Archives: BETs

25-year-old presents to the emergency department after sustaining a laceration to his ankle after cutting his leg on a piece of metal. The wound is hemostatic on presentation. There does not appear to be any gross contamination and a simple closure is adequate with nonabsorbable sutures. After closure the patient is given routine discharge instructions when he questions you about removing his sutures at home.

You are a clinician working in a busy Emergency Department overnight. A 35 year-old woman presents feeling very nauseous, and requests medications to alleviate symptoms while awaiting results of her investigations. You prescribe an appropriate antiemetic, but note that the nurses are busy dealing with a number of other patients. You therefore anticipate a delay in administration of the antiemetic and wonder whether there is anything you can offer in the short term. You recall an anaesthetic colleague talking about how they ask patients to smell alcohol-containing wipes to treat post-operative nausea. You wonder whether there is any evidence to support similar practice in the Emergency Department.

A 55-year-old male with a history of hypertension, depression, and obesity presents to the Emergency Department with back pain that began 2 days ago after he was helping a friend move into a new apartment. He describes the pain as 10/10 in severity, radiating down his right leg and not improved with 600 mg of ibuprofen twice daily. He denies a history of similar back pain or traumatic injury but is requesting medication to relieve his pain so he can go back to work at a local manufacturing plant.

The pandemic of COVID-19 affects many households. Governments install strict policies to prevent the further spread of the novel coronavirus. Schools are closed and working from home is recommended. A woman goes to her general practitioner to ask advise. Her child, who is now at home as well, had contact with a classmate who tested positive for sars-CoV 2. Her husband, who works now at home, belongs to the risk population because of reduced immunity. The woman wants to know if her asymptomatic child should be isolated from her husband, the grandparents and/or herself. Does it make sense to avoid contact with healthy children to prevent virus transmission?

Since the outbreak of COVID-19, we are facing an imminent shortage of surgical facemasks and respirators to protect patients and healthcare workers. Inspired by the widespread use of cloth masks in Asia, alternatives out of cotton and old bras are on the rise in Belgium. This raises the question whether these homemade facemasks are effective in the prevention of virus transmission. And if so, which materials are most suitable.

A 65-year-old obese female with a history of atrial fibrillation and chronic back pain returns to the emergency department for exacerbation of her low back pain. Her vitals are normal and her exam reveals reproducible paralumbar muscular tenderness consistent with previous exams. You would like to treat her pain but are concerned about her risk of falling at home given her risk factors of age, anticoagulant use, and polypharmacy. You wonder about the effectiveness of trigger point injections for this patient’s musculoskeletal pain.

A 55 year old with a background of hypertension is brought to the emergency department with a 7 day history of fever, cough, and shortness of breath. His oxygen saturations are 93% on 6 litres of oxygen via facemask and arterial blood gas results suggest type 1 respiratory failure. You suspect COVID-19 and refer to the medical team for conservative management and inpatient care. Having made the referral, you remember listening to a podcast about prone positioning and wonder if this would improve his oxygenation or reduce the likelihood of clinical deterioration?

A 70 year old man presents in PEA cardiac arrest. An ED echocardiogram shows cardiac activity but no pulse is palpable. Pseudo-PEA is diagnosed. You wonder whether CPR timed to systole may improve his chances of survival.

A 50-year-old female from Eastern province of Saudi Arabia presented with symptomatic severe aortic stenosis. She was known to have sickle cell trait(HbSS), with hardly any vaso-occlusive crisis. A transthoracic echocardiogram demonstrated severe Aortic stenosis and moderate LV systolic dysfunction. Her coronaries were normal on angiogram and hence it was decided to proceed with surgical Aortic valve replacement. The patient wanted to know if cardiac surgery could increase her mortality and if there was any alternative, including Transcatheter aortic valve replacement.

You are a physiotherapist working on a vascular ward. A 30 year-old female is admitted to the ward after first rib resection surgery with no complications intra-operatively. Post-operative instructions request day 1 intensive physiotherapy input but no guidance has been given. What acute postoperative physiotherapy exercises should be provided for optimum recovery?

A 2 month old infant is admitted to hospital with 2 day history of fever, irritability and reduced feeding. A septic work-up including lumbar puncture is performed. CSF white cells are raised and culture confirms Neisseria meningitidis organism. The infant is appropriately started on antibiotic regime as per local anti-microbial guidelines. On day 2 of admission, the infant develops focal motor seizures. It is well established that infants with a diagnosis of meningitis are at risk of developing seizures. You wonder whether the infant should have been prophylactically started on an antiepileptic medication when the diagnosis of meningitis was confirmed.

A 60-year-old man is brought to the emergency department (ED) via Emergency Medical Services (EMS) after a fall with vital signs absent. EMS provided Cardiopulmonary Resuscitation (CPR) and was able to achieve return of spontaneous circulation (ROSC) on route, however the patient became pulseless again. In the ED the patient was assessed, CPR was initiated and he was intubated; ROSC is achieved once more. Shortly thereafter the patient is found to be pulseless and CPR is restarted. The ACLS algorithm has been followed and all standard resuscitation practices have been implemented. You wonder if the use of Esmolol could have helped you achieve sustained ROSC.

A young female adult attends the emergency department complaining of a severe headache associated with nausea and sensitivity to light. A diagnosis of acute migraine is made and her symptoms improve in the department following analgesia. She has frequent headaches and does not want to keep attending the emergency department. She does not wish to take prescription medications. She asks you which over the counter medications are most effective and work quickest.

A patient develops flu-like symptoms 3 days after taking Holy Communion at church. You wonder whether in the current climate of coronavirus (Covid-19) risk does the sharing of a communion cup practiced by millions of Christains around the world put it's participants at risk of infection?

A 4 year old boy attended the paediatric emergency department following a circumcision for religious reasons earlier that day. He had ongoing bleeding from the surgical site. Is there any evidence behind the use of topical adrenaline in the management of these patients.

A young patient has been stabbed in the right lower abdomen and is in PEA cardaic arrest. You wonder whether emergency thoracotomy would improve his chances of survival?

A 60-year old gentleman travels by ambulance to ED Majors. A varicose vein on the dorsum of his foot was caught on his sock while dressing. A puddle of blood quickly appeared. Despite direct pressure by the person and the ambulance service, the varicosity is still bleeding. You elevate the foot above the person's heart. You apply a compression dressing up to the level of their knee. You consider applying tranexamic acid as a topical haemostatic agent to reduce blood loss.

A 30-year-old male presents to the emergency department with cough, fever, and an infiltrate on chest x-ray. He is subsequently diagnosed with community-acquired pneumonia. You would typically prescribe him amoxicillin-clavulin as an outpatient but he is reporting a vague history of penicillin allergy. You wonder whether this is a true allergy.

The Royal College of Obstetricians and Gynaecologists (1) reports that 11 pregnancies per 1000 are ectopic and that the maternal mortality rate from ectopic pregnancy is 0.2 per 1000. The Healthcare Safety Investigation Branch (2) found of the 12 maternal deaths in early pregnancy in the UK between 2009-14, 9 were related to ectopic pregnancy.

A 47 year old female presents to the ED with a 6 cm superficial laceration on her forearm. She sustained the injury while cutting wood to build an outdoor patio set. She is very anxious and complaining of severe pain making it difficult to exam the entire wound or provide local anesthetic. You wonder how to proceed with irrigation and closure. Distraction methods are commonly used in paediatric emergency departments to ease anxiety and reduce pain perception in children undergoing painful procedures. Can distraction methods, specifically virtual reality, be effective in decreasing pain perception in adults undergoing painful procedures?