Archives: BETs

A 45 year old man presents having been assaulted the day before. He has no signs of external injury to his chest and is in significant discomfort. He denies shortness of breath, he has a normal respiratory examination and his pulse oximetry registers 99% on air. Does he require a chest radiograph to rule out a traumatic pneumothorax?

A 77-year old woman presents to the Accident and Emergency department following a simple fall in which she has sustained a fractured neck of femur. You have recently completed a secondment in anaesthetics and consider a "3-in-1" block for pain relief. One of the consultants with whom you worked stated that to perform a nerve block without using a nerve stimulator would be poor clinical practice. When you gave the example of nerve blocks in fractured neck of femur he commented that ultrasound (US) has been used as an alternative to nerve stimulators (NS) in this setting.

An elderly Patient with the history of BPH presented in A/E department with acute retention. He was successfully catheterised; he has no signs of UTI or acute renal impairment. Some hospitals discharge these patients and arrange Trial without Catheter as OP. I wonder if early TWOC is more successful than delayed in this group of patients.

A 60 year old patient with risk factors for ischaemic heart disease suffers a non traumatic out of hospital cardiac arrest. There is no return of cardiac output despite advance life support. You know that the majority of sudden cardiac arrests are thrombotic in origin and you wonder whether thrombolysis would be of benefit.

A 57 year old man presents with a one hour history of central chest pain the character of which he cannot describe. There is no radiation but there is mild sweating and subjective shortness of breath. He has a history of smoking, hypertension, angina and a hiatus hernia; the pain came on after a curry. He has a normal ECG on admission and an unremarkable examination. You cannot decide whether this is cardiac or oesophageal in origin and wonder whether a single dose of antacid might relieve his pain and therefore clarify the diagnosis.

A 73 year old woman presents to the emergency department with chest pain. Her ECG shows left bundle branch block. She is on warfarin for recurrent pulmonary emboli. Her INR is 2.7. While you look for her old notes to see if LBBB is new or not, you try to find out at what INR thrombolysis is contraindicated. Everyone gives you an answer, but the answers are all different. You wonder if there is any evidence to support any of the recommendations.

A young poacher comes into the Emergency Department complaining of a sore thumb after a night pilaging the local squire's estate. He smells strongly of game birds and clinically he has a rupture of the ulnar collateral ligament of his thumb. You wonder whether to plaster him or place him in a functional splint in the first instance?

A 27 year old woman attends the emergency department with a two day history of headache with mild neck stiffness. She appears otherwise well. Her CT scan is normal and you feel that if a lumbar puncture is normal she can be discharged. The duty physician advises you that the patient will require four hours bed rest after the lumbar puncture. The duty anaesthetist overhears and says that the patient will be able to go home immediately. You wonder if either of them is right.

You are seeing a patient in the A&E department with a fracture shaft of humerus.You have never applied a U-slab before and wonder if applying a brace instead would be detrimental to the healing of the fracture.

An adult is brought into the emergency department following an out of hospital ventricular fibrillatory arrest. Ventricular fibrillation persists despite repeated shocks. You remember reading about biphasic defibrillation and wonder if it offers any advantages.

An 18-year-old male presents after having been stabbed with a 9inch screwdriver 1cm below the left nipple. On arrival he is tachycardic at 125 bpm with a blood pressure of 110/75. This settles with two litres of normal saline to a pulse rate of 85 bpm and a blood pressure of 129/82. He is fully alert. His chest X-ray reveals the presence of a pneumopericardium. He has no other injuries.

You have just performed a manipulation under anaesthesia for a displaced supracondylar fracture in a child. Check X-rays reveal a satisfactory reduction. You wonder whether a simple collar and cuff is as effective as other means of holding reduction.

A 25 year old male sustains an inversion ankle injury while playing football. Clinical examination and radiographic studies confirm an acute ligament rupture. You wonder whether this patient should be treated conservatively or admitted for surgical repair.

One evening after the emergency eye centre has closed you assess a patient and diagnose acute bacterial conjunctivitis. Your usual practice is to prescribe topical antibiotic therapy. Having recently attended a BestBETs course you wonder if this has been shown to reduce the time to clinical remission.

A paramedic ambulance is dispatched to a 24-year-old male who has been ejected through the windscreen of his car. On arrival at the scene the patient is found to have major maxillofacial injuries a seriously compromised airway. Airway control cannot be achieved by manual techniques and endotracheal intubation is not possible. You decide to attempt cricothyroidotomy and wonder whether the surgical technique is more preferable to the percutaneous dilatation technique.

A 67 year old man has been brought into the emergency department by paramedic ambulance. He was initially in ventricular fibrillation, but now has pulseless electrical activity. He collapsed 15 minutes ago and received immediate bystander basic life support. You wonder whether intravenous vasopressin would be better than adrenaline in this situation.

A paramedic ambulance is dispatched to a 36-year-old female who has fallen from a horse. On arrival the rider is not wearing a helmet, is unconscious with a GCS of 3 and has laboured diaphragmatic breathing. A cervical spine injury is suspected and orotracheal intubation is indicated due to the reduced respiratory effort, possible head injury and the long transport time to the nearest emergency department. The patient has a grade 3 laryngoscopic view (Cormack and Lehane). You wonder whether intubation would be made easier if you had a gum elastic bougie or stylet.

A mother with her 11 month old daughter attends the surgery. The child has gastro-enteritis and is mildly dehydrated. Mum has been starving the child the last 24 h as "everything comes back up". She has read this and also to avoid milk feeds in her health manual at home. Having read a paper once on continueous milk feeding as opposed to gradual regrading of milk, I decide to look which approach would be better.

A 65 yrs old gentleman presented to the ED with Acute SOB and high temperature with previous history of LVF. Will IVC diameter help decide whether we need to give or restrict fluids to treat him?