Archives: BETs

A 75 year old female patient presents by ambulance to the Emergency Department after a fall from standing on to her left hip. On clinical examination she is unable to straight leg raise and cannot weight bear. You suspect a fractured neck of femur. Plain radiographs of her pelvis and hip are inconclusive. You remain suspicious for a hip fracture. Is CT or MRI the next most appropriate imaging modality?

A 45 year old man (Mr X) sustained significant trauma in a road traffic accident (RTA). From clinical examination and a trauma series CT scan Mr X is diagnosed with grade 3 liver and splenic injuries. Mr X is haemodynamically stable and has no evidence of ongoing bleeding, initial plan is to manage the patient non-operatively. Mr X is in significant discomfort and is not mobilising from bed, you wonder about the safety of prescribing low molecular weight heparin (LMWH) venous thromboembolism (VTE) prophylaxis.

A 41 year old male presented to the emergency department with a 48 hour history of increasing erythema, swelling, and pain over his left lateral thigh. On examination you note a 4 cm area of erythema with associated fluctuance and induration. The decision is made to perform an incision and drainage, and you wonder whether irrigation of the abscess cavity would improve patient’s outcome.

A 50-year old patient presenting to ED falls in the department and sustains fracture of the wrist. What steps could be taken to reduce the number of falls in patients presenting to the ED/CDU?

A 70 year-old gentleman has presented to the Emergency Department (ED) for the 3rd time in 7 months. Your SHO insists that he should be admitted or he will just come back again. What factors in his assessment suggest that he is more likely to re-attend?

A witnessed non traumatic out-of-hospital cardiac arrest occurs in your neighbourhood and the paramedics are rapidly called on scene. Basic Life Support (BLS) guidelines are applied and ventilation may be necessary at this point.

A 40-year old female known pulmonary aspergilloma in the left upper lobe is scheduled for surgical resection.The patient questions which is better,VATS or Thoracotomy?

A witnessed non traumatic out-of-hospital cardiac arrest occurs in your neighbourhood and the paramedics are rapidly called on scene. Basic Life Support (BLS) guidelines are applied and ventilation may be necessary at this point.

A 60 year old male suffering from low back pain and numbness in the posterior thighs, has been found to have a low grade spondylolisthesis at L5-S1. You wonder if a course on core staability exercises would help to improve pain and function.

A 41-year-old male with a past medical history of symptomatic paroxysmal atrial fibrillation (on metoprolol), hypertension, diabetes, morbid obesity, and chronic alcoholism was BIBA to the ED for palpitations and light-headedness that started one hour prior. Electrocardiogram and labs showed atrial fibrillation without RVR and ST changes, and a normal CK, troponin level, and chemistry panel. The patient claimed to be adherant with all medications and was on the maximum dose of metoprolol. He last ate a large meal one hour ago. The patient claims that flecainide, propafenone, amiodarone, and procainamide have been ineffective in the past for cardioversion and that he does not want to try any of them again. In an attempt to cardiovert this patient back to normal sinus rhthym, you wonder if ibutilide should be used.

-A 35 y/o male presents to the ER following a low speed MVA. Patient was a restrained driver hit on the front passenger side while turning into a parking lot. He had no LOC and was able to ambulate following the accident. He presents with chest pain on the right and pain with inspiration. Patient is GCS 15 on arrival with HR 88, BP 145/75, RR 18, O2 sat 97% RA, T 37.

A 5 year-old boy presents to the emergency department with an acute exacerbation of asthma, with a tight chest and an oxygen requirement. He is followed up regularly in a paediatric respiratory clinic and is normally on a preventer inhaler. Along with back-to-back mixed nebulisers, you prescribe oral prednisolone, which he vomits 10 minutes later. The paediatric SHO says she has heard of a recent RCT that shows that a single dose of oral Dexamethasone is as good as 3 days of Prednisolone in the management of acute wheeze and you know from your own experience that oral Dexamethasone is usually well tolerated by kids presenting with croup. Given how often you see children vomit Prednisolone, you ask yourself whether the emergency department should switch to oral Dexamethasone instead for childhood wheeze?

A 28 year old patient with a past medical history of type II diabetes and irritable bowel syndrome currently taking a SGLT-2 inhibitor for his diabetes presents to the Emergency Department with the chief complaint of nausea and vomiting with associated fatigue. The patient is evaluated and treated for their nausea and vomiting. The patient continues to have intractable vomiting despite conventional therapy. On laboratory evaluation they are found to have a blood sugar of 162, pH of 7.2, elevated betahydroxybutyrate and large ketones in the urine.

A 75-year old man is referred to you for elective cardiac surgery. He has already been taking simvastatin for many years. You know that preoperative statin therapy improves post-operative outcomes in statin-naive surgical patients. You consider whether you should prescribe him additional preoperative statin doses in an attempt to recapture this benefit. To answer this question, you carry out a literature search for the evidence.

You are a final year medical student visiting US for a Month long clinical rotation in the department of cardiothoracic surgery. During the Grand Rounds the attending surgeon makes a statement that the use of cerebral oximetry is not clinically significant and puts an extra burden on the patient’s medical bills. He tells you that there is not much evidence regarding effectiveness of Cerebral Oximetry (Transcranial Near-Infrared Spectroscopy-NIRS to monitor ScO2) for Cardiac Surgery and about its potential applications, overall clinical value and whether to keep using it or not. You take the issue at hand to check the literature yourself and reach a conclusion.

A 25 year old man comes to the ER with an injury to his right ring finger. It is a Monday and the waiting room is full, you wonder if there is a way to diagnosis nailbed injury without removing the finger nail.

An 11 year old male presents to the emergency department after jumping for a rebound at basketball practice. He falls to the ground striking his head against the floor. He briefly loses consciousness and comes to emergency department with repetitive questioning, vomiting, and complaining of headache. You order a head CT which is unremarkable, symptoms improve during a brief observation period, and as you prepare for discharge the patient’s parents question about returning to physical and cognitive activities.