Archives: BETs

A 25 year old male presents at casualty with partial thickness burns to his arm and elbow. The visual analogue scale shows 80mm on the 100mm scale. Do you give opiate analgesia or another method of pain control.

A 24 year old male with asthma presents to the Emergency Department with severe wheeze and dyspnoea. While nebulised bronchodilators are being administered you wonder whether it is better to prescribe oral or intravenous steroids.

A young woman attends the Emergency Department with pain in her right eye. Her infant son has inadvertently put his hand in her eye. Examination reveals a corneal abrasion. You wonder whether an eye patch should be applied to protect the cornea.

A patient presents to the emergency department following a road traffic accident. He is found to have loin pain and tenderness and microscopic haematuria on dipstick testing. He is not hypotensive and has no other major injuries. You wonder whether radiological imaging is necessary to exclude significant injury to the renal tract?

A 23 year old woman attends an emergency department having taken sixty 500mg paracetamol tablets. Her four hour paracetamol levels are above the treatment line. She does not want to be treated with intravenous therapy. You wonder whether oral antidote is as effective.

An adult patient presents to the emergency department with a nosebleed that came on spontaneously and which has not responded to simple first aid measures. The bleed appears to be from the front of the nose and the patient has no underlying disease. You wonder whether packing or cautery is the best method of obtaining haemostasis.

A 4 year old girl attends the emergency department with moderately severe croup. You have heard that croup responds to steroid therapy, but wonder whether it is more effective than nebulised epinephrine.

A 40 year old male is admitted into the resuscitation area of the Emergency Department following a high speed road traffic accident. He tells you he has not injured his head and has no pain in his pelvic area. He is alert orientated, he is not under the influence of any alcohol or drugs, and is neurologically intact. You cannot find any major injuries, his pulse is 94, and BP 145/90. He has no pain on flexing his pelvis. You wonder if it is necessary to perform a pelvic x-ray.

A 45 year old man attends emergency department having fallen off his bicycle. He has pain around his left upper arm. Examination reveals a probable fracture of the humerus and an x-ray confirms this. There are no neurovascular complications. You have received differing advice about the best way to support the arm after this injury. You wonder whether a broad arm sling or collar and cuff is best.

A 20 year old woman presents to the emergency department having suffered her first lateral patellar dislocation 1 hour before. She has managed to reduce it herself. You wonder whether surgery is superior to conservative management.

A 40 year old man attends the emergency department having recently eaten fish. He feels that a bone has got stuck in his throat. Examination of the oropharynx does not reveal a bone. You wonder whether an x-ray would aid diagnosis.

A 3 year old boy is brought into the Emergency Department by his mother. She says that he swallowed a coin 2 hours earlier. The boy is asymptomatic. You wonder whether a chest x-ray should be done to exclude oesophageal impaction.

A 28 year old man presents to the emergency department with a swollen, bruised and painful ankle following an inversion injury. After examination and appropriate investigations a grade 2 inversion ankle sprain is diagnosed. You wonder whether early mobilisation or immobilisation in a short leg cast is more suitable for this patient.

A 20 year old woman presents to the emergency department having suffered her first lateral patellar dislocation 1 hour before. She has managed to reduce it herself. You know that surgery offers no advantage over conservative management, but wonder what is the best approach to initial immobilisation.

A 24 year-old woman is brought into the Emergency Department having fallen into a frozen lake. Passers-by heard her cries for help and alerted the Emergency Services who rescued her 15 minutes later. On the way to hospital she suffered a cardiac arrest. Her core temperature on arrival is 25 degrees centigrade. You know that she needs rewarming but wonder whether her eventual outcome will be improved by cardiopulmonary bypass rather than external rewarming.

A patient presents to the Emergency Department with a laceration to the right forearm. The wound will need cleaning and then closing. There appear to be many different cleaning solutions available - you wonder which is best.

A 4 year old boy presents to the emergency department following a 1 metre fall onto a carpeted floor. The child has vomited 3 times in the last hour but is otherwise well. Clinical examination is unremarkable. You wonder how significant the vomiting is.

A 3 year old girl presents to the emergency department after catching her face on the edge of a table. She has a 2.5 cm laceration to the cheek which requires closure. The wound is not suitable for steristrips. The parents are very worried abbout her having stitches and also about scarring. You wonder whether glue is the best option for this child.

A 35 year old man presents with acute onset of difficulty walking which came on while paying sport. He describes sudden onset of pain at the back of the ankle. Clinical examination reveals complete rupture of the achilles tendon. You wonder whether operative treatment is better than conservative management in this case.

A 6 month old baby with 3 day history of coryzal symptoms, increasing cough and wheeze presents to the emergency department. Your clinical diagnosis is bronchiolitis. You wonder whether the addition of nebulised ipratropium will improve the clinical condition.