Archives: BETs

A 40 year old male has been diagnosed with an anterior shoulder dislocation following a fall. Is inhaled Methoxyflurane a safer, more practical and efficacious drug to use for pain control before and during the reduction when compared to nitrous oxide?

An ambulance crew attends to a 46-year-old man who has presented in cardiac arrest. His presenting rhythm is VF and advanced life support (ALS) protocol is instigated. The patient remains in VF in spite of early defibrillation with escalated energy and intravenous amiodarone. Pad position is changed to anterior-posterior (AP) pads; and yet the patient remains in VF. He has now received 7 attempts at defibrillation and reversible causes have been optimised. Does escalation to double sequential defibrillation, initially though AP pads followed by anterior pads improve the chances of the patient regaining spontaneous circulation? Can this be extrapolated to in hospital atraumatic adult cardiac arrest?

A 26-year-old multiparous female presents to a rural emergency department. She had a precipitous delivery on her way into the hospital. On arrival in emergency department, she is having a significant amount of vaginal bleeding and is beginning to become symptomatic, though her blood pressure is currently stable. You contact Obstetrics, obtain labs and blood type and cross, and begin uterotonics. You wonder if adding tranexamic acid will improve this patient’s outcome.

A 6 year old boy with an angulated forearm fracture presents to your ED. You feel he is a suitable candidate for procedural sedation. Your department’s policy for procedural sedation is IV ketamine 1-2mg/kg. You know that one of the recognised side-effects of ketamine is vomiting and you wonder whether giving prophylactic ondansetron would reduce his chance of vomiting.

You are evaluating a patient in the emergency department in whom you are considering the diagnosis of acute community-acquired bacterial meningitis. You perform a lumbar puncture and when ordering CSF studies wonder if sending a CSF lactate would help distinguish acute bacterial meningitis (ABM) from acute viral meningitis (AVM).

A 66-years-old man is brought to the emergency department following a fall from his height. He has a score of 14 on the Glasgow Coma Scale and suffers from nausea. An initial Ct Scan is done showing a 4 mm subdural hematoma in the left frontal lobe. The emergency doctor decides to keep him in observation. The patient remains stable during the next eight hours but still complains about nausea. The doctor considers discharging the patient but is aware of case-reports about late clinical deteriorations. He wonders if a clinical decision rule exists to help him assessing the risk for his patient.

On a busy night shift, I was called to a cubicle because a patient had presented with epistaxis that had not responded to simple first aid measures. Visualisation of the bleeding point was difficult because of ongoing haemorrhage and that made cauterisation with silver nitrate impractical. I asked for a nasal pack and the nurse brought me a foam-based device, commonly known as “Merocel®”. The patient tolerated the insertion and expansion of this device extremely poorly, despite using 1% Xylocaine as anaesthetic. Although haemostasis was achieved, the patient required intravenous opioid medication after the procedure in order to alleviate their pain. I had previously used inflation devices known as Rapid Rhino® and I wanted to know if there was a significant difference in the two types of nasal packs in achieving haemostasis and which device is more comfortable for the patient.

Blood gas analysers are typically preset to assume a patient’s temperature is normothermic at 37 degrees centigrade. In clinical practice the temperature of the patient is infrequently taken at the time of sample or entered into the analyser. With emergency departments exposed to patients presenting with temperature extremes, you wonder whether the temperature entered into the gas analyser has a significant effect on results and subsequent clinical management.

A 25 year old male presents to the emergency department in the late evening with symptoms of persistent nausea, vomiting and abdominal pain. He denies any diarrhea, fever, anorexia, sick contacts, or travel history. He reports daily use of 1-2g of THC/marijuana for the last 2 years, having started smoking in his early teens. He has had previous similar episodes in the last year lasting a few hours at a time. He typically takes 2-3 hot showers a day to improve his general symptoms of mild nausea and abdominal pain on a regular basis. He had a previous presentation and admission to hospital for two days with similar symptoms resolved with fluids and anti-emetics. This time, the symptoms have been persisting now for two days with no improvement. Clinically, he appears diaphoretic, and uncomfortable in pain. Vital signs are within normal limits. He appears clinically dehydrated with generalized abdominal tenderness but no acute peritonitis. History, physical exam, and investigations have ruled out emergent non-functional causes for his abdominal pain and vomiting. The clinical presentation is felt to be in keeping with cannabinoid hyperemesis syndrome (CHS). He received fluids, anti-emetics and pain control, all of which did not resolve his symptoms. You have heard that a single dose of haloperidol can improve symptoms of hyperemesis cannabinoid syndrome in the emergency department and avoid admission to hospital.

A 50-year-old male presents to the Emergency Department with suspected carbon monoxide (CO) poisoning following an attempted suicide. He is haemodynamically stable; but is noted to have mild confusion and you are unsure if he requires admission for further monitoring or hyperbaric oxygen (HBO) therapy.

An 18 year old male presents to the emergency department with unilateral testicular pain and swelling. You are unsure whether you can safely discharge or whether he requires further urological work up for testicular torsion.

You are working in A&E and have just reviewed a patient with symptoms and clinical signs consistent with suspected acute appendicitis; you wonder whether there are any further clinical signs which may help your diagnosis and a referral to general surgery. You recall hearing of the speed bump sign from a colleague and wonder how useful this sign is in the diagnosis of acute appendicitis.

A 63-year-old gentleman with a history of hypertension comes to the Emergency Department complaining of sudden onset of right-sided weakness and slurring of speech 2 hours ago. You request an immediate non-contrast CT brain. However, you wonder if blood biomarkers could be used instead to diagnose a stroke, or more accurately, an ischaemic stroke.

A child presents to the ED with distal fibular pain after a fall. The x-rays are negative for fracture, but the child still has significant pain despite analgesia. You suspect a Salter-Harris Type I fracture, but remember that your physical exam is not very specific for this injury; it could actually be a sprain. You do not want to immobilize this child without cause, so you wonder whether you can improve your diagnostic accuracy for a Salter-Harris Type I fracture with bedside ultrasound.

A 45-year-old man presents to the emergency department with new onset abdominal pain, and the nurse asks you to quickly prescribe some paracetamol. You wonder if there is any difference in the analgesic effect by route of administration.