Archives: BETs

A tearful 10 year old was playing in the park and accidentaly pricked himself with a needle he found. His injury site was still bleeding when he presented to the emergency department. We wondered if HIV postexposure prophylaxis was indicated.

A 53 year old female with acute intermittent porphyria presents to the emergancy department with abdominal pain. The medical student shadowing you who has done a special study module on acute porphyria tells you that carbohydrate loading had been the standard treatment for decades. You wonder if this could help resolve the attack.

Following an RTA, the female driver of one of the vehicles is stretchered into the accident and emergency department, complaining of epigastric pain. She displays the "seatbelt sign", her BP is >100mmHg and her pulse rate is 95bpm. The decision is made to CT scan her abdomen, and the use of oral contrast solution is debated between two registrars in the resuscitation area. One advocates its use, arguing that extravastion will be more easily spotted. The other suggests that an unacceptable delay will be cause by its administration. Should oral contrast be used in this situation?

A young man presents to the Emergency Department with a left sided foot drop.He was seen three days ago with blunt injury to his left calf whilst playing football. He was treated as a soft tissue injury and discharged. On his return he was diagnosed as a case of compartment syndrome.You wonder what is the diagnostic utility of clinical signs and symptoms in the diagnosis of compartment syndrome of the lower limb.

A 45 year old homeless man presents to the emergency department after he was found lying on a park bench. Glasgow Coma Scale is 5, so he is intubated. Prior to administration of intravenous fluids, you consider whether you should administer thiamine to prevent Wernicke Korsakoff syndrome.

A 40 year old female presented with inferior heel pain after jogging. She is otherwise fit and well, and a keen jogger. A similar episode had occured to her few weeks prior to this presentation and it resolved by rest and NSAIDs. A diagnosis of Plantar Fasciitis was established. Which treatment modality is best for this condition in an Accident & Emergency setting:a conservative approach (rest/physiotherapy) with NSAIDs or the use of Ultrasound Shockwave Therapy?

A 50 year old gentleman attends the Emergency Department following a collapse. After initial resuscitation you obtain a CT scan of his brain, which shows a spontaneous intracerebral bleed. You want to know if rFVIIa will improve your patients survival rate / functional outcome.

A 50 year old man presents to the accident and emergency department with epigastric pain. Acute pancreatitis is suspected. You have carried out several diagnostic tests and results are awaiting. You wonder if carrying out a serum alanine aminotransferase test can help identifying the cause of pancreatitis in this patient.

A 51 year old patient present to the emergency department with abdominal pain and vomiting. She tells you she has acute intermittent porphyria and has vomited 7 times in the past hour. You wonder if cyclizine or a phenothiazine would be safe to use to stop her vomiting.

A 45-year-old man presented to the emergency department with a history of sudden onset left-sided loin pain radiating to the left groin. Urinalysis revealed 2+ blood and nil else. Plain abdominal x ray did not reveal any radio-opaque calculus. You wonder whether a spiral computed tomography (CT) scan or intravenous urography (IVU) will be more appropriate for the further evaluation of the patient.

A 24 year old female attends the emergency department at 10pm on a Sunday night with her boyfriend. She tells you that a condom broke during penile-vaginal intercourse, and her boyfriend is HIV positive, though she is not. She had recently read a newspaper article about postexposure prophylaxis and wished for it to be precribed. You wonder if it would reduce the risk of seroconversion in this patient.

It is 7am on a Saturday morning and you are seeing a 19 year-old female university student who is dishevelled and still wearing the clothes she wore to a club the night before. She smells faintly of alcohol. She tells you she had unprotected sex while drunk, and requests the morning-after pill and postexposure prophylaxis for HIV. When you question her as to her need for PEP, she tells you that her partner of the night before was a student from South Africa, and she was aware of the high prevalence of HIV infection there. While giving you her medical history, she tells you that she has had the morning-after pill four times in the past eight months, all purchased over-the-counter in the large city-centre pharmacy, to avoid, she says, 'sanctimonious proselytising' from her GP. As you give her her prescription, you wonder if there are any behavioural interventions that might help reduce her risk-taking behaviour.

A 19-year old male patient presents to the accident and emergency department following an assault in which he sustained direct blows to the abdomen. Following opiate administration, the SHO dealing with the patient wonders which antiemetic to presecribe, if any.

A 34-year old male pedestrian presents to the accident and emergency department after being involved in a vehicle vs. pedestrian event. He is haemodynamically stable, and complains of diffuse abdominal pain. Which analgesic should be prescribed in order to provide the best pain relief?

A term neonate presents at 24 hours of age with tachyapnoea and a temperature of 37.8 °c following a low-risk normal vaginal delivery. There had been no prolonged rupture of membranes and a high vaginal swab was negative for any significant pathogens. You provisionally diagnose suspected bacterial neonatal sepsis, perform a septic screen, and start IV antibiotics according to local antibiotic protocol. His CRP is 42 and FBC reveals a leukocytosis with left shift on blood film examination. Blood, urine and CSF cultures are all negative. CXR shows no significant focal abnormality. His symptoms resolve over the next few days and you wonder how long antibiotics should be continued.

A 65 year old patient with Alzheimer's disease presents to the accident and emergency department following a fall. Abdominal injury is suspected. The patient's BP systolic is 96mmHg, pulse rate 110. Is CT scanning more efficacious at diagnosing abdominal injury that diagnostic peritoneal lavage (DPL)?

It is 5pm on a Sunday afternoon. Your patient is a gentleman in his mid 20s who tells you that he had unprotected receptive anal sex on Thursday night with a man he now knows to be HIV positive, The patient is aware of PEP through literature he has seen in the GUM clinic, and requests a prescription. You calculate that 69 hours have passed between the exposure and now, and wonder if giving PEP at this time will reduce the risk of seroconversion. When giving the patient details of the PEP prescription, he is surprised to learn that it is a 28-day course. You wonder if a 28-day course has proven to be more efficacious in reducing the rate of seroconversion compared to a shorter course.

A 44 year old South African female with variegate porphyria presents to the ED with severe abdominal pain. You wonder whether IV pethidine or morphine would be safe and effective at relieving the pain.

A 43 year old female present to the emergency department with an acute porphyric attack. You wonder if a beta blocker would be safe to use to reduce her heart rate and blood pressure.

The Implantable Cardioverter Defibrillator (ICD) has been proven to save lives through prevention of lethal ventricular dysrhythmias and sudden death. The ICD is not only for candidates who have been resuscitated from these conditions, but now is also being implanted in high-risk cardiology patients such as patients with bradyarrhythmias for pacing, tachyarrhythmias and those with heart failure and low left ventricular ejection fractions. One would assume placement of such a device that could aid in halting or postponing death would result in a sense of security and comfort. However, research reveals the opposite is likely to occur in a vast majority of recipients of the ICD. Many suffer post-implantation fear, anger, anxiety and a loss of desire to participate in any activity. It is clear that a post-operative intervention is imperative, and Cognitive Behavior Therapy (CBT) may be the solution for these ill effects toward this cardiac device. CBT could quite possibly have global application if determined to have a positive bio-psychosocial effect on this population.