Archives: BETs

A child suffers major trauma resulting in cardiac arrest.

A 24 year old male presents to the emergency department with sudden onset of right flank pain radiating to the groin. A clinical diagnosis of renal colic is made. However, the patient is allergic to opioids. You recall a recent study describing treatment with parenteral lidocaine for intractable renal colic.

You are asked to see a patient in the ED who is not fluent in English and requires an interpreter. You find that the telephone translation service is a bit difficult and you wonder if video conferencing or translation services using novel technologies may lead to better outcomes than the telephone service.

You are a newly appointed Emergency Medicine Consultant at a large inner-city hospital, and you notice a high incidence of assault victims attending your department, and you wonder which interventions might be helpful in reducing this.

A 35 year old, male, recreational basketball player, attends the physiotherapy department with a diagnosis of right sided patella tendinopathy. He wants to know what the best exercise regime is to allow him to return to pain free basketball

A 39 year-old patient presents to the emergency department with a displaced angulated limb fracture that requires reduction under conscious sedation. It is decided that intravenous Ketamine is the best agent to use but doctors in the department recommend different dosage regimens. Some believe that administration of a bolus of 0.5mg/kg Ketamine and then topping up by 10mg boluses is safe, effective and reduces the risk of adverse events, especially emergence phenomenon. Others feel that giving small titrated boluses of 10mg from the beginning is safer. You wonder which is the most effective method?

A previously fit and well 36 year old male returns from a holiday to Greece 48 hours ago and presents to the Emergency Department complaining of headache, malaise and feeling generally unwell. While waiting to be seen, the patient’s headache rapidly worsens, he spikes a high temperature of 38.9 ̊C, becomes increasingly agitated and starts vomiting. He is taken to a resuscitation cubicle and has a heart rate of 135 bpm and blood pressure 71/45 mmHg. Examination of the patient reveals several small non blanching petechiae. You manage the patient as suspected meningitis and commence appropriate sepsis management. After 3 litres IV fluid the patient remains with a systolic blood pressure less than 80mmHg. The intensive care doctor informs you that they are trying to make a space available in the ITU for this patient but are struggling to step anyone down and the patient must remain in the resuscitation department. The resuscitation nurse asks you to prescribe more fluid. You wonder whether a peripheral metaraminol infusion would be more effective at increasing arterial pressure and maintaining organ perfusion.

A 30-year-old motorcyclist is brought to a major trauma centre following a road traffic collision. He has multiple injuries with clinical evidence of haemorrhagic shock. You activate the major haemorrhage protocol, and wonder whether early cryoprecipitate would be beneficial in this patient.

A man aged 21 years presents to the ED with a 3-day history of increasing redness, swelling and pain in his right thigh. On examination there is an area of fluctuance, approximately 3 cm in diameter, with associated tenderness, on the right anterior thigh. Erythema extends approximately 1 cm beyond the edges of the fluctuance. As the emergency physician, you incise and drain the abscess. You wonder whether a 7-day course of trimethoprim-sulfamethoxazole is really necessary in a healthy person, despite the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections.

Jennifer, a healthy 25-year- old medical student, presents to your emergency department (ED) during your afternoon shift with a severe headache that she has had for the past 8 hours. She has had nausea with vomiting for 6 hours. She has a long history of migraine headaches that keep her from her clinical duties for 1 or 2 days if untreated. After ruling out any cause for secondary headache, you decide to give 1 liter of intravenous (IV) saline along with IV metoclopramide. You consider if administration of IV fluid bolus might be associated with short-term or sustained outcomes

A 7 year old boy is brought to the emergency department (ED) after falling onto the corner of a table. On examination he is noted to have a large laceration across his right cheek that needs suturing. The young boy is afraid of needles and will not allow you to place a cannula or give an IM injection. As the ED physician, you consider using intranasal dexmedetomidine for sedation in this patient.

During a night shift, you receive in your resuscitation room your classical 6am pulmonary oedema patient. You start nitrates, furosemide and you initiate positive pressure ventilation, but you are asking yourself if you should still use the M of your LMNOP treatment mnemonic.

A confused patient presents to the ED. Is the abbreviated mental test score the best method to screen for delirium/acute confusional state?

A two year old boy presents to the emergency department with a 4 hour history of barking cough, rhinorrhoea, stridor on exertion. A diagnosis of croup is made. What does of dexamethasone should be given?

A 22-year-old female patient arrives to your emergency department with severe left-sided non-pulsating headache that began 3 days ago. She had been discharged from your ED a few hours earlier with a diagnosis of new onset migraines after partial resolution of her symptoms with analgesia and rest. She complains of progressive unilateral headache and mild nausea, which appears to be different from the occasional headaches she experienced in the past. She is healthy and takes only an oral contraceptive pill without any previous thromboembolic complications. Her neurological exam is once again unremarkable and you decide to order a non-contrast head CT which is completely normal. Once again, her symptoms partially resolve and you consider migraine headache to be the most likely diagnosis. However, the persistence and severity of her symptoms makes you wonder if cerebral venous thrombosis could be the cause of her headaches. Instead of repeating an imaging exam with venous contrast (magnetic resonance or computed tomography), you wonder if D-dimers, a laboratory assay frequently used in the exclusion of venous thromboembolism, could safely exclude cerebral venous thrombosis in this case.