Archives: BETs

A 35 year old presents with an acute sore throat, although no tonsillar exudates, fever or lymphadenopathy. He asks what is the best pain relief?

The major determinant of survival from cardiac arrest due to ventricular fibrillation (VF) is the time interval between collapse and defibrillation. For every minute that defibrillation is delayed, survival rates drop by as much as 7 – 10%. In an effort to hasten access to defibrillation, the automatic external defibrillator (AED) was developed. AED's can now be found in a wide variety of public places from airports to supermarkets. Designed for use by people with little or no training, they are of proven benefit in improving the prognosis of adults who suffer out-of-hospital cardiac arrests. Ventricular fibrillation was assumed to have an extremely low incidence in children, therefore AED were designed solely for the treatment of adults. In 1995, a study by Mogayzel et al. demonstrated that VF was the initial rhythm in as many as 19% of children suffering out-of-hospital cardiac arrest. Therefore the use of AED's may be beneficial to a significant number of children. The efficacy of AED's in children is uncertain due to two major concerns. Firstly, there are concerns as to whether an AED can accurately assess ventricular arrythmia in children and respond appropriately. Secondly, AED's provide fixed-energy shocks that could potentially inflict myocardial damage in young children. In the event of an out-of-hospital paediatric cardiac arrest, would it be safe to use an adult AED?

An eight year old child presents with pain, swelling and local tenderness of the elbow, having fallen onto an outretched hand. a supracondylar fracture of the humerus is suspected. should this patient be treated with immobilisation or referred for surgery

A 63 year old lady presents to the Emergency Department with a 3 week history of intermittent dark urine. She says it has become worse over the last 2 days and is now convinced that she is passing blood. You wonder if cytology testing will detect significant underlying pathology or if cystoscopy is necessary as well.

A 12 month old baby presents to the Emergency department and you suspect UTI. The hospital policy is to refer to the infant to paediatrics. You wonder why this is the case and the paediatrician explains that it is because of the need to investigate this young age group due to the high incidence of GU abnormalities in children <2years. You wonder what the incidence oF GU abnormality is in children <2years

You are called to the emergency department following the arrival of a 23 year old male electrician who is suspected of ingesting 25 imipramine tablets. You are shown an ECG that was taken shortly after his arrival. You wonder which ECG abnormalities are predictive of complications.

A 33 year old woman arrives to the emeregency department with suspected tricyclic antidepressant overdose. Blood samples and an ECG are taken. You wonder whether the ECG or the serum drug level is better at prediciting arryhthmias and seizures.

It is a busy shift in the A&E, and you receive a courtesy call from the paramedics of a 65 years old gentleman with chest pain. When you see the patient you find out that he had crushing central chest pain with radiation to his left arm, diaphoresis, and nausea for about one hour, but he is pain free now. On further questioning you find that he is receiving Warfarin anticoagulation for previous pulmonary Embolism. You think of treating him for ACS, and decide that he should receive the Aspirin, but not the LMWH. But you are puzzled whether giving Clopidogrel is of any proven benefit or not?

A seven year old child presents with primary oropharyngeal infection. The SHO wonders if if oral aciclovir will be of use or if conservative treatment should be prescribed.

A 29 year old woman presents to the emergency department with tricyclic antidepressant overdose. She remains alert and shows no sign of major toxicity. You wonder how long this patient must be monitored before she can be safely discharged

An 18 year old male with known infectious mononucleosis presents with sore throat, anterior cervical lymphadenopathy, fever and tonsillar exudates. The SHO wonders if antibiotics would help?

A 24 year old man presents with a sore throat, anterior cervical lymphadenopathy, fever and tonsillar exudates. He is prescribed penicillin V but the SHO wonders if cephalosporin would be more effective?

in our tertiary neonatal unit, we had a preterm baby, who was born at 26 weeks. we had difficulty in weaning from ventilation as she had symptomatic PDA. we tried with indomethacin twice but we could not help her. once we have done the ligation, she came off the ventilator very soon after the surgery. then we wondered about the best initial treatment for PDA.

A 60 year old woman presents to the A & E department with acute heart failure symptoms. The SHO wonders whether the administration of nitrates or ace-inhibitors would be most beneficial.

A 40 year old man is brought to the A & E department with acute cardiogenic pulmonary oedema. You wonder whether it would be better to treat him with a combination of nitrates and diuretics, or just nitrates alone.

A 37 year old lady returned from a holiday in Barbados. 3 days later later she presented to the emergency department with a red painful itchy area on her left foot which started on the last day of her holiday. You are not sure whether to prescribe antibiotics.

A 31 year prison warden presented to the emergency department with a human bite wound to his leg after a quarrel with an inmate. There was deep puncture of tissue and a lot of blood. Pain releif and tetanus immunisation was given. After the wound was cleaned you want to know whether surgical debridement reduces the risk of infection.

A 55 year old woman represents to her general practitioner with back pain of 3 years duration. Previous assessments and investigations have not suggested a serious cause of her back pain but it so severe that she has had to give up work and has become depressed. She attends as she has read on the internet that the nerves to the joints in the back can be electrified and that this will cure her pain. She asks you if this is true and if so could you refer her for the treatment.

A 55 year old woman represents to her general practitioner with back pain of 3 years duration. Previous assessments and investigations have not suggested a serious cause of her back pain but it so severe that she has had to give up work and has become depressed. She attends as she has rad on the internet that the joints of the back can be injected and that this can relieve her pain. She asks you if this is true and if so could you refer her for the treatment.

A 71 year old lady on warfarin for her atrial fibrillation presents to the Emergency Department with blood in her urine. You know that warfarin increases the chance of bleeding but wonder if urological investigation might reveal a significant pathologic finding.