Archives: BETs

A 25 year old male presents to the Emergency Department after punching a wall. He has a closed, minimally displaced fracture of the neck of the fifth metacarpal on his right hand. There is no rotational deformity of the little finger. The patient is not keen on being in plaster and asks is there another option?

An 8 week old infant presents to the paediatric emergency department with a toe tourniquet formed from a hair thread. You struggle to unwind the thread but wish to avoid removing it via incision, and so consider the use of hair removal cream - but could it be effective?

You are present in resus when a 35 year old arrives as a standby, with a low GCS. The anaesthetic team is in attendance. This history is of recent overdose of sedative and antidepressant medication, but there is also a history of recent respiratory illness. Blood gas analysis reveals a mixed acidosis and a decision is taken early to sedate and ventilate for airway protection and predicted clinical course. You don PPE, discuss roles during the team brief and agree to be the primary intubator, with anaesthesia administering induction drugs and providing team leadership. During the checklist you suggest an airway plan that starts with direct laryngoscopy (DL). The anaesthetic team recommend use of videolaryngoscopy (VL), stating that not only will this allow them to see a bit more of what is happening but also now has an evidence base suggesting better first pass success rates. They also suggest it is recommended for intubation of COVID-19 patients in several international guidelines. You did not know this and resolve to have a look at the evidence. Right after you’ve intubated this patient….

You are working in the Emergency Department and a patient presents in acute pain. They have tried simple analgesics and are keen to avoid opiate medications. You are aware of Amitriptyline use in patient's with chronic pain. You wonder if there is any evidence supporting the use of Amitriptyline for symptom control in acute pain.

You are part of the response team on route to a multi-vehicle road traffic collision. Initial reports state that one of the vehicles is an overturned minibus carrying 12 children, with all sustaining varying degrees of injury. Aware that you have limited clinical resources immediately available you consider whether a paediatric major incident triage tool would help to prioritise patients needing life-saving interventions.

A 67-year-old male with a history of type II diabetes and hypertension presents following an out-of-hospital cardiac arrest. Bystander CPR was initiated immediately. His initial rhythm was ventricular fibrillation and ACLS protocol was followed by EMS prior to arrival. Upon arrival, he remains in refractory ventricular fibrillation. A stat venous blood gas is obtained which reveals a pH of 6.8. You consider whether sodium bicarbonate would significantly increase the chances of obtaining return of spontaneous circulation in this patient.

26-year-old man presents to the emergency department (ED) with concern for recent perioral swelling, wheezing, nausea and urticaria after bee envenomation. He has a known allergy to bees and was able to administer 1 dose of intramuscular epinephrine. He arrived to your ED within thirty minutes and his symptoms of anaphylaxis are largely resolved. You consider how long to monitor the patient in the ED.

A child is referred for Occupational Therapy (OT) assessment by a specialist paediatric consultant with a diagnosis of upper limb joint hypermobility syndrome. They experience pain and difficulty with fine motor tasks. We wonder if a prescribed hand strengthening exercise programme would impact on this.

33 year old male presented to the ED with pain around the Achilles tendon and decreased physical performance whilst training for a marathon. His symptoms had been gradually worsening as his training progressed, but now he was struggling to walk. He had seen a physiotherapist and was carrying out regular strengthening exercises. Furthermore, he had seen a podiatrist and now had specialised in-soles in his running trainers. You wonder if extra-corporeal shock-wave therapy (ESWT) conducted via referral is likely to improve his symptoms?

33 year old male presented to the ED with pain around the Achilles tendon and decreased physical performance whilst training for a marathon. His symptoms had been gradually worsening as his training progressed, but now he was struggling to walk. He had seen a physiotherapist and was carrying out regular strengthening exercises. Furthermore, he had seen a podiatrist and now had specialised in-soles in his running trainers. You wonder if extra-corporeal shock-wave therapy (ESWT) conducted via referral is likely to improve his symptoms?

A 27 year old primigravida at 19 weeks gestation presents to the Emergency Department with shortness of breath and pleuritic chest pain. She is afebrile, has a respiratory rate of 28, a heart rate of 120 and oxygen saturation of 96% on room air. There is no evidence of leg pain or swelling. Her ECG is normal. Since imaging tests expose both mother and fetus to ionizing radiation, you wonder whether a clinical decision rule will allow you to safely rule out a pulmonary embolism.

A 32 year old female was driving home on a cold winter night and lost control at the wheel. On EMS arrival, the patient is obtunded, cool, and clammy. She loses pulses at the scene and EMS personnel begin CPR. After a significant delay in extrication and travel via ambulance, the patient arrives at your hospital. She undergoes multiple rounds of CPR, bilateral chest tube placement, pericardiocentesis and was found to have a large pericardial effusion in the ED trauma bay. Unfortunately, time of death was called as it is now approaching an hour-long resuscitation without ROSC. You consider if her outcome would have changed had her out of hospital traumatic arrest been managed by a helicopter emergency medical service.

A 70-year-old man with a 60-pack year history with known lung cancer presents to the Emergency Department with hemoptysis that started 3 days ago. Hemoptysis was initially intermittent but has now become more persistent. Patient is hemodynamically stable. The pulmonologist on-call suggests trying inhaled tranexamic acid to control bleeding.

A 24 year old male presents to the emergency department with complaint of sensation of esophageal obstruction and inability to swallow liquids. This started while eating steak dinner. He has not had any vomiting, although he has not been able to tolerate any liquids by mouth since the onset of symptoms, and he has never had this before. You diagnose him with esophageal soft food bolus impaction. He asks how you are going to treat him.

A 6-year-old girl presents to the Emergency Department with two days of fever, mouth pain, and poor oral intake consistent with hand-foot-mouth disease. The parents ask you what they can do to maintain adequate oral intake while the patient is ill.

An emergency department patient needs a computed tomography angiogram to rule out a pulmonary embolism. The patient has a shellfish allergy noted on the medical record and you wonder if it is safe for the patient to receive intravenous radiocontrast.