Archives: BETs

A 12 year old girl presents to the emergency department with "tummy ache". The history and examination are suggestive of appendicitis. You call the surgical team but they are unable to attend for one hour as they are tied up in theatre. You wonder if giving analgesia will affect the accuracy of the surgical diagnosis.

A 25-year-old man presents to the A+E department following a crush injury to the middle finger. There is a laceration over the distal phalanx involving the nail bed. The nail bed is disrupted. The injury requires removal of the nail and repair of the underlying nail-bed laceration. You wish to perform this procedure under local anaesthesia and suggest using a digital nerve block for anaesthesia. Your colleague suggests that a metacarpal block would be a better method as it is less painful to perform.

A 15 year old boy was playing in the local canal. He jumped off a small bridge and got his foot caught in an old shopping trolley on the bottom. He was pulled out but he was unconscious and apnoeic. He was given BLS by the paramedics so that when he arrived in A&E he was conscious, tachypnoeic, and centrally cyanosed. He had rhonchi and coarse crepitations in both lung fields. You wonder whether he would benefit from intra-venous steroids.

An insulin dependent diabetic adult is brought into the Emergency Department uncooperative and acutely confused. A blood glucose stick test confirms hypoglycaemia. You wonder whether parenteral glucose or glucagon is the drug of first choice.

A 35 year old man presents to the emergency department with a 1 day history of a right sided facial weakness. Examination reveals a complete right facial nerve palsy, without any evidence of herpes zoster, middle ear disease, trauma or further neurology. A diagnosis of idiopathic (Bell's) facial nerve palsy is made. You wonder whether early high dose steroids would improve his prognosis or speed of recovery.

A 40 year old man presents to the emergency department one day after suffering an injury to his knee. There is no evidence of bony injury on x-ray and a diagnosis of a traumatic haemarthrosis is made. You are unsure whether aspiration of the tense haemarthrosis will benefit him symptomatically.

A 17 year old female presents to the Emergency Department following a fall onto the right forearm. She complains of elbow pain and has a limited range of movement of that joint. X-ray reveals a moderate elbow effusion and an undisplaced fracture of the radial head (Manson type 1). You wonder whether aspirating the joint is worthwhile.

An 80-year old man is brought into the Emergency Department in the early hours of the morning with acute shortness of breath. He is pale, clammy and very distressed. You diagnose acute left ventricular failure. You have heard that frusemide may increase vascular resistance and wonder whether nitrates should be used instead.

A 45 year old man is brought to the emergency department with acute, central chest pain. You have diagnosed an acute myocardial infarction from the ECG for which he is receiving thrombolysis. You know that giving him a beta-blocker will improve his outcome but you only have tablets in the department and wonder whether he will be at a disadvantage for receiving this rather than an intravenous dose.

A 50 year old man attends the emergency department with a 12 hour history of chest pain that may be cardiac in origin. His ECG is normal. You want to rule out possible myocardial damage and wonder whether a single troponin T measurement taken at this time is sensitive enough to do this.

A 55-year-old man with cardiac-sounding chest pain presents to the emergency department. The first ECG is normal. Just before you discharge him you stop to wonder what the sensitivity of the initial 12 lead ECG is in predicting acute myocardial infarction.

A 25 year old woman is brought to the emergency department having taken an overdose of drugs. She will require gastric lavage but you consider that her airway is at risk. You call the duty anaesthetist who examines her and states that she does not need intubation as her gag reflex is present. You wonder whether gag reflex is a good test to predict the need for intubation.

A young woman presents to the emergency department having taken an overdose of her iron tablets. She is in an emotionally distressed state but is cardiovascularly stable and requests treatment. It has been less than 2 hours since she took the tablets and you prescribe activated charcoal. You wonder whether this will actually do her any good.

A 23 year old woman attends the Emergency Department having taken 60 500mg paracetamol tablets 2 hours prior to presentation. You wonder whether she should receive activvated charcoal.

A 25 year old patient with no history of respiratory disease attends the Emergency Department with acute onset of shortness of breath. A chest x-ray reveals a left-sided pneumothorax of approximately 50% the volume of the left lung; there is no tension. You wonder whether needle aspiration or chest drain insertion is the treatment of choice.

A young man comes into the emergency department after sustaining a knee injury while playing football. Examination reveals a tense haemarthrosis; there is no evidence of fracture on x-ray. You wonder whether a MRI scan would be better than an arthroscopy to establish a diagnosis.

A 3 year old child is brought into the emergency department with a crusty yellow rash on the forearm. She is systemically well and a diagnosis of impetigo is made. You wonder whether oral or topical antibiotics are better.

A 38 year old woman presents to the emergency department following an inversion injury of the right ankle. Clinical examination and x-ray confirm that there is an avulsion fracture at the base of the fifth metatarsal. You wonder whether immobilisation in a plaster cast is better than simple support bandaging.

A 32 year old man presents to the Emergency Department following a fight. He complains of pain around the base of the right thumb metacarpal. X-ray reveals an undisplaced Bennetts' fracture. You wonder whether he should be treated conservatively or surgically.

A 24 year old man is brought into the Emergency departmment having sustained a laceration over the dorsal aspect of the metacarpophalangeal joint of the left index fingger. You explore the wound and find that there is a 50% laceration of the extensor tendon. You wonder whether this requires repair.