A 6 month old child arrives in the emergency department distressed (crying) with a fever of 38.5°c, she received oral Paracetamol treatment to reduce the temperature but the mother asks if there is anything else that could possibly be done to cool her child down as she is worried the high temperature may cause a febrile convulsion.
Archives: BETs
An 11 month old child presented to the emergency department after just having a febrile convulsion. The child does not like to look at the lights in the department but otherwise appears well. You wonder whether this child should be investigated for meningitis, and whether a lumbar puncture is necessary.
A 23 year old female with variegate porphyria presents to the emergency department with generalised seizures. You ask your colleague about the protocol for fitting but she points out that some anticonvulsants may exacerbate porphyric attack.
A 36 year old female presents to the ED with abdominal pain and vomiting after a week of crash dieting. She tells you she has been previously diagnosed with an acute porphyria but has never experienced these symptoms before. You remember reading that urinary porphobilinogen is raised in the acute attack. You wonder if this is of use in diagnosing the acute attack?
A 24 year old female with acute intermittent porphyria presents to the emergency department with abdominal pain, paresis and difficulty breathing after a night of heavy drinking. You fear progression to respiratory paralysis so decide to perform rapid sequence induction. You wonder whether Etomidate or Propofol will be the most effective induction agent and whether these may exacerbate the acute porphyric attack.
A 24 year old female with acute intermittent porphyria presents to the emergency department with abdominal pain, paresis and difficulty breathing after a night of heavy drinking. You fear progression to respiratory paralysis so decide to perform rapid sequence induction. You wonder if the use of suxamethonium as a muscle relaxant may exacerbate the attack.
A 33 year old female presents to the ED with an acute porphyric attack. The medical student shadowing you tells you that he has done a special study module on porphyria and suggests IV heme therapy. You wonder if this would be better than conservative therapy.
A 43 year old male presents to the ED with severe abdominal pain. He tells you suffers from acute intermittent porphyria, he is having an acute attack and requires IV pethidine. Your colleague takes you aside and advises you to not to give him any opiate analgesia as he suspects the patient is an opiate abuser. You wonder if there is a higher incidence of opiate abuse in patients with an acute porphyria.
Accuracy of Emergency Department Ultrasound in Detecting AAA.
A 55-year-old man presents to the emergency department with a sudden onset of abdominal and flank pain associated with hypotension. Our concern is that he may have an AAA, but at this time the patient is too unstable to leave the emergency department for formal imaging. The vascular surgeons suggest a bedside ultrasound study. We perform one scan and see no AAA. Can you be confident that an ultrasound scan performed by an emergency physician can accurately rule in or out an AAA?
A 65 year old lady with no history of DVT/PE presents with acute onset unilateral calf swelling/tenderness. There is no history of trauma, recent surgery, and no infective symptoms. She is investigated with a D-dimer blood test which comes back at 8000 ng FEU/ml and undergoes a doppler US which is negative. What is the evidence to suggest an underlying malignancy?
Does antibiotic ointment make a corneal abrasion more comfortable than antibacterial eye drops
A carpenter presents to the emergency department complaining that they can feel something in their eye. On examination a foreign body is found and removed leaving a small corneal abrasion. Prophylactic antibiotics are prescribed to prevent infection. The patient tells you it is painful and you wonder whether it is best to give him an ointment or drop preparation of chloramphenicol and if one of them may make the eye more comfortable.
Are topical antihistamines better than systemic at relieving allergic conjunctivitis symptoms
A 14 yr old patient comes into the accident and emergency eye centre with red, sore, itchy eyes. He had been out in the countryside on an activities day with school and has a clear case of allergic conjunctivitis. His eyes have become incredible swollen and itchy and you want to give him some relief as quickly as possible and you wonder if topical antihistamines might be more effective than systemic tablets.
Treatment of torsion within the 8 hour ‘window of opportunity’
A 20 year old gentleman presents to the Emergency department with a one hour history of an acute onset of severe testicular pain. On examintion the left testicle was found to be rather swollen and tender.
The use of colour doppler ultrasonography in differential diagnosis of testicular pain
A 20 year old gentleman presented to the Emergency Department with a one hour history of acute onset testicular pain. On examination the left testicle was found to be rather swollen and tender.
The role of clinical examination in the differential diagnosis of acute testicular pain
A 20 year old gentleman presents to the Emergency department with a one hour history of an acute onset of severe testicular pain. On examintion the left testicle was found to be rather swollen and tender.
A combination of Ribavirin and interferon is more effective at reducing hepatitis C virus
A very distressed nurse came to the emergencgy department with a bleeding injury site following a needlestick injury from a patient who was an intravenous drug user and already known to be hepatitis C positive. We wondered if in the event of her developing hepatitis C, is inteferon monotherapy or inteferon and ribavirin combination therapy more effective at managing hepatitis C.
In children under the age of 12 what body temperature would be classed as a fever?
A 36 month old child arrives in A and E looking well, the parent says she has had a temperature for the last 24 hours with no additional symptoms. You measure the temperature and it is 38°c you wonder whether this is a fever that we should be concerned about or can the child be sent home without any intervention.
A 6 year old child arrives in A and E with a temperature of 39°c. In order to reduce the child's fever and distress you would like to prescribe an antipyretic but are unsure which is better Ibuprofen or Paracetamol.
A worried 21 year old student accidentally walked into an intravenous drug user not long ago at a party. On questioning her about the circumstances surrounding the exposure we wondered if the presence of visible blood on the device or a bleeding injury site would increase the risk of transmission of blood bore viruses.
Can sodium bicarbonate prevent contrast induced renal failure?
You wish to investigate the cause of severe abdominal pain in an elderly diabetic female in the emergency department. You determine she needs a C.T. scan of her her abdomen/pelvis. You would like to use I.V. contrast to evaluate for mesenteric ischemia or diverticulitis, but her baseline creatinine is 1.7. Not using I.V. contrast could cause you to miss the diagnosis, yet using I.V. contrast could be devistating to her kidney function. You wonder if anything other than hydration could prevent contrast associated renal failure.