Archives: BETs

An ambulance is called to a patient suffering from acute chest pain, which is diagnosed as cardiac in origin.The pt has taken a spray of their own GTN with little effect, and you wonder whether a buccal GTN preparation would be more effective at relieving the pain?

You are a paediatric SHO, on a night shift. You are called to the ward to see a 6 year old girl, who cannot get to sleep because her eczema is too itchy. The nurses want you to prescribe an anti-histamine, but you doubt the efficacy of this treatment. As it is a surprisingly quiet shift, you go off to do a literature search.

You are an intensive care registrar who has taken over the care of a three week old baby boy diagnosed as having clinical bronchiolitis (now found to be RSV +). He was initially admitted and ventilated because of increasing respiratory distress and apnoeas. His ventilatory requirements are increasing and gas exchange is getting worse. You have just finished your stint on neonates and recall hearing that surfactant has been used on infants with bronchiolitis in trials. You wonder if it may help this child.

A nine year old boy is brought into the emergency department by his parents. He is a known asthmatic and has become acutely short of breath. He is struggling to talk in full sentences and his PEFR is less than 50% predicted. You suspect acute severe asthma and begin the appropriate treatment in accordance with the BTS asthma guideline. You wonder if the addition of nebulised magnesium sulphate would improve his outcome.

A 68 yrs old female presents with Fracture neck of femur in ED after a fall and now in severe pain 10/10 and we couldn't get a line so IV morphine can be given, so would intranasal diamorphine be a suitable alternative?

A known diabetic child presented to ED with abdo. pain vomiting and high blood glucose, you suspected DKA,you canulated the child and took blood samples including a sample for venous gases but your FY2 wondered (without chalenging your autharity) whether a venous sample is good enough to reflect the degree of acidodsis as compared to an arterial sample? you thought the answer was yes but wasn't sure about the evidence.

A 30 year old man presents to the ED with a 3 days history of right sided chest pain that increases in intensity with breathing, lying on the right side and application of local pressure. His BP is 130/70mm Hg, heart rate 90 beats per minute, respiratory rate 23/min, and temperature 37.3°. He denies any history of trauma. Pulmonary embolism is one of the differential diagnoses, but you question whether the presence of the chest wall tenderness is enough to rule out pulmonary embolism before carrying out further tests.

A 41 week gestation male infant, birth weight 4320g, is born by an emergency caesarean section at a District General Hospital for fetal distress and a poor fetal scalp blood gas. The infant is in poor condition at birth and requires intubation and ventilation. As the Tertiary Neonatal transport fellow you are called to transfer the infant to the Tertiary unit as he is hypoxic despite 100% oxygen and a peak pressure of 32. You calculate his oxygenation index to be 32. Your Consultant talks you through the use of the portable Nitric oxide equipment before you leave. You wonder what the long term neurodevelopment effect of Nitric oxide is in Term babies.

You have seen a 26 year old right hand dominant man with 5 days old suspected fracture of Scaphoid in A&E, he is still tender around his Scaphoid area, and asking for early return to work. You have heard about advances in Ultrasonographic (US) diagnosis of upper and lower limbs pathologies, and wondering if US is a sensitive and specific test for early detection of suspected Scaphoid fractures.

A twenty year-old lady presents to the Emergency Department claiming to have taken 100 co-codamol tablets two hours ago. The guidelines suggest that activated charcoal is of no benefit at this stage. However, you are aware that opioids encourage gastric stasis and wonder if there is any evidence that activated charcoal is still of benefit to this patient.

A 26-year-old man attends the emergency department having recently used cocaine. He is hyperthermic. You have heard that dantrolene may have a place in the management of hyperthermia in other situations and wonder whether it would be useful now.

Following a 999 call to their home, an adult insulin-dependent diabetic patient is successfully treated with IM glucagon for hypoglycaemia by the attending ambulance crew. The patient is now fully recovered, they feel fine and their blood glucose level is above 5mmol/l. The patient does not want to go to hospital so is it safe to leave them at home?

Ambulance is called to an RTA involving a motor cyclist who has sustained upper and lower leg fractures on the same limb. You wonder whether his leg be immobilised using a traction splint.

A 60-year-old man presents to the Emergency Department with acute severe crushing chest pain. ECG shows changes consistent with acute myocardial infarction. You prescribe aspirin, thrombolysis, nitroglycerin, beta-blockers and high-flow oxygen. You know that oxygen therapy is traditionally held to be beneficial in this situation, but wonder if there is any evidence that it reduces mortality.

A 64 year old lady on long term warfarin for atrial fibrillation attended the A&E department following a fall. She has sustained a frontal head laceration with very brief loss of consciousness. She has a GSC score of 15 with no neurological symptoms. You wonder if patients on warfarin and a minor head injury are at risk of intracranial injury and as a result if they all require admission for neuro-observation

A one year old child is admitted following their first febrile seizure (FS). We wish to prevent recurrences during further febrile episodes. The nursing staff ask you to prescribe an antipyretic. Later you come to advise the parents on methods of preventing further febrile seizures.

A 73 year old woman presents with a six hour history of a left sided hemiparesis. She has a past history of hypertension. On examination she is GCS 15 with a dense left hemiparesis and her basic observations are stable. You wonder whether the use of supplemental oxygen in the acute stage is needed and will have any effect on long term prognosis.

You are seeing a 70 year old American man with three discrete 70% stenoses in the mid LAD, mid Circumflex and Proximal RCA. He has grade III angina and apart from Hypertension and a high cholesterol he has no other significant past history. You advise him that his best option is certainly to have Coronary Arterial Bypass grafts in terms of relief of symptoms. However he tells you that he had a friend in the States with the same problems as him who had 3 stents that were impregnated with drugs that will keep his arteries open forever. You wonder whether drug-eluting stents would be just as good for him if he could get them.

A 17 year old male presents to the Emergency Department after a road traffic accident. His GCS was 8 on arrival but an immediate CT scan showed no focal abnormality. His GCS returned to 14 after 4 hours. You are talking to his mother who is reassured that he does not need urgent neurosurgery, but she asks whether he will suffer any long term consequences from this injury. You tell her that it is difficult to predict, but you have recently head that S-100 protein measurement is available in your hospital for research purposes. You wonder whether S-100 could help predict his long term prognosis.