Archives: BETs

You are reviewing urine culture and sensitivity results in your ED. You come across a result growing a germ that is sensitive to ciprofloxacin only. You contact your patient to come and collect a prescription later in the day. Your colleague who has been listening to your phone conversation warns you of the increased risk of tendinopathy in patients taking fluoroquinolones. You wonder if this is just anecdotal. You decide to search and review the current literature to see if any evidence substantiates this risk at all.

You are part of an EMS crew dispatched to the scene where a construction worker has fallen from a rooftop onto the concrete below. He was initially reported as combative when a basic life support crew arrived, and they now report that he has just lost vital signs. You quickly think about your ATLS approach to the trauma patient and wonder if a finger thoracostomy would be effective and safe in this environment to rule out tension pneumothorax as a cause of his arrest.

You attend the scene of a vehicle collision and find a 23 year old male unbelted in the drivers seat, slumped over the steering wheel unconscious. As the patient is rapidly extricated to the waiting ambulance, you note spidering of the windshield from the patient’s head and airbag deployment. Rapid ATLS exam reveals that the patient requires thoracostomy for a suspected tension pneumothorax. You have recently heard about finger thoracostomy as an alternative to needle decompression and wonder if this would be effective.

A 27 year old professional footballer sustains a structural right hamstring injury during a match. A visiting club official says that in his country, PRP injections are used to bring a quicker return to field based activities (including match play) in addition to a traditional rehabilitation protocol. You decide to find evidence to support his view.

Search and rescue services locate a missing adult male, who is found to have reduced consciousness and a core temperature of 32 degrees. Preparing for hospital transfer, the team insulate the casualty to prevent further heat loss.

An 8 year boy with coeliac disease has eaten a biscuit at a friends birthday party. His mother has brought him to A+E because she has read on a coelaic disease support forum that charcoal can reduce the risk abdominal pains and diarrhoea.

A busy emergency department has a long list of patients in the waiting area and several patients have recently arrived on trolleys from the ambulance service. There is pressure to get patients seen and either discharged or admitted as soon as possible. You wonder if asking the triage nurses to determine whether they think each patient will need admitted will speed the process along by allowing earlier booking of inpatient beds.

An 8 year old child is brought the emergency department following a high speed road traffic collision. He was unrestrained in the vehicle and has evidence of head trauma. He arrested at the scene and on arrival has undergone 15 minutes of CPR, has fixed pupils with no pulse and asystole on the cardiac monitor. Is it appropriate to stop resuscitation?

You are the most senior doctor in the Emergency Department when you receive an alert call from the pre-hospital medical team. They are bringing an 8 year old boy who was a pedestrian struck by a bus. He is displaying signs of hypovolaemia due to suspected ongoing internal bleeding, with tachycardia and hypotension despite fluid resuscitation. You are concerned that he is at risk of cardiac arrest, but are unsure of the optimal method of identifying cardiac arrest in such patients to help you decide when to start your traumatic cardiac arrest protocol.

An adult patient with a history of variceal bleeds presents to the Emergency Department with haematemesis associated with tachycardia and hypotension. Despite treatment with Terlipressin, Omeprazole, Tranexamic acid and blood transfusion, hypotension and tachycardia persist and the patient continues to experience haematemesis. There is approximately a thirty-minute delay before endoscopy can be undertaken. You wonder whether insertion of a Sengstaken-Blakemore tube may be beneficial in achieving haemostasis and improving haemodynamic stability.

A 32 year old female with presents to the emergency department with an occipital headache and intermittent blurred vision for the past 3 weeks. D-dimer performed on admission is within normal range. Can you safely rule out cerebral venous sinus thrombosis?

A 67-year-old male presents to A&E with shortness of breath. He is found to be hypoxic, tachycardiac and tachypnoeic. Chest auscultation reveals bilateral wheeze and reduced air entry throughout. A clinical diagnosis of acute exacerbation of COPD is made. Patient is given Salbutamol and Ipratropium nebulisers followed by intravenous hydrocortisone. He is also given titrated supplemental oxygen. Since patient is already on theophylline and its serum levels is not available, intravenous aminophylline is not given. NIV is considered. You wonder if giving intravenous Magnesium Sulphate is of any benefit.

An 18-year-old man presents to the Emergency Department having been bitten by his neighbour's dog three hours previously. He has a simple but ragged wound without signs of infection or inflammation. He is normally fit and healthy with no regular medications or allergies and has been immunised in accordance with the National Immunisation Programme (including five doses of tetanus immunisation). You wonder whether you should use simple wound care and irrigation alone or whether he should be discharged with prophylactic antibiotics, in conjunction with safety netting advice.

A patient arrives in your resuscitation bay in respiratory distress with a background of chronic obstructive pulmonary disease. After administering standard medical therapy, and controlled oxygen the patient remains in respiratory acidosis. Non-invasive ventilation is instituted, but the patient continues to be acidotic and deteriorates. The patient is prepared for rapid sequence induction and mechanical ventilation, but you wonder if there is an alternative?

A 48 year old male presents to the emergency department with a history of 45 minutes of palpitations. He is otherwise well and his only past medical history is of paroxysmal SVT. His ECG confirms SVT on this occasion. You are going to attempt the valsalva manoeuvre and wonder whether the patient should stay sitting or whether the trendelenburg position would be better.