Archives: BETs

A patient attends the emergency department having sustained a blunt head injury. On examination they have clinical signs of raised intracranial pressure and a Glasgow Coma Score of 5. You decide that the patient needs a rapid sequence intubation and contiuous mandatory ventilation in order to protect the airway and reduce intracranial pressure. You wonder whether the pretreatment with lignocaine will attenuate the rise in intracranial pressure from the rapid sequence intubation.

A 25 year old man is stabbed in the chest during a pub brawl. He sustains an isolated chest injury that requires a tube thoracostomy. You wonder whether the administration of prophylactic antibiotics will reduce the incidence of intrathoracic infection in this patient.

A 30 year old male elctrician attends the emergency department having suffered an electrical shock while servicing a washing machine. There was no water involved.

A 35 year old woman attends the Emergency Department with a swollen and painful left leg. A DVT is suspected and confirmed on ultrasound. You are aware of the possible risks of developing post-thrombotic syndrome and wonder whether this young woman would benefit from the use of compression stockings.

A 55 year old male presents with massive haematemesis. He has known oesophageal varices. He is tachycardic, peripherally shut down and continues to actively vomit fresh blood. You wonder if pharmacological treatment with terlipressin or somatostatin will be effective in reducing the bleeding.

A 69 year old woman has slipped and caught her leg on a chair. She attends your A&E department with a large flap laceration to the anterior aspect of her right leg. She has no other injuries, no other significant past medical history and has good social support. you want her wound to heal quickly so that she may get back to her normal activities as soon as possible. You wonder whether a primary split skin graft or a simpler procedure using the existing flap would be best to achieve this.

A 25 year old female attends the emergency department having been in a rear end shunt. She complains of pain in her neck. On examination she has right sternomastoid tenderness and restricted movement. You diagnose a neck sprain and advise physiotherapy, exercise and anti-inflammatory drugs. She asks you whether she should go and see an osteopath or a chiropractor. You wonder whether there is any evidence for these alternative treatments.

A 45 year old female epileptic presents after sustaining a grand mal convulsion at home. She starts fitting again on arrival in the emergency department; the fit does not stop spontaneously after 5 minutes. The paramedics have secured intravenous access prior to arrival but have not given any anti-convulsants. You wonder whether lorazepam is more effective than diazepam as a first choice drug to safely terminate this convulsion.

A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical team who ask you to obtain a white cell count. You wonder whether this test has any value in this situation.

A 56 year old immunocompetent man presents to the emergency department at 10pm on a Saturday night with acute shingles. You know acyclovir is effective but wonder how quickly it needs to be started.

A very anxious mother brings her 4 year old daughter to the emergency department concerned about her persistent fever. Examination reveals that she does indeed have a temperature of 37.6ºC. She has no obvious signs of localised infection, so you decide that you need to test her urine to see whether she has got a UTI. After much coaxing she provides you with a sample but you now wonder if dipstick analysis is sufficient for diagnosis, or whether you ought to arrange for urgent microscopy.

A 40-year-old woman with known paroxysmal supraventricular tachycardia (PSVT) presents to the emergency department with an acute episode of palpitations, dizziness and chest tightness of sudden onset. She is found to have a further episode of supraventricular tachycardia on ECG and her systolic blood pressure is 55 mm Hg. Previous episodes have been terminated by DC cardioversion and you are aware of the algorithm recommending such treatment in the 2011 ALS course manual. However, the text also states that it is reasonable to give Adenosine to patients with regular narrow-complex tachyarrhythmias where there are adverse features while preparations are being made for synchronised cardioversion. You wonder whether it is really effective and safe to give adenosine first to unstable patients and whether this is so for children also.

A 32 year old man presents with a pedal puncture wound, which was sustained 4 hours prior to attending the emergency department. You wonder whether antibiotics should be prescribed to reduce infective complications.

A patient attends the Emergency Department with signs and symptoms consistent with a Deep Venous Thrombosis. Somebody suggests that there is a new bedside blood test, called SimpliRed, that may help to rule out the diagnosis in your patient. You know that ruling out a diagnosis is possible by having a test with a high sensitivity or negative predictive value. You wonder what evidence there is to suggest that SimpliRed fulfils these criteria?

A 40 year old man presents with acute suspected pulmonary embolus (PE). You wonder whether a negative SimpliRed d-dimer assay is sufficient to rule out the diagnosis of PE.

A 20 year old man presents to the emergency department with a history of something having blown into his eye. Clinical examination reveals a small abrasion to the cornea. You prescribe chloramphenicol ointment and discharge the patient. A friendly Ophthalmologist suggests that you should have given a dilating drop as well. You wonder if there is any evidence to support this.

An otherwise fit 71-year old lady presents to your department having slipped on the ballroom floor during a tea dance. She is unable to weight bear and has pain in her left hip. X-ray reveals a dislocation of her hip prosthesis, and she tells you that it's not the first time. You wonder if it's reasonable to sedate her and manipulate it in the department, or refer her to orthopedics to join the rather long emergency list, to be manipulated later. Perhaps days later. She is starved, and you have suitable anaesthetic experience.

A 27 year old woman presents to the emergency department having taken a paracetamol overdose; she is not vomiting. You have been told that people with a significant overdose of paracetamol will vomit. You woner whether this is true?

A 16 year old male is brought to the emergency department following a drive by shooting. He has an isolated entry wound to the right temporal region consistent with a .22 calibre bullet. On arrival he is cardiovascularly stable but has GCS of 5 (extending to pain) with reactive pupils. You decide to intubate using an RSI technique but you are worried as the patient has a small mandible and may present difficulties in intubation. You wonder if it is safe to remove the C-spine collar, flex the neck and extend the head, but you are worried about a c-spine injury. You take a risk, remove the collar and intubate the patient. Later you wonder just how risky it was.

A 45 year old female attends the emergency department with a four 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 serum lipase might be better than serum amylase as a diagnostic marker for pancreatitis in this patient.