Archives: BETs

A very distressed medical student presented to the emergency department with a bleeding injury site following a needlestick injury sustained while trying to cannulate a known HIV source. We wondered if triple compared to dual anti-retroviral therapy is the most effective at reducing HIV infectivity.

A distressed young man came into the emergency department with a needlestick injury which he had sustained from a known hepatis C source who was also an intravenous drug user. We wondered if HCV-RNA PCR is more sensitive test than anti-HCV antibody test at detecting HCV.

A previously healthy overweight 38-year-old female comes to your Emergency Department complaining of postprandial right upper quadrant abdominal pain and vomiting for the last two hours. She appears to be in pain and is mildly tachycardic, but vital signs are otherwise normal. She has tenderness in the right upper quadrant without guarding. You want to know if glycopyrrolate is a reasonable medication to use to treat her pain initially.

A 25-year-old man presents to the emergency department with a traumatic laceration to his left index finger. The wound needs a thorough clean and will require suturing and you decide to do this using a digital nerve block technique. A colleague who has recently worked in plastic surgery suggests you use epinephrine (1:100 000) to help with haemostasis, but you have always been told that this can cause finger necrosis and that it should never be done. You wonder whether in fact this is true and decide to look at the evidence for yourself.

A 51 year old male attends the accident and emergency department with acute severe epigastric pain. You suspect that he may have acute pancreatitis and have sent off bloods for his serum amylase level to confirm the diagnosis. You wonder if an ultrasound scan or a CT scan at this stage is better in identifying the cause of his condition.

A 48 year old woman presented to the accident and emergency department with severe epigastric pain radiating to the back. Acute pancreatitis was diagnosed. You wonder if Ranson's criteria or Glasgow criteria is better in predicting the need for referring her to the intensive care unit.

A 50 year old man presents to the Emergency Department with epigastric pain. Acute pancreatitis was diagnosed by routine diagnostic tests. You wonder whether CRP level is better than lactate dehydrogenase level in predicting the severity of the pancreatitis.

A 50 year old man presented to the accident and emergency department with epigastric pain. Acute pancreatitis was diagnosed. You wonder if early prophylactic antibiotics will improve survival and length of hospital stay in this patient.

A 51 year old male attends the accident and emergency department with acute severe epigastric pain. After carrying out a few diagnostic tests, he is diagnosed with acute pancreatitis. You wonder if epidural analgesia might be better than intravenous morphine in controlling pain in this patient.

A 46 year old female presents to the emergency department. Subarchnoid haemorrhage is confirmed by CT. Upon examination there are signs that she has raised intracranial pressure and her clinical condition is deteriorating. You ask one of your colleagues if you should administer mannitol. Neither of you are sure what to do as you have both heard that it is important to maintain cerebral blood pressure fairly high to prevent rebleeding. However, you wonder if the administration of mannitol would help this patient.

A 39 year old woman presents to the emergency department with a thunderclap headache. She has not suffered from anything like this before. You suspect a subarachnoid haemorrrhage. You send her for urgent CT scan which comes back negative. You then wait until 12 hours after the onset of the symtoms and do a lumbar puncture which also comes back negative. You are worried about discharging her because you have heard horror stories about the consequences of misdiagnosis of SAH. You feel you have done everything you can you know want to know if you can dicharge this patient

A mother rushes her 20 month child into A and E with a temperature of 40°c. The child is lethargic and making little eye contact. The fact that the child's temperature is so high raises cause for concern that the child could have meningitis.

A 37 year old male presents to the emergency department. Subarchnoid haemorrhage is confirmed by CT. You wish to transfer this patient to a nearby neurosurgical unit so you contact the neurosurgical SPR to see if he will accept the patient. The SPR asks for the patients GCS which is currently 7. He says that there is a shortage of bed he will not accept this patient and asks for him to be referred to the medics. You wonder if by not being in a specialised neurosurgical unit this patients' outcome will be comprimaised.

A patient presents to the emergency department with a unilateral, red, painful eye. Visual acuity is reduced in the affected eye. The pupil is normal and the cornea is clear. There is some cillary flush around the iris. You can't decide if the diagnosis of iritis is correct or not. The other features of iritis (i.e unilateral, red, painful, decreased visual acurity) are present but the pupil remains a normal size and shape. Is this a common presentation?

A 34-year-old man has been diagnosed with gonococcal urethritis. Your consultant suggests you prescribe oral cefixime, but you had heard that i.m ceftriaxone is the first line treatment for this condition. You wonder which antibiotic would be better at eradicating his infection.

A 21-year-old man has been diagnosed with gonococcal urethritis. You are advised to give treatment to cover chlamydia infection as well and you wonder if this is necessary.

A 35-year-old man presents to the emergency department with a history of burning pain radiating from his epigastric area up through his mediastinum that started after dinner. The patient had a history of gastro-oesophageal reflux disease and was placed on prilosec treatment last year, but has stopped taking this for 3 months. You decide to treat this probable case of dyspepsia with a gastrointestinal cocktail, a mixture of lidocaine and antacid, but wonder if adding the lidocaine yields any benefit.

A 22 year old woman with sickle cell disease presents with a two day history of pain in her arms, legs and chest. Her pain and symptoms are consistent with an acute chest syndrome. You are about to admit her to the ward when you wonder if her symptoms are severe enough to warrant admission to HDU.

A 30 year old man with sickle cell disease presents with a 3 day history of pain in his arms and legs. His pain is consistent with his usual painful crisis. He is febrile but has normal vital signs and no acute findings on physical examination. You promptly treat his pain. As you order blood cultures and other tests to find if there is any cause for infection you wonder would starting empirical antibiotics be of any benefit to the patient.