Archives: BETs

A 13 year old adolescent presents to emergency department with one day history of unilateral headache associated with phonophobia and photophobia which gets better on lying down in a dark room after taking NSAIDs. There is a past history of recurrent headaches of similar nature and frequency has increased over past two months (4-5 episodes/month) and response to NSAIDS has also reduced. This affects his quality of life in terms of missed school days. After complete history and examination, a diagnosis of migraine is made. I wonder if migraine prophylaxis should be considered and if riboflavin is effective prophylactic medicine in reducing the frequency, duration or severity of migraine attacks.

A 59-year-old male is admitted to our ICU because of fever, low level of consciousness, decreased SPO2,he has a past medical history of diabetes mellitus. Chest radiography (CXR) was performed, which reported patchy air space opacity in the right upper lobe suspicious for pneumonia . Lung HRCT revealed bilateral ground-glass opacities (GGOs). LAB data shows leukocytosis and elevated CRP and ESR levels

A 42-year-old man presents to the Emergency Department (ED) with an acute anterior shoulder dislocation following a fall. He does not tolerate reduction with nitrous oxide and intravenous (IV) access is not possible. Your Consultant suggests using intra-articular lidocaine (IAL) to aid reduction. You wonder if IAL is a safe and effective alternative to intravenous analgesia with or without sedation.

In patients who have isolated fracture of the greater trochanter seen on plain film, does further cross sectional imaging (CT or MRI) help diagnose occult unstable extension of the fracture

A Physiotherapist would like to know if the benefits of participation in early mobilisation with patients post SAH with EVD outweigh the risks of adverse events relating to EVD and mobilisation

Since the outbreak of COVID-19, there is a worldwide shortage in protective masks such as surgical and filtering facepiece (FFP) masks. However, your local government advises the public to wear an alternative protective mask, such as a homemade made from household materials or cloth mask, to avoid virus transmission during the pandemic. You are faced with the question whether in non-healthcare settings cloth or homemade facemasks are effective at preventing virus transmission or illness caused by viruses?

A 48 year old male presents to the emergency department following a fall at work. He recalls grabbing a pole as he tried to slow his fall. He complains of right shoulder and elbow pain. Active elbow flexion and supination is painful and weak. Radiographs exclude fracture and/or dislocation at the shoulder and elbow. You suspect a distal bicep injury and recall there is a time urgency to manage such injuries. You perform the 'hook test' but are unsure of its reliability and accuracy in detecting Distal Biceps Tendon Rupture (DBTR). You consult the literature to support your discussion to expedite this case to the upper limb orthopaedic team.

A 68-year-old man with a past medical history of COPD, hypertension, and diabetes who presents to the emergency department (ED) with a 3-day history of suprapubic pain. Initial vistal signs were T-37.6C, HR: 92, BP: 100/52, RR: 21, 02%: 94%. Patient was in no apparent distress and the abdominal exam was significant for tenderness in the suprapubic region, no evidence of pulsatile mass. Diagnostic workup showed no evidence of leukocytosis or urinary tract infection. He had a computerized tomography scan of the abdomen within two years that showed a normal abdominal aorta diameter. Patient received 1L of fluid, ketorolac, and ondansetron and on re-evaluation after negative workup, he was discharged. On discharge it was noted that his temperature was 38.1C. The patient returned 4 days later in septic shock secondary to a peri-nephric abscess.

A 23 year old woman attends your department having been kicked in the chest by her horse. On arrival, she is complaining of right sided chest pain. Her vital signs are normal and she has no respiratory distress. Your examination reveals an isolated chest injury. You arrange a portable chest x-ray which shows a small, right sided, apical pneumothorax. You wonder whether you can avoid inserting a chest drain, and manage this patient conservatively.

A 71-year-old male with a history of tobacco abuse, sleep apnea, and obesity presents after awakening from sleep due to sudden onset, severe chest pain that radiates to the back between the shoulder blades. Exam reveals a diaphoretic and anxious appearing male. He is tachycardic and hypertensive with regular heart sounds. There is no pulse differential and no neurologic deficit. You suspect that the patient has an acute aortic dissection and you request that nursing perform bilateral upper extremity blood pressure (BP) readings. The right arm reads 191/92 mmHg and the left arm reads 168/90 mmHg. You wonder how reliable this finding is in determining whether the patient likely has an acute aortic dissection.

A 34-year-old male presents to the emergency department with a laceration to his left hand inflicted by a clean knife approximately 12 hours prior to arrival. The patient washed the wound thoroughly after the injury and then wrapped it in a pressure bandage. He comes to the ED this morning because he is concerned it needs stitches. You remember hearing of the “golden window” for wound closure and wonder if closing this patient’s wound would significantly increase his risk of developing an infection.

The ambulance service is called to a 33-year-old-gentleman who has been found unresponsive. The dwelling is dark and confined with poor hygiene. The patient is confirmed to have self-administered opiates intravenously and is also reported to be HIV positive. On examination the patients peripheral vasculature is delicate and bruised. The intranasal (IN) route, as opposed to intravenous (IV) or intramuscular (IM) routes, of administering Naloxone is considered.

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You are tasked to assess a 42-year-old solider who has developed sudden onset slurred speech and weakness in the right arm whilst on exercise. The National Institute for Health and Care Excellence (NICE) guidelines recommend the use of a validated stroke screening tool such as “FAST (Face Arm Speech Test)” in the pre-hospital setting, or “ROSIER (Recognition of Stroke in the Emergency Room)” in the hospital setting. Recognising different screening tools are recommended between settings, you wonder whether there is a difference in accuracy between the screening tools.