Archives: BETs

A 65 year old man presented to the Emergency Department with hypoxia and confusion. Chest xray is consistent with severe COVID-19 pneumonia. COVID-19 was confirmed with PCR testing. A colleague mentions Azithromycin as a possible treatment. You wonder if Azithromycin would reduce mortality or length of stay. You also wonder if it is associated with increased adverse events.

A 22 year old female attends the emergency department after falling on her outstretched hand. On examination she has tenderness over the scaphoid, scaphoid tubercle with pain on axial loading of the thumb as well. Initial plain radiographs are normal. You have recently completed a musculoskeletal ultrasound course and wonder if ultrasound as a modality is useful in the diagnosis of occult scaphoid fractures.

A 28-year-old male football player has a blunt trauma to his quadriceps sustained 5 days previously. He now has painful, localised focal swelling over the lateral aspect of the mid-thigh and limited painful knee flexion. You suspect he may be developing Myositis Ossificans Circumscripta (MOC) within the Vastus Lateralis muscle. You decide that he would benefit from further investigation in the form of imaging. You have access to immediate point-of-care access to diagnostic ultrasound (US), but you wish to know if US will give you an accurate diagnosis comparable to that of the gold standard, computerised tomography (CT).

A 60-year old man in the emergency department develops a shockable arrhythmia leading to cardiac arrest. As you prepare to deliver a rescue shock, you instructed everyone to clear away from the patient. Knowing that minimizing interruptions to chest compression has been shown to improve outcomes,(1,2) you wonder if there is a safe way to perform hands-on defibrillation and deliver rescue shocks without interrupting chest compressions.

A 52 year old presented to the Emergency Department with a 9 day history of coryzal symptoms including sore throat and fever, after 5 days developed a dry cough and shortness of breath on exertion. Shortness of breath had become more severe over the last 24 hours, now breathless at rest and complaining of right sided pleuritic chest pain. Chest X-Ray and blood result findings were highly suspicious of COVID-19 and this was confirmed on PCR testing. With ongoing research into novel therapies for COVID-19, you wonder if Lopinavir-Ritonavir would reduce mortality or length of hospital stay for this patient.

A 28-year-old male with a history of IV drug use presents to the emergency department for injuries sustained during a motor vehicle collision. The patient was non-ambulatory at the scene with multiple injuries to his extremities including an obvious right-sided femur fracture. Upon arrival, the patient is hypotensive with weak distal pulses. Nurses are unable to obtain IV access but you successfully place an intraosseous (IO) line in the left proximal tibia. You consider whether administering tranexamic acid (TXA) via IO will have the same efficacy as IV or intramuscular (IM) administration.

A 40-year-old male with a history of hypertension and tobacco abuse presents to the emergency department (ED) complaining of chest pain. Workup is completed including a metabolic profile which is remarkable for a blood glucose of 294. He has no history of diabetes or hyperglycemia. The remainder of the workup reveals no abnormalities and undetectable troponin. The patient’s pain resolves after a dose of antacid in the ED. As you prepare discharge instructions, you wonder if you need to correct his hyperglycemia prior to sending him home.

A young male was self-presented to the ED with sudden onset left-sided pleuritic chest pain. His physiological observations were within normal limits with an unremarkable physical examination, ECG and chest x-ray. The calculated two-level PE Well’s score was ‘0’ and the D-Dimer was reported as above the 99th percentile. He was clinically risk-stratified by sPESI scoring as low-risk mortality PE presentation. A CTPA could not be done until the following day and he wished to go home. The BTS guidelines 2018 recommends that patients with suspected PE who are deemed as low-risk are eligible for OP care with an alternative strategy of anticoagulation. Hence, can this patient with suspected PE be treated as OP safely pending radiological investigation?

A 25 year old female attends your emergency department with fever and cough. She is streamed to the Amber area for assessment where you see her and diagnose probable COVID-19. Are there specific points from the history and specific blood test which would help you assess her risk of disease progression, and therefore influence your decision to admit or discharge?

One month after social distancing measures were introduced in the UK, a 35 year-old man attends with shortness of breath and is streamed to be seen by you in your COVID-19 assessment area. He has been isolating at home for the last three days after developing myalgia and a fever. He is normally fit and well and has not been tested for COVID-19. His oxygen saturations are 93% at rest on air and his respiratory rate is 22 breaths per minute. You consult the NHS England guidance which advises that the decision to admit or discharge should be based on a senior clinical assessment. You wonder if a model is available to guide this decision.

A middle aged otherwise fit and well gentleman presents to your emergency department with symptoms highly suggestive of COVID-19 infection. He is streamed to be seen by you in the Amber area. He has been isolating at home for the last three days after developing myalgia and a fever. His oxygen saturations are 95% at rest on air and his respiration rate is 22 He is normally fit and well. Would a Computed Tomography (CT) scan help you to risk stratify him and decide whether admission is required?

One month after social distancing measures were introduced in the UK, a 35 year-old man attends with shortness of breath and is streamed to be seen by you in your COVID-19 assessment area. He has been isolating at home for the last three days after developing myalgia and a fever. He is normally fit and well and has not been tested for COVID-19. His oxygen saturations are 93% at rest on air and his respiratory rate is 22 breaths per minute. You know the NHS England guidance advises you to consider conducting a 40 step test to see if the patient desaturates on exertion. You wonder if this advice is evidence-based.

You are asked by a junior colleague to help place a difficult peripheral cannula in a patient in ED using ultrasound guidance. You wonder if there is an increased risk infection from the ultrasound equipment.

A 67-year-old female with a history of diabetes and hypertension, on metformin and an ACE-inhibitor, presents to the emergency department (ED) following an episode of syncope while walking into her bathroom. She had preceding lightheadedness, but no other symptoms. She has a blood pressure of 158/87 with a heart rate of 78, unremarkable ECG, and her blood glucose is 84 mg/dL. As part of her diagnostic evaluation, you consider whether orthostatic vital signs will help to rule out any life-threatening causes of her syncope?

A 49 year old man presents to your family medicine office with signs and symptoms of alcohol use disorder. He is willing to explore pharmaceutical support to reduce his drinking.