Archives: BETs

A 54 year old female presents to the physiotherapy department for treatment of lateral hip pain of insidious onset on going for more than one year. Pain is aggravated by prolonged standing and laying on the affected side. GTPS has been diagnosed on ultrasound. She had a steroid injection which had no long-lasting effect and has now been referred to try exercise rehabilitation in physiotherapy.

A 78 year old male patient was undergoing an urgent cardiopulmonary bypass operation after a coronary angiogram revealed severe triple vessel disease. He also suffers from multiple co-morbidities and his ECHO revealed an ejection fraction of 25%. The cardiothoracic registrar suggests using a levosimendan infusion instead of an intra-aortic balloon pump. You wonder whether there is any evidence for this treatment.

a patient presenting to A&E with simple shoulder dislocation. Should they receive a USS guided interscalene block or a procedural sedation for the joint reduction

A 78 year old women with no cognitive impairment is brought to the ED with a story of an accidental fall from her height followed by right hip pain and inability to walk or bear any weight on her right leg. Initial evaluation followed by plain films denoted a stable right hip fracture. Initial pain management in the ED was limited. You are concern with the overuse of opiates and development of delirium in the ED and you wonder if the use of regional anesthesia using ultrasound guidance could beneficial for this patient in the ED.

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 53 year old man attends the emergency department with a 2 hour history of chest pain that may be cardiac. You want to rule out possible acute aortic aneurysm dissection and wonder whether a D-Dimer level can help do this

A 52 year old gentleman presents to the emergency department with tacchypnoia and confusion, and is found to be tacchycardic, pyrexial, and hypotensive. You recognise that he is septic, and wonder if the addition to tranexamic acid to standard care might improve his risk of death?

A 45 year old man attends the emergency department after being involved in a road traffic accident. He has sustained a blunt chest injury during the impact and has bruising across his chest wall. His ECG shows non specific ST segment changes and the chest radiograph are normal. You wonder about the benefit of performing a BNP level to aid the diagnosis or exclusion of myocardial contusion.

A 55-year-old female presents to the emergency department with an infective exacerbation of chronic obstructive pulmonary disease. The patient requires intravenous (IV) fluids and IV antibiotics whilst on non-invasive ventilation. The patient does not require ionotropic support. You and your fellow colleagues have failed at siting a peripheral cannula using traditional methods to administer IV medication. Does the use of US help obtain PIV and reduce the need for a CVC in this clinical scenario?

A 32 year old woman presents to the emergency department complaining of lower abdominal pain associated with bleeding. She has a history of bad period pain for which she takes medication. She has taken all her normal oral medication and is still in pain. You are familiar with salbutamol and it’s action on smooth muscle and know that it is used for tocolysis; you wonder if they may help her pain.

A forty years old male attends the emergency department, with abdominal pain, nausea, heartburn, dyspepsia, reflux and bloating. Physical examination with stable vital signs, abdominal pain without peritoneal irritation. Contrast studies and upper endoscopy reveals a large hiatal hernia. We decided a laparoscopic repair, it has be with mesh or simple suture.

A 12 year old girl with autism was admitted for elective orthopaedic surgery, requiring a 4 week inpatient stay for post-op physiotherapy. She required significant dietetic and psychiatric input, and had lost weight at successive outpatient appointments prior to hospital admission. She was diagnosed with anorexia during her admission. This case, is one of many, that highlighted the need for dietetic and psychiatric input intervention early in children with autism. Patient group: Children aged 5-15 years old with Autism Intervention: Eating Disorders (Anorexia AND/ OR Bulimia) Control group: Children aged 5-15 years old without Autism Outcome: Data on the prevalence of Eating Disorders in children with Autism compared to children without Autism

59 year old male, presented to the emergency room with dyspnea and angina at rest. His past history was significant for Esophageal cancer on chemo-radiation, Ischemic stroke (left ACA territory – month prior to current presentation), Chronic Kidney disease, hypertension and diabetes mellitus.On examination, He had a heart rate of 192/minute and not in shock; ECG showed Atrial Fibrillation. His Blood Urea was 68 g/dl and Serum Creatinine was 2.3 mg/dl. His Troponin I was positive. Metaprolol was given at out emergency room which brought the heart rate under control.As the heart rate improved, the ECG changes were suggestive of Non-ST Elevation Myocardial Infarction. ECHO showed severe LV dysfunction with Ejection Fraction of 33%. The dilemma of administering an anticoagulant as the patient had stroke recently and what is the anticoagulant of choice? In this patient with abnormal renal function enoxaparin sodium is contraindicated. Warfarin is contraindicated in patients with abnormal liver function test. Generally, anticoagulant is contraindicated in inaccessible ulceration (esophageal carcinoma in this patient).

A patient is brought into ED with airway difficulty and stridor and requires intubation. Rapid sequence induction for anaesthesia is performed. On laryngoscopy the view is Cormack Grade 2 and the anaesthetist says they don’t need a bougie to pass the endotracheal tube and intubate the patient. You wonder if the endotracheal tube will be passed first time.

A 75 year old patient has been brought into the emergency department having been seizing for 20 minutes. The prehospital crew have administered buccal midazolam followed by IV Lorazepam but the seizure is ongoing. You have heard that phenytoin has side effects and drug interactions and you don't know the patients background history. You wonder whether levetiracetam is a safe and effective alternative to phenytoin in terminating this seizure.

A 55 year old man has presents to the emergency department with severe hypoxia secondary to an exacerbation of congestive heart failure. His initial saturation is 83% with a reservoir oxygen mask; he is tachypneic with a respiratory rate of 35. You decide to intubate this patient and want to optimize his oxygen saturation before induction. You place a standard reservoir face mask with a flow rate of oxygen set as high as possible. After 3 minutes the saturation has improved to 95%. One of your colleagues suggests using high-flow nasal cannula oxygen during the intubation procedure to reducing desaturation (apneic oxygenation).

A patient who is to undergo an open thoracotomy for lung resection presents to a physiotherapist. The patient would like to know which physiotherapy treatment is the most effective at treating or preventing post-operative complications.

A 45-year-old woman attends the emergency department with a painful and swollen right calf. Her Wells score is low risk, but a d-dimer returns over the cut point for your local assay. Whole leg ultrasound examination later that day confirms a thrombosis of the posterior tibial and peroneal veins. She has no other medical history but you cannot identify a clear provoking factor for the thrombus. She is worried and symptomatic. A colleague reports to you that he does not treat any below knee DVT’s, as the NICE guidance supports above leg scanning only and he believes that the sensitivity and specificity of whole leg ultrasound are too low to be of clinical value. You are concerned about the idea of leaving an unprovoked isolated distal deep vein thrombosis (IDDVT) untreated in a patient who is symptomatic. However, you also worry about anticoagulation related bleeding. You decide to consult the literature to guide your decision-making.