopurolent disharge and a follicular (inclusion) conjunctivitis. An initial diagnosis of adenovirus infection is made, but swabs taken show chlamydial infection. He is referred to the GUM clinic but does not test positive for genital infection. You decide to start him on a 10 day course of doxycycline, but are advised that you could treat him with a single dose of Azithromycin.