Archives: BETs

A fifty year-old man with no previous medical history presents to the Emergency Department with two hours of vague dull central chest pain. Initial ECG is normal. You arrange admission for troponin T testing at 12 hours but can't help thinking that there must be a better and quicker way to exclude acute coronary syndromes. A colleague tells you that myeloperoxidase (MPO) is set to make world headlines as a new definitive early cardiac marker.

A 27 year old man comes into the emergency department with a suspected opiate overdose. He exibits marked miosis and depressed mental status and had needle track marks on his arms. His mother, on questioning, shows you an empty temazepam bottle she found in his pocket. You wonder if he has had a polydrug overdose and if this will result in a poorer outcome.

A 40 year old man is brought into the emergency department unconscious and smelling of alcohol. On examination he has pinpoint pupils, bradypnoea and needle track marks consistent with heroin injection. His friend claims they drank a bottle of whiskey together prior to him injecting. You wonder if the alcohol will potentiate his repiratory depression and result in a poorer prognosis.

An ambulance arrives at the emergency department with a 35 year old male known heroin abuser who has overdosed. The patient dies despite naloxone administration and full attempts to resuscitate him. You treated him for a non fatal overdose 8 months ago and wonder if this could have been a factor in predicting fatal overdose on this occasion.

A 31 year old women presents to accident and emergency with vaginal bleeding. You wonder if a single measurement of serum progesterone can be used to diagnose or rule out an ectopic pregnancy?

A middle aged lady is receiving physiotherapy for her OA knee. She mentions that her husband has heard that Glucosamine tablets are great for arthritis and is thinking of buying some from a health-food shop. She asks what you think about them. Before imparting wise words, you decide to check the evidence first.

A middle aged patient is referred to physiotherapy with a 6 months history of CRPS following an innocuous trauma. You usually try hydrotherapy with such a condition but want to know if this is more beneficial than 'dry-land' treatment.

An 38 year old male arrives in your emergency department complaining of palpitations and feels slightly light headed. He has never had these symptoms before and is certain that they started 1 hour prior to arrival. He is awake and alert with a blood pressure of 134/82 and a pulse of 128. His physical exam is unremarkable with the exception of tachycardia and an irregularly irregular rhythm.

A 3-year-old boy has been brought to the Emergency Department after a convulsion at home, which has now resolved. His parents say he has been hot, sleepy and irritable that morning, and has been crying when his bedroom light was turned on. After investigation, meningitis is diagnosed and treated. You wonder how commonly meningitis is a cause of febrile convulsions.

A 2-½ year-old girl has been brought to the Emergency Department with a simple febrile convulsion with unclear focus of infection on examination. She does not appear septic. Her parents say she is potty training and have noticed her urine has smelt strong the past day or two. You test a sample of her urine and diagnose an UTI. You wonder if an UTI is a common cause of febrile convulsions.

A 2-year-old boy is brought into the Emergency Department one evening and his parents say he has been feeling hot the last 24 hours, and has a sore throat and is feeling irritable. They have measured his temperature at home using an oral thermometer and it read 39oC. You wonder if the tympanic thermometer in the Emergency Department is a more accurate way of measuring his temperature.

A known asthmatic adult patient is brought into the emergency department with signs consistent with acute asthma. Little improvement is noted with nebulised beta agonist therapy. You wonder if adjunctive nebulised furosemide would provide any benefit.

A 26 year old woman presents to accident and emergency with vaginal bleeding. She has a positive pregnancy tes. You suspect she may have an ectopic pregnancy and wonder if any findings on examination are can help rule in/out this diagnosis?

A patient presents with a simple transverse fracture of his second metatarsal, you wonder whether he could be safely discharged in a support bandage rather than a below knee backslab

A 51 year old female patient attends the emergency department with a history of ally trapped her right index finger in a door and developed subungual haemotoma. X-ray was done showed no bony injury. The skin and nail bed margin were intact. You wonder is it safe to simple trephining drainage this subungal haematoma to reduce the pain severity

A 32 year old woman presents to the emergecny department with vaginal bleeding. You want to know if she is pregnant, and wonder if a urinary pregnancy test is sensitive enough to detect an ectopic pregnancy?

An 8 year old presents to A&E with a sore throat and anterior cervical lymphadenopathy and a 3 day history of a cough. She is examined and told it is probably just a virus'. Is there any evidence for this statement or should she be investigated further?

A child is diagnosed with UTI and you want to prescibe some medication. You wonder whether a short 2-3 day course is better than longer 7-14 day course of antibiotics.

A 56 year old woman arrives at A & E complaining of palpitations and lightheadedness. An ECG is performed and she is diagnosed with paroxysmal supraventricular tachycardia. She is haemodinamically stable but distressed with the palpitations. The physician attending this lady wonders which vagal manoeuvre to use before giving any drug intravenously.

A 35 year old man came into A&E complaining of a sore throat. He had a fever, anterior cervical lymphadenopathy and tonsillar exudates. He had returned from Russia 1 week ago and was unsure of his vaccination status.