Archives: BETs

A 35-year-old male presents to the Emergency Department with an anterior abdominal stab wound (AASW). He is haemodynamically stable; you are unsure of the best method of investigation to detect significant intra-abdominal injury including hollow viscus perforation.

A 45-year-old man attended the Emergency Department (ED) with one-hour history of chest pain that could be of cardiac origin. His ECG did not reveal acute ischemic changes. It is important to substantiate or rule-out ACS in this situation. This analysis is aimed at finding whether a hs-cTnT measurement taken at 0-hour and 1-hour after presentation is sensitive enough for this purpose.

A 53 year old woman presents to the Emergency Department after falling on her right outstretched arm. On arrival her wrist appears to be swollen. X-ray examination reveals a displaced distal radius fracture. While performing Böhlers anesthesia, you wonder if US-guided closed reduction would increase the likelihood of reduction adequacy, thereby avoiding the need of repeat reduction or open reduction and internal fixation [ORIF].

On-going CPR on a 50 year-old male is occurring in your ED. He remains pulseless after 20 minutes and you doubt about the cardiac activity on the POCUS examination. You wonder what your other colleague would say.

Whilst on a clinical shift in the Emergency Department you attend to a 24 year old female who has taken a clinically significant paracetamol overdose, and requires n-acetylcysteine (NAC), you are wondering if a reduction in infusion rate of NAC will reduce adverse side effects such as vomiting and nausea?

A 60 year old male of African origin comes to emergency department with intermittent flashing lights and floaters for 24 hours. He refuses consent for pupil dilation as he intends to drive back home if discharged. Its not possible to gain a clear view of retina with ophthalmoscope. Can you use the bedside ultrasound with linear array probe to diagnose retinal detachment ?

A 55-year-old male presents to the Emergency Department following a fall down the stairs while intoxicated. He suffers immediate onset tetraplegia with a high sensory level to his upper chest. He remains alert and a CT confirms a fracture dislocation at the C5/C6 junction with retropulsed fragments into the spinal canal. You site an arterial line while he awaits spinal orthopaedic review, but at present there is no sign of neurogenic shock and his mean arterial pressure (MAP) sits at 60. A colleague asks if you are planning to start vasopressors and aim for a higher MAP target in order to reduce the ischaemic penumbra. You nod sagely, then sneak off to a computer to google the word penumbra which you have heard before but never remember exactly what it means. While at the computer, you wonder if there is any actual evidence to support the idea of induced hypertension to improve outcome in traumatic spinal cord injury.

A 17 year old female has presented to the Emergency Department after taking forty 500mg tablets of paracetamol. Her 4 hour plasma paracetamol levels are above the treatment line. However, she is needle-phobic and refusing intravenous treatment. You want to treat her with an oral antidote and wonder if oral N-acetylcysteine is as effective as intravenous.

A 35-year-old male presents to the Emergency Department with an anterior abdominal stab wound (AASW). He is haemodynamically stable; you are unsure what the best method of investigation is to detect any significant intra-abdominal injury including hollow viscus perforation.

A 14 year old boy is seen in the Emergency Department for exertional heat stroke that was subsequently complicated by multiorgan failure including acute liver failure (ALF). You wonder if N-acetylcysteine (NAC) which is used routinely in acetaminophen-induced ALF will be useful in the management of this teenager in the Children’s Intensive Care Unit (CICU).

At 22:40 the ambulance service operation centre receives a call for a 56-year-old patient complaining of chest pain and an ambulance unit is dispatched to the patient. On paramedic arrival, the woman is alert and orientated and shows no evidence of diaphoresis. She has no previous medical history. The chest pain had self-resolved 5 minutes ago. On examination, she has a clear airway, respiration is shallow, talking in complete sentences; lung sounds clear, skin warm and not clammy. The electrocardiogram (ECG) recorded on the scene shows benign early repolarization with no other abnormalities. There are no other pertinent findings. Her vital signs are: respiratory rate 20/minute, heart rate 65 beats per minute, oxygen saturation 96% in air, blood pressure 124/62. She stated that she suddenly could not catch her breath while stood up, then the chest pain started. She got dizzy, sat down, and called 999 but is now feeling back to normal. You are aware that the history, physical examination and ECG cannot be used to ‘rule out’ an acute coronary syndrome (ACS) alone. You wonder whether a point of care troponin test could help you to ‘rule out’ ACS without requiring transfer to hospital.

You are asked to assess a 32-year-old who has waited two hours after being fully immobilised following a RTC. He has midline cervical tenderness and undergoes CT as X-rays are inadequate. You wonder whether immobilisation is doing more harm than good and if it actually prevents secondary neurological deterioration (SND).

A patient is sent to the ER after being involved in a car accident while driving under the influence of alcohol. Basic trauma interventions and investigations are applied to rule out life-threatening injuries, and you keep him under surveillance until his alcohol blood level normalizes. Could a brief alcohol intervention or counselling be useful in order to decrease the risk of trauma recidivism and alcohol intake?

A 37-year old patient who has never been to your hospital presents for shortness of breath. He reports a history of HIV, but is not currently on treatment and does not know his last CD4+ count. His oxygen saturation is 94% on room air, and lung sounds are distant. His CXR shows possible interstitial markings in the right middle lobe, his LDH is 240, absolute lymphocyte count (ALC) is 2200, and he has a normal A-a gradient. In addition to covering for community acquired pneumonia, should TMP/SMX be started in the ED?