A patient is brought in after attempting suicide by inhaling exhaust fumes from their car. He/she has a GCS of 3 and has required intubation but is otherwise stable. He/she has a carboxyhaemoglobin level of 40%. They have been receiving high flow oxygen, but you wonder if transfer for hyperbaric oxygen therapy is indicated.
Archives: BETs
U-slab, hanging cast or collar and cuff in uncomplicated shaft of humerus fractures in the elderly
A 60 year old woman presents with a closed, undisplaced, uncomplicated fracture of the shaft of the humerus. You seek advice on the best method to support / splint the arm and receive a range of different answers. You wonder whether there is any evidence to suggest that any one method is the best.
Ultrasound scanning in the diagnosis of acute appendicitis in pregnancy
A 28 year old woman presents to the emergency department with a 4 hour history of right iliac fossa pain, and an examination suggestive of acute appendicitis. You are aware that an isolated blood count is neither specific nor sensitive in the diagnosis of appendicitis, and the on-call surgeon suggests that an ultrasound scan may be helpful.
The relationship between post traumatic stress disorder (PTSD) and affective disorder.
A 30 year old woman comes into the Emergency Department having been the victim of a vicious non-sexual assault. She has suffered from depression since the age of 18. The Mental Health liaison nurse says that you should refer her for psychological support straight away as she has a predisposition to develop PTSD. Although it seems likely that someone with a known depressive disorder is more likely to get post assault psychological problems, you wonder whether there is any evidence to show that this really does occur.
A 27 year-old man sustains punches to the face and ear during a drunken brawl. He attends the Emergency Department the next day complaining of unilateral deafness and otalgia. Examination reveals an intact tympanic membrane but blood in the middle ear cleft. The SHO on-call for ENT suggests he needs a myringotomy to drain the blood. You wonder whether there is any evidence that this could relieve symptoms and improve outcome.
Rectal or Intravenous non-steroidal anti-inflammatory drugs in acute renal colic
A 21 year old male presents to the emergency department with sudden onset of left lumbar pain radiating to the groin. A clinical diagnosis of renal colic is made. You wonder whether rectal NSAID's would be more effective than IV or IM NSAIDs?
Do non-steroidal anti-inflammatory drugs cause a delay in fracture healing?
A 21 year old man attends the emergency department having sustained an undisplaced, closed fracture of his distal radius. You wonder whether giving the patient a course of NSAIDs will delay fracture healing.
A 35 year old man returns unplanned to the emergency department. He had been assaulted a week previously and suffered a blow to the head. At the time of initial presentation a skull x-ray did not reveal a fracture and he had been discharged home with head injury instructions. Currently he describes non-specific symptoms of a persistent but not progressive headache. Examination does not reveal any abnormal neurological signs. You wonder about his further management and specifically as to whether he requires a CT scan of his brain.
Combining clinical probability and ventilation-perfusion scan for diagnosis of pulmonary embolism
A 20 year old woman presents to the emergency department with shortness of breath and chest pain. Her D-dimer level is abnormal and you have sent her for a ventilation-perfusion scan. The scan result is reported as "low probability for pulmonary embolic disease, however this does not rule out pulmonary embolism". You have assigned her a low clinical probability of pulmonary embolism score and wonder if this helps interpret the scan.
A 3 year old child comes into casualty and you need to assess their pain. Would it be better to use the Oucher scale, a self report measure, or CHEOPS, a behavioural pain measure, as at this age using either seems equally valid.
A 26 year old man attends the emergency department having been bitten on his right hand 30 minutes previously by his pet – a non-venomous snake. Examination reveals localised swelling and oedema of his right hand and forearm, he is systemically well, has no relevant previous medical history and is fully anti – tetanus immunised. You know there is the potential for infection from the snakes fangs and oropharynx, as well as contamination from the victim's skin and clothing. You thoroughly clean the wound with local wound toilet, and are happy that there is no fang left in situ. You wonder if prophylactic antibiotics are indicated to reduce the risk of infection.
Prior injection of local anaesthetic and the pain and success of intravenous cannulation
A 45 year old female attends the emergency department with cellulitis. You decide to admit her for intravenous antibiotics. She becomes agitated, distressed and tearful when you explain this to her. On questioning she reveals that she is afraid of the pain of intravenous cannulation. You wonder whether a prior injection of local anaesthetic would lessen the pain of cannulation without affecting your chances of success.
Urinary Trypsinogen to rule out acute pancreatitis in patients with abdominal pain
A 45 year old female attends the emergency department with a 4-hour history of acute onset of epigastric pain. She has a history of alcohol usage. On examination you can elicit tenderness in the epigastrium but no peritonism. You are concerned that the patient may have pancreatitis. You wonder whether a urinary trypsinogen can be used as a diagnostic marker to rule out pancreatitis in this patient.
A 24 year old known asthmatic is brought into the emergency department by friends. She has been in a smokey bar and has become very wheezy. You assess her asthma as severe. You wonder whether a nebuliser is necessary, or whether a spacer device will suffice.
Outpatient treatment for patients with uncomplicated above knee deep vein thrombosis
A 25 year old man presents at the Emergency Department with a 2 day history of a swollen and painful right leg. A DVT is suspected and an ultrasound confirms the presence of an extensive clot in the femoral vein. Otherwise he is fit and well. There are no beds in the hospital and you wonder whether the evidence exists to confirm that this patient can be treated safely as an outpatient using low molecular weight heparin.
A 25 year old man atttends the emergency department having trapped his right index finger in a door. He has a compound fracture of the distal phalanx. You wonder whether antibiotics should be given after wound care.
A 24 year old man is brought to the emergency department by his friends having been shot in the leg. Examination of the thigh reveals a through and through wound with no bone, nerve or major vessel involvement. You wonder whether simple entry and exit wound cleaning with or without antibiotics or surgical debridement is the best treatment.
A 8 year old child has a 3cm wound requiring local anaesthesia prior to wound closure. While preparing a measured amount of lignocaine, you wonder if buffering with sodium bicarbonate will reduce the pain of administration.
A 19 year old man attends the Emergency Department having been assaulted in a night club. He has sustained an isolated head injury with no loss of consciousness and is fully alert and orienttated. He has CSF rhinorrhoea secondary to bbase of skull fracture. You wonder whether the administration of antibiotics will reduce the chances of meningitis developing.
A 70 year old woman presents to the Emergency Department with a pretibial flap laceration. The wound will need cleaning and then closing. You wonder whether adhesive strips or sutures should be used to achieve closure.