Archives: BETs

A 4 year old boy comes in to the ED with 3 days of vomiting and diarrhea. Given the history and exam, you determine this child has gastroenteritis with signs of dehydration. His fingerstick blood glucose is 80 mg/dL (4.44 mmol/L). As the treating physician, you order a rapid infusion of intravenous saline with 5% dextrose. You wonder if the dextrose is really necessary.

When faced with a trauma patient in a prehospital setting there has been numerous looks into the use of blood products. The practice of prehospital transfusions has been revitalised by recent military conflicts and has been shown to increase casualty survival leading to a resurrection of military prehospital blood product (PHBP) resuscitation. This has began to apply in a civilian setting with increasing focus on the use of blood and blood products during prehospital trauma. However, when faced with a pre-hospital trauma situation there any prospective and comparative data to support giving blood or blood products over the current standard practice of crystalloid fluid resuscitation?

A mother of an 8-year-old child asks if there are glasses can help with her son’s shortsightedness progression.

A 65 year old male presents to the emergency department with new onset dyspnea. He has no prior history of congestive heart failure. Bedside lung ultrasound is preformed by the emergency physician and found B lines in multiple lung zones. The question is how accurate is bedside lung ultrasound in the diagnosis of acute heart failure?

You are a mountain medic as part of an expedition trekking the Annapurna Circuit in central Nepal and you have just delivered a speech on altitude sickness. One of the trekkers has been given Ginkgo Biloba extract and told that it is effective at reducing the risk of altitude sickness. You are asked if this is true and if it is effective as prophylaxis against acute mountain sickness.

A 5-year-old boy presents to the ED after falling off his skateboard, onto his left arm. He is complaining of forearm pain and is unable to move his left arm. He is very tender to palpation at the middle to distal aspect of his left forearm and edema is noted. You concerned about a radial or ulnar fracture and wonder if ultrasound can be used to exclude a fracture.

A 24 year old woman in her first trimester of pregnancy presents to the Emergency Department with nausea and vomiting, with no other concerning features of alternative pathology. She provides a urine sample at triage and is found to have 4+ ketones present. On examination she is clinically dehydrated and you wish to start intravenous fluids. You wonder, would dextrose-containing solutions be better at switching off ketogenesis and providing symptomatic improvement than intravenous fluids without glucose?

A 24-year-old woman presents to the ED with shortness of breath and pleurisy. She is otherwise healthy and on no medications except the birth control pill for the past year. There are no other clinical signs or symptoms suggestive of DVT, and her heart rate is normal. You wonder whether as an emergency room physician with some training in bedside ultrasound, reliably confirm or refute the diagnosis of a pulmonary embolus using point-of-care ultrasound (POCUS)?

A 37-year-old man is involved in a rear-end shunt road traffic collision (RTC). He is alert and is brought to hospital with no cervical spine immobilisation in place. You wonder whether efforts should have been made to immobilise his cervical spine to protect from potential spinal cord injury.

A 69 year old man presents to the emergency department with epigastric pain that radiates to the back. He has been vomiting and has a fever. You suspect acute pancreatitis and wish to predict disease severity in order to start appropriate treatment.

A 72 year old gentleman is admitted to the Emergency Department Resuscitation suite. He is hypoxic, hypotensive with right ventricular strain on ECG and a CT scan performed showed a large saddle embolus. He is given thrombolytic therapy and you are asked to prescribe ongoing anticoagulation. You wonder if there is any evidence to support the use of a unfractionated heparin infusion as compared to a Low Molecular Weight Heparin to reduce adverse outcomes?

A 45 year-old women presents to your Emergency Department with right elbow pain after accidentally falling on her outstretched hand. Her elbow examination reveals a slightly limited flexion and extension and significant pain during pronation and supination. On palpation, the pain is limited to the radial head. The skin and neurovascular exam are normal. Given that the elbow x-ray does not show a fracture or frank effusion, you wonder if ultrasound can be used to confirm your suspicion of radial head or neck fracture.

An 84 year old man presents to your Emergency Department with septic shock. He has a long list of medications, but you learn from his medical notes that he is normally independent at home. You need to decide what level of intervention is in this patient’s best interests. What factors should you consider in order to institute an appropriate ceiling of treatment for this patient?

A 68 year-old male is brought to the emergency department with tachypnea (32 breaths per minute), tachycardia and a core temperature of 39.2°C. He complains of a progressive back pain since 3 days and recently noticed hematuria. In the emergency department, his systemic arterial blood pressure is 80/56 mm Hg and his heart rate 136 beats per minute. You suspect a severe sepsis from an acute pyelonephritis. To restore the blood pressure, you administer a first bolus of intravenous crystalloid. To guide your fluid therapy, you wonder if bedside lung ultrasound will help you assess the interstitial fluid status of your patient to avoid over-hydration.

It is Friday evening and a 2-year-old child presents to the ED with colicky abdominal pain. The ultrasound technician has left for the evening and no ultrasound imaging will be available over the weekend. You wonder whether you can use a fecal occult blood test to rule out intussusception in this patient.

You note that international guidelines recommend the use of chewable aspirin for patients with acute coronary syndromes (1). This conflicts with your personal experience of using soluble aspirin. You wonder if there is any evidence to suggest that chewable aspirin leads to faster inhibition of platelet function than soluble aspirin.

You are first on scene to a road traffic collision (RTC) involving a 32 year old male who has crashed his motorbike at 30mph. He is haemodynamically normal but complains of pain in his right chest and right hip and is unable to walk. You wonder whether the optimum management of this patient would be to bypass the nearby trauma unit for direct transfer to the closest major trauma centre.

A 70-year-old man presents to the ED with acute chest pain. His ECG shows ventricular paced rhythm with left bundle branch block morphology. You are aware that the Sgarbossa criteria could be used to diagnose acute myocardial infarction (AMI) in this context1 and that the modification to those criteria proposed by Smith et al 2 could improve diagnostic accuracy. You wonder if the same criteria can be applied to diagnose AMI in patients with ventricular paced rhythm.

A 29-year-old pregnant lady at 26 weeks of gestation, attends to the Emergency Department with painful swollen leg. An ultrasound evaluation showed no evidence of deep vein thrombosis, she was subsequently discharged with analgesics. She returned 5 days later with severe respiratory distress and an evaluation by CT PE showed bilateral pulmonary embolism