Archives: BETs

A 60-year old gentleman is brought into the Emergency Department with an OOHCA. All monitoring is attached whilst ALS protocol is ongoing, including CO2 monitoring. You want to assess whether the patient is going to survive and thereby achieve a return of spontaneous circulation (ROSC) and you wonder whether the patient’s ETCO2 level can prognosticate this.

You have seen a 2 year old boy with croup, using parameters based on his clinical features you work out his Westely score is less than 7. He can be discharged with oral steroids. Do you advise his parents to treat with humidified air?

A 5 year old boy, suffering from hyperinsulinemic hypoglycaemia and arterial hypertension secondary to polycystic kidney disease, was given nifedipine (0,3 mg/kg/TDS) to treat his high blood pressure. Normotension was restored and secondly, his blood sugar levels normalised. We wondered whether nifedipine could be used safely as long term treatment to counter hypoglycaemia in persistent hyperinsulemic hypoglycaemia of infancy (PHHI)?

A six-month-old boy was admitted to the Paediatric ward with history of fever, non-blanching petechial rash, shrill cry and poor capillary refill. He required 20 ml/kg of fluid bolus. After a full sepsis screening including a lumbar puncture, he was started on IV Cefotaxime for a presumed diagnosis of meningococcal meningitis. Next day on the ward round the Specialist Registrar wondered if a short course of dexamethasone should have been started with the first dose of antibiotic to improve neurological outcome in this child.

A 44 year old man presents to the Emergency Department with a six hour history of palpitations. His ECG confirms that he is in atrial fibrillation and a detailed history suggests that this is acute atrial fibrillation of less than 48 hours duration. It is decided that cardioversion is the treatment of choice, but which waveform is likely to be more effective? Monophasic or biphasic?

A healthy 25-year-old man involved in an altercation with another man sustains a bite wound on the arm and presents to the Accident and Emergency Department. The wound is thoroughly cleaned and no signs of infection are present. You wonder whether prophylactic antibiotics are indicated to reduce the risk of wound infection in this patient.

An 85 year old man presents to the emergency department with headache and sudden loss of vision. He has signs of an acute retinal arterial occlusion. He has a moderate headache and some mild tenderness along his scalp arteries. His ESR is 110 and his CRP is 150. You diagnose temporal arteritis and decide to give him steroids. The Ophthalmic nurse practitioner suggests Methylprednisolone, but your departmental handbook says that oral steroids will suffice. You wonder which to give.

After seeing a 50 year old man with coffee ground vomiting secondary to NSAID use you refer him to the RMO. You know the SIGN guidelines don't advocate pre-endoscopic proton pump inhibitors in non-variceal upper gastrointestinal haemorrhage, but ,yet again, the RMO requests an IV PPI. You wonder whether the medical SHO cohort know something that you and SIGN do not, so decide to evaluate the evidence yourself.

A 27 year old athlete presents with acute rupture of his Achilles tendon, which is treated surgically. What is the best rehabilitation regimen for optimising his recovery and returning him to competitive sport?

A 3yr old boy is brought to the Emergency Department suffering with diarrhoea and vomiting. You estimate him to be suffering from moderate (5-10%) dehydration, and feels he needs rehydrating. Aware that he does not want to take oral fluids, and is likely to vomit these back anyway, you wonder whether naso-gastric rehydration would be a satisfactory alternative.

A 28 year old diabetic attends having been found unrusable by friends. Initial examination shows her to be GCS 5/15 with a BM measurement of high. Blood gases show her to have a pH of 7.02 and a blood sugar comes back at 41mmol/l and her urine shows three plus ketones. You begin treatment with insulin and IV fluids and contact ITU for an opinion on airway management and ventilation. The ITU registrar asks you to start a bicarbonate infusion while he is on the way down. You are unsure if this is beneficial and decide to find evidence on who is right.

A 65 year old man on aspirin presents to the emergency department having fallen sustaining a minor head injury. You wonder whether he is at higher risk of intracranial bleeding due to aspirin.

You are a Paediatric Registrar on duty. The S.H.O asks you to review a child recently returning from Spain, presenting with acute gastroenteritis. The mother shows you a prescription indicating treatment with a Probiotic preparation started by the doctor abroad and wonders about whether you would continue with the same. The S.H.O also quotes some studies supportive of this intervention. You have some time and go off to search for evidence in this regard.

A 32 years old male presented to the A & E Department with bloody stools, fever after his return from holiday abroad. He had moderate signs of dehydration & was given IV Fluids. The next question was whether to start him on antibiotics or not

A 12-year-old boy presents to the emergency department with a history of limp and decreased range of movement at his right hip. You suspect that he may have a slipped capital femoral epiphysis. You wonder whether plain film radiograpy or ultrasound sonography would be a more sensitive diagnostic modality for slipped capital femoral epiphysis.

An 18-month-old boy is admitted with his first febrile convulsion. At discharge his parents ask if there is there anything that can be done to prevent another one?

A 28 year old diabetic arrives in the department with a blood sugar of 1.4. After 50mls 50% dextrose she is briefly alert enough to tell you she has taken an overdose of 2ml insulatard into her left thigh. There is a raised area of skin suggestive of an injection site. You wonder whether surgical excision will reduce the availability of insulin and so aid her recovery.