Archives: BETs

Current practice for patients after routine primary total hip replacement is to have unsupervised physiotherapy in the home-based setting followed by one hospital-based out-patient appointment check at 6 weeks post-op. A colleague feels that physiotherapy out-patient services should manage all post-op THR more frequently. You are concerned about the pressure on your out-patient service, particularly in view of the current COVID-19 pandemic limiting face-to face appointments. You want to establish what is the current evidence for physiotherapy in the home-based compared to the hospital-based settings.

A 65 year old male presents to the ED with a 3 day history of cough and breathlessness. You are unsure of whether this is likely to be COVID-19 or something else. You worry that sending this gentleman into the hot zone of the department will expose him to COVID-19. You know that a nasopharyngeal swab will take a long time to come back, and wonder whether LUS will help you decide whether this gentleman is likely to have COVID-19 or not, in order to triage him safely.

A 45 year-old female presents to the ED with a 3-day history of cough and breathlessness. You wonder whether this patient has COVID-19. You worry that sending this lady into the hot zone of the department may result in a potentially vulnerable patient being exposed to COVID-19. You know that a CT scan is the gold standard imaging choice for COVID-19 pneumonitis, but its practicality, cost, and irradiation cause you to wonder whether LUS would be an appropriate alternative to facilitate safe triage of this patient.

A 2 year old boy presents to the emergency department with a large laceration to his temple after he fell onto a corner of a coffee table. He will require procedural sedation to suture the laceration. You ask the bedside nurse to start an IV to administer ketamine. As the child squirms and cries getting the IV, you wonder, is there a better option?

You are referred a 55 year old woman for a mobility assessment. She was diagnosed with an acute calf DVT yesterday and started on anticoagulation therapy. Is it safe to complete a mobility assessment today?

A 22-year-old woman presents to the Emergency Department (ED) with suicidal ideation and ongoing Medically Unexplained Symptoms (MUS). This is her second attendance today, and her fourth this week. This patient is a known high-intensity user/Frequent Attender (FA) due to multiple previous episodes of Deliberate Self-Harm and intentional overdose. She has a background of emotionally unstable personality disorder, depression & anxiety, and a learning disability- all of which contribute to her distress while in the department, meaning she frequently leaves before being seen by a clinician. You wonder if there is an effective intervention that you could implement, to reduce her number of ED visits.

A 14-year-old male presents to the emergency department at 3 A.M. after awakening suddenly from sleep with severe right sided groin pain. A clinical exam of the genitourinary system, with chaperone, is grossly normal, however the cremaster reflex on the right side is equivocal. You recognize that testicular torsion is an emergent diagnosis on the differential of Acute Scrotum and speak with the Radiologist on Call to arrange a formal ultrasound. The Radiologist asks if you have performed a POCUS? As you hang-up the phone, you wonder 'what is the diagnostic accuracy of POCUS for testicular torsion?'

A 5 year old girl presents to your paediatric ED with a one day history of abdominal pain and an acute episode of haematemesis. Her mother explains that she is unable to locate a button battery she left on the kitchen table. She is tachycardic (heart rate 150 beats per minute) but normotensive (blood pressure 105/55 mmHg). A chest x-ray identifies a button battery in the proximal oesophagus. You are worried about the potential for this child’s haematemesis to worsen and consider whether any novel strategies could be used to mitigate deterioration prior to endoscopic removal.

A 5 year old girl presents to your paediatric ED with a one day history of abdominal pain and an acute episode of haematemesis. Her mother explains that she is unable to locate a button battery she left on the kitchen table. She is tachycardic (heart rate 150 beats per minute) but normotensive (blood pressure 105/55 mmHg). A chest x-ray identifies a button battery in the proximal oesophagus. You are worried about the potential for this child’s haematemesis to worsen and consider whether any novel strategies could be used to mitigate deterioration prior to endoscopic removal.

Fascia iliaca blocks (FIB), first described by Dalens et al in 1989, have become a key method of managing pain in patients with fractured neck of femur. In your department FIB tend to be performed using a landmark (loss of resistance) technique. However, it has been noted that there have been a number of ineffective blocks recently, leaving patients still in need of opioids to manage their pain. At clinical governance one of the consultants, a point of care ultrasound enthusiast, suggests that the department should move to performing FIB under ultrasound guidance as he believes they are more likely to succeed. You leave the meeting wondering if he is right.

Polytrauma patients with penetrating trunk injuries alongside a TBI would be treated by the Ambulance Service anywhere in the UK and that crew would follow clinical treatment guidance published by the Association of Ambulance Chief Executives and Joint Royal Colleges Ambulance Liaison Committee (JRCALC). In this scenario JRCALC would suggest maintaining permissive hypotension despite all of the evidence maintaining that one drop in systolic blood pressure below 90mmHg in a TBI patient leads to as much as a 100% increase in mortality.

30 year old male has been involved in a road traffic collision and sustained penetrating injuries to the chest. You arrive on scene and the patient loses his pulse and goes into traumatic cardiac arrest. You wonder whether a prehospital resuscitative thoracotomy (PHRT) would improve his chances of survival?

A 55 year old man is admitted to the vascular ward following a fasciotomy and bilateral lower limb embolectomy. He presents with reduced ROM and strength of his ankle and is struggling to weight bear due to pain. Does physiotherapy and exercise improve functional recovery?