Archives: BETs

A 30 year-old female is brought to the emergency department with extensive burns after having been trapped in a burning car. After initial resuscitation of the patient you attempt to assess the surface area of skin affected by the burn in order to guide the volume of fluid required for resuscitation. You wonder which method of surface area assessment is the best tool for assessing the surface area of her burns.

A 65 year old female arrives to the emergency department following burns after falling asleep in front of a gas fire. She shows no signs suggestive of smoke inhalation, you wonder if it is necessary to measure her COHb levels.

A 55 year old woman has been trapped in a small room in a house fire. COHb levels confirm she has carbon monoxide poisoning. You wonder whether normobaric or hyperbaric oxygen will give her a better outcome.

A 45 year-old male has been trapped in a house fire. You are concerned that he may have an inhalational injury. You wonder which clinical features suggest significant inhalational injury.

A 20 year old patient presents to the A & E department with severe pulmonary oedema of cardiac origin. You wonder whether diuretic and ace-inhibitor combination therapy is better than either of them alone.

A 35 year old man has been trapped in a burning building and suffered extensive burns over his chest and legs. He requires fluids and you start fluid therapy based on the Parkland formula. You wonder if this formula will provide sufficient fluids for resuscitation.

An 18 year old presents to A&E with a sore throat, fever, tonsillar exudates and anterior cervical lymphadenopathy and no history of a cough. She is prescribed antibiotics but should she be investigated further?

A 30 year old male attended the Emergency Department with complaints of loin pain on the right side. Urinalysis was performed which came back as negative for haematuria. The SHO questioned whether that was enough to discard the diagnosis of a calculus as he knew that a percentage of patients are indeed diagnosed with urinary calculi despite having no haematuria.

a 27 male is admitted to the Emergency Department with pain in the right flank. A KUB is taken for an initial diagnosis. The SHO wondered whether a CT scan would be better than an US scan in confirming the presence of a calculus.

A 35 year old male comes to A&E complaining of severe pain in his loin. After initial KUB and urinalysis, the registrar on duty questions which method; US or IVP, is better at detecting calculi.

a 54 year old lady with a history of palpitations is refered to A & E by her GP, complaining of palpitations and lightheadedness. The attending registrar performs a 12 lead ECG revealing revealing a regular rhythm, an absent P wave and a narrow complex QRS with a ventricular response of >150 beats/min on the bedside monitor strip on leads II and V5. She is diagnosed with atriventricular nodal reentrant tachycardia and the valsava manoeuvre is attempted unsuccessfully. IV Adenosine is given which restores sinus rhythm but fails to maintain it as the lady relapses into the arrhthmia. A beta-blocker is then considered and the attending clinician debates which beta-blocker is more efficient at restoring and maintaining sinus rhythm.

A 60 year-old Asian lady, who speaks little English, is brought to the Emergency Department with what seems to be a three-day history of worsening exertional dyspnoea and a three-hour history of resting dyspnoea with light-headedness. On examination she is apyrexial with a pulse of 150 beats/min, a respiratory rate of 20/min, blood pressure 100/60 and oxygen saturation 93% in air. A 12-lead ECG is recorded, which reveals a rapid supraventricular tachycardia. Interpretation of P wave activity is difficult due to the rapid heart rate and you cannot be entirely sure whether this is atrial flutter, junctional tachycardia or sinus tachycardia. You wonder if increasing the ECG speed will help you to make a more accurate diagnosis.

An ambulance arrives at the Emergency Department with a patient who is said to have suffered a heroin overdose. On arrival the patient has a GCS of 14 with no signs indicative of opiate overdose. The friend that accompanied him in the ambulance claims to have injected him with some naloxone he obtained. You wonder if there is any convincing evidence that known addicts should be given naloxone to administer to other addicts in order to prevent deaths from overdose.

a 54 year old lady with a history of palpitations is refered to A & E by her GP, complaining of palpitations and lightheadedness. The attending registrar performs a 12 lead ECG revealing revealing a regular rhythm, an absent P wave and a narrow complex QRS with a ventricular response of >150 beats/min on the bedside monitor strip on leads II and V5. She is diagnosed with atriventricular nodal reentrant tachycardia and the valsava manoeuvre is attempted unsuccessfully. IV Adenosine is given which restores sinus rhythm but fails to maintain it as the lady relapses into the arrhthmia. A beta-blocker is then considered and the attending clinician debates which beta-blocker is more efficient at restoring and maintaining sinus rhythm.

A 25 year old man is brought into the emergency deparment by his brother who found him unconscious at home. He is pinpoint pupils, a respiratory rate of 6. ABGs show a pH of 7.05 and a pCO2 of 14kPA. In light of the suspected opiate overdose you administer naloxone, but wonder if it would have been beneficial to treat the respiratory acidosis first.

You are the Emergency Department physician seeing a 35 year old woman who presents with extreme, short bursts of dizziness. Upon further questioning and physical exam, you find out that she is experiencing vertigo several seconds after moving her head, the vertigo resolves when her head is kept still and she has a positive Dix-Hallpike test. She did not experience any prodromal symptoms prior to the onset of her vertigo. You are confident that she has benign positional vertigo and recall the Epley Maneuver as a way to help treat her symptoms. Before performing the Epley Maneuver on the patient, you wonder if there has been any proof that the Epley Maneuver actually works in reducing the symptoms of acute benign positional vertigo.

An eight year old child presents to the emergency department with swelling, local tenderness, pain and crepitus. Can this clinical information accurately diagnose a wrist fracture?

An eight year old child presents to the emergency department with signs and symptoms of a fractured wrist. radiology confirms a fracture of the distal radius.

A forty-five year old abusive, intoxicated recurrent attendee complains of central chest pain of 2 hours duration. His initial ECG is normal. Your gut feeling is that he does not have an acute coronary syndrome. You are reluctant to admit him for troponin estimation at 12 hours but wonder if you ought to risk discharge without further investigation. Having heard about PAPP-A, a promising cardiac marker, you wonder if the evidence is sufficient to allow clinical use in this situation.

A 4-year-old girl has been brought into the Emergency Department having had a febrile convulsion lasting 25 minutes. She has not had a febrile convulsion before. Her parents are extremely worried and are asking if this will cause her any problems in the future. You wonder what advice to give them.