Archives: BETs

A 25 year old man presents to the emergency department complaining of a 4 hour history of painful right eye after it was scratched by his 3 month old daughter. You recall being told that topical non-steroidal may be of help but wonder if they are any better than lubrication on its own. You also wonder if the non-steroidals may affect the eventual outcome and time to healing.

You refer a fifty year-old man, with vague central chest pain but normal ECG, to the Medics for troponin testing at 12 hours. The medical registrar comments that one day this will be a thing of the past, as Emergency Departments will be able to test all patients with suspected cardiac chest pain for whole blood choline, thus referring only those with genuine acute coronary syndromes (ACS). You wonder if she is right.

A consultant physician informally comments about the high volume of patients with vague central chest pain that pass through the Medical Admissions Unit for exclusion of acute coronary syndromes by troponin testing at 12 hours. Wondering if there is a better way, you perform a quick literature search and find several articles investigating the utility of soluble CD40 ligand as a cardiac marker. You wonder if there is any evidence that it may be useful for exclusion of acute coronary syndromes in the Emergency Department.

You are in the resuscitation room and are faced with a combative head injury requiring a CT scan. He needs to be intubated via a rapid sequence induction and you wonder whether you should do this, as you have previous anaeasthetic training or call the anaesthetists down to do it for you.

A seven year old child with a known history of asthma presents with a 24h history of exacerbation of wheeze. He has been using his salbutamol inhaler with little benefit. You prescribe a ß-agonist by nebuliser but wonder if it would have been cheaper and more effective to administer this drug via a spacer (holding chamber).

A 7 year old child, previously healthy attends Emergency Department following first generalised tonic clonic seizure. There is no history of drug and alcohol ingestion or other provoking factors. Clinically the child is afebrile and you wonder whether serum biochemistry is nessecary for the diagnosis and management of this patient

A fifty year-old man has presented to the Emergency Department with chest pain. ECG shows 4mm anterior ST elevation with reciprocal ST depression in the inferior leads. You discuss the case with the on-call cardiology registrar, who accepts the patient for primary angioplasty. He asks for the patient to be given 600mg clopidogrel. You wonder if there is any evidence that this is superior to a 300mg loading dose.

An 18month old girl presents to A&E with coryzal symptoms and wheeze. You wonder whether the addition of oral steroids (prednisolone) would lead to a faster resolution of her symptoms than bronchodilators alone.

A young healthy adult with known asthma presents to the emergency department with an acute severe asthma attack. Following the BTS guidlines, you use salbutamol and ipratropium nebulisers and IV hydrocortisone, and wonder if a single dose if IV magnesium sulphate would be beneficial.

A neonate on the intensive care unit requires semi-urgent intubation. As the procedure is being carried out one of the medical students notices that the neonate is struggling, prolonging the procedure and appeared to be in distress. The medical student asks why no medication was given before the neonate was intubated as this was seen when the procedure was carried out in adults and children.

A 43 year old re-presents to her GP with a 3 year history of intermittant back pain. She is rarely without any pain but has regular exacerbations. She is concerned that her sickness record is causing concern amongst her employers and if fearful that she might lose her job. She has heard that she can go to special classes to help her get better and wonder if you know if these "back schools" are any good. You endevour to find out.

A thirty year-old lady has fallen onto her outstretched hand and sustained a radial head fracture, which is virtually undisplaced. Knowing that prolonged immobilisation is likely to lead to poor functional outcome, you wonder whether there is any evidence for immediate mobilisation.

A five year-old boy is admitted with severe anaphylactic shock having inadvertently ingested peanuts at a birthday party. He had a previous reaction two years ago and was given an epinephrine auto-injector for use at home. His mother had used this when the reaction first started but to no avail. You administer intramuscular epinephrine while wondering whether there is any evidence for the effectiveness of epinephrine self-injection.

An elderly lady presented in severe pain with shorted and externally rotated leg in keeping with a NOF fracture. You are worried about giving her iv Morphine. In your anaesthetic secondment you observed a Fascia iliaca Block being used for post operative pain control and you wonder whether you can do the same.

A 55 year old patient presents to her general practitioner with a 5 day history of lower back pain. Heis previously fit and well, has no neurological symptoms or signs or features to suggest a serious underlying cause. You diagnose a simple low back strain and advise him to take keep mobile, take analgesics as required and expect to improve fairly rapidly. He informs you that his brother in law is a massage therapist and wonders if you think it would help him get better quicker.

A 35 year-old man presents to the Emergency Department two hours after experiencing an episode of central squeezing chest pain lasting thirty minutes. Initial ECG is normal. You wonder whether serial measurement of CK-MB plus serial electrocardiography will allow you to effectively rule out myocardial infarction (MI), thus avoiding admission for troponin testing at twelve hours.

an eight year old child presents to the emergency department with a suspected wrist fracture. radiology confirms a greenstick fracture of the distal radius. treatment is with the application of a plaster of Paris cast, but in which position should the forearm be immobilised (pronated, neutral or supinated)

an eight year old child presents to the emergency department with signs of a fracture. Radiology shows a fracture of the lateral condyle of the humerus.

A 25 year old male arrives to the emergency department following Tricyclic antidperessant overdose. He is drowsy upon arrives and soon after develops a grand mal seizure that lasts over five minutes. You wonder whether benzodiazepines are a safe and effective treatment for the seizures in the specific situation of tricyclic antidepressant overdose.