Archives: BETs

A 35 year old male patient presents to ED feeling non-specifically unwell following subcutaneous administration of 'Melanotan II' for the purposes of tanning. He describes hyperpigmentation around the injection site, but otherwise no localising symptoms.

A 2 year old boy presents to the Emergency Department with pain to the lower leg and inability to walk after jumping from a low wall. His initial x-ray of the tibia and fibula shows no fracture. You suspect a possible toddler's fracture and wonder if point of care ultrasound (POCUS) would be useful to make a diagnosis.

A 70-year-old woman presented to the Emergency Department with hypoxia and confusion. Her chest X-ray findings are consistent with severe COVID-19 pneumonia. COVID-19 infection was confirmed with RT-PCR testing. A colleague mentions inhaled budesonide as a possible treatment. You wonder if inhaled budesonide would reduce mortality or time to recovery. You also wonder if it is associated with increased adverse events.

An 11-month old boy is admitted with difficulty breathing, cough and poor feeding. On examination he has bilateral wheeze with fine inspiratory crepitations and moderate recession. His oxygen saturations are 88% on room air. Management with nasogastric feeds and supplementary oxygen is commenced in line with national guidelines. The Nurse in Charge suggests placing him in the prone position. You wonder what effect ‘proning’ may have on his clinical outcome and what the evidence for this is.

An 18 years old gentleman presents to the Emergency department with a two hours history of an acute onset of severe left testicular pain. On examination, the left testicle is tender with absent ipsilateral cremasteric reflex.

A 32-year-old patient presents to the emergency department following a high-speed motor vehicle accident. He is hypotensive and has obvious ecchymosis on the abdomen with a “seatbelt sign.” Paramedics were unable to administer tranexamic acid (TXA) due to difficulty in establishing IV access. You wonder if IM would be effective alternative to an IV route for administering TXA in bleeding trauma patients.

It is a warm humid evening in July and you are working a stretch of evening shifts in a busy emergency department. Given the humidity, you check the weather as you are coming in to work and see thunderstorms on the forecast for all day tomorrow. You go about your shift and when you check the trackboard to see who is in the waiting room, you notice that 11 of the 18 patients in the waiting room all have the same chief complaint, “shortness of breath”. Additionally, you notice that the age of these patients varies widely, with age range from as young as 7 to as old as 68. You wonder if the impending thunderstorm has anything to do with the influx of all these respiratory complaints.

The patient is a 52-year-old male with history of hypertension who presents to the emergency department (ED) with complaints of chest pain that started 1 hour prior to arrival. On arrival to the ED, he appears comfortable with stable vital signs, and has a normal physical exam. His pain is reported as mild, sharp and substernal, non-radiating, and worse with certain movements but not exertion. His pain resolves after 324 mg chewable aspirin and a lidocaine patch. His lab workup and elecrocardiogram are normal. The patient has a heart score of 2. You consider ordering a chest x-ray (CXR) prior to discharging the patient.

Patient is a previously healthy 8-year-old male who presents to your emergency department as a level II trauma activation after being involved in a motor-vehicle collision. The patient was a restrained back-seat passenger when their vehicle was T-boned at a suspected speed of 45 mph. There was no loss of consciousness on scene. EMS report his vital signs have been stable enroute. The child has some moderate abdominal tenderness, and you consider whether to order computed tomography (CT) or perform point of care ultrasound (POCUS) to evaluate his abdomen.

A 5-year-old child with presented to the emergency department following an motor vehicle collision. He was a restrained passenger of a vehicle going approximately 30 mph when the collision occurred. Air bags deployed at the time of impact. His workup in the emergency department was significant for atlantooccipital dissociation and the patient was eventually pronounced dead on arrival. During your review of the case, you wonder whether airbag deployment contributed to his cervical spine injury.

Patient is a 45-year-old with a history of alcohol abuse who presents to the emergency department intoxicated. On your initial assessment, the patient’s eyes are closed and only open to pain; he only moves when a painful stimulus is applied; he is not speaking. You give the patient a GCS of 8 and you question whether this patient would benefit from being intubated.

A 12-year-old Vietnamese speaking female with a complicated past medical history presents to the emergency department (ED) with complaints of dizziness. History and physical exam are obtained from the patient and her family using a professional interpreter. You wonder how using an interpreter impacts ED utilization (incidence and costs of diagnostic testing, admission rate, and length of ED visit).

A 65-year-old male with a history of hypertension, hyperlipidemia, stage 4 chronic kidney disease (CKD) and daily smoking presents to the emergency department (ED) complaining of chest pain. Vitals show that he is hypertensive with a blood pressure (BP) of 170/95, with otherwise normal vitals. He has no neuro deficits. Workup completed shows an EKG with a normal sinus rhythm and non-specific ST-T wave changes but without evidence of acute ischemia. Troponins are normal. You wonder if he may have an aortic dissection, but he is well-appearing without neuro deficits and equal pulses. Given his CKD you wonder if there is a way to rule out an acute aortic syndrome without having to give a contrast load for a computed tomography (CT) angiogram. Will using the aortic detection risk score in conjunction with a d-dimer help either rule out or increase suspicion for acute aortic syndrome?

A 50-year-old male/female with a past medical history of rheumatoid arthritis attends pre-operative clinic prior to an elective right upper lobectomy. Amongst the regular medications is methotrexate. You wonder whether the patient should continue methotrexate to reduce risk of flare-up and problems with post-operative pain control or stop this medication prior to surgery due to concerns about immunosuppression and increased risk of post-operative complications; especially wound infections and air leaks. If you were to stop it, how long should it be discontinued for and when should it be re-started?

Climate change is the biggest global health threat of the 21st century. According to the recent Intergovernmental Panel on Climate Change, the global mean temperature is projected to rise by 1.4 to 5.8 degrees by the end of the century. Extreme temperatures overwhelm the body's heat regulatory mechanism, and multi-system organ dysfunction results. In light of recent global heatwaves, it is imperative that emergency care clinicians appreciate the diversity of climate sensitive emergency health conditions and their impacts on emergency care systems.

A 23-year-old male presents with right shoulder pain after falling and catching himself. Physical exam demonstrates a squared off right shoulder with anterior fullness, with the patient holding his arm in slight abduction and external rotation. Anterior shoulder dislocation is suspected. The x-ray department is backed up, and you are wondering if point-of-care ultrasound is appropriate for diagnosing a shoulder dislocation.

A 74-year-old male with a history of diabetes and COPD presents via EMS in acute distress. EMS reports the patient was found somnolent and minimally responsive by a family member who came to check on him. He has a productive cough. Vital signs initially are significant for a rate of 122 BPM, a temperature of 39 degrees C, respiratory rate of 56, SpO2 of 89% and blood pressure 88/45. He has a GCS of 14. You suspect sepsis and begin your workup and treatment, including placing him on 6L nasal cannula. The patient is fluid resuscitated with 30 mL/kg of normal saline, cultures are drawn, and antibiotics are started. As the second liter is finishing, the patient becomes progressively less responsive and his SpO2 begins to drop. His blood pressure is now 82/38. As you prepare to intubate, you are concerned about his fluid-refractory hypotension in the peri-intubation period and consider a bloused dose of phenylephrine to bridge him to more definitive therapy.

25 year old male patient presenting to ED 3 days after a head injury where a heavy wooden door swung into his head. He presented with ongoing symptoms of nausea and headache