Archives: BETs

You are put on standby by the paramedic emergency service for a cardiac arrest in a 2-year-old boy hit by a car. As you send for the ‘CPR step’, you wonder whether you really should give chest compressions as per ALS-teaching or whether they are ineffective in hypovolaemic or obstructive shock due to trauma (as recent opinion has suggested).

A 28 year old male presents to the emergency department with a 2-week history of cough and progressive shortness of breath. An outside chest x-ray was non-diagnostic. Chest CT here demonstrates bilateral interstitial infiltrates, consistent with pneumonia. You wonder how often CT scan is necessary to diagnose a pneumonia after an equivocal chest x-ray.

An 8-year-old girl presents to the paediatric ED with palpitations. She is not distressed, and has a normal BP, but her pulse is 200 beats per minute. An ECG reveals supraventricular tachycardia. If she were an adult, you would try the posturally modified Valsalva manoeuvre and then reach for the adenosine, but you wonder what evidence there is for this or other vagal manoeuvres in children and, indeed, what evidence there is for the use of adenosine.

A 32 otherwise fit and well man attends the ED two hours after running his hand along an old wooden broom. He sustained a penetrating wound from a large wood splinter which he thought he had removed. He now complains of ongoing sharp sensation in the ulnar border of his palm on palpation and movement. A radiograph by the triage nurse shows no foreign body but you know that wood is radiolucent 85-100% of the time. You consider whether ED ultrasound might be useful

A 24 year old male presents with chronic low back pain. Investigations have ruled out any serious disc, joint or bony pathology. Current opinion advocates core stability as the ‘go to’ treatment for this non-specific pain scenario. You wonder if it would be more effective than a conventional exercise programme?

A 33-year-old patient presents to ED with a 5 mm calculus in the right distal ureter. You heard about a new type of medical expulsion therapy, tadalafil, which supposedly has a high ureteral stone expulsion rate as well as significant pain control. You wonder how it might compare to α-receptor blockers, such as tamsulosin or silodosin.

After an international conference on the management of patients in cardiac arrest and watching a lecture on this subject, I felt that this was a novel approach and wanted to explore the evidence surrounding this approach and the feasibility of this being introduced into our ED.

You have reviewed a 45 year old woman complaining of vertigo on head movement with no other concerning features. She has a positive Dix-Hallpike test and you diagnose BPPV. In teaching today you were shown the Semont manoeuvre, you wonder if this manoeuver or the Epley manoeuvre would be more effective in treating her.

A 57-year-old man attends the Emergency Department with bilateral ptosis. You only have a short time in order to ascertain the cause of the ptosis and therefore refer appropriately. The ED SHO wonders if there is a simple bedside test to distinguish whether Myasthenia Gravis is the cause of this presentation.

While working the night shift, a patient is admitted for thunderclap headache 12 hours ago. After a negative head CT, you decide to do a lumbar puncture to rule out subarachnoid haemorrhage. You specifically need a non-traumatic LP and you wonder if localizing the right lumbar space with an ultrasound would reduce the rate of traumatic LP.

A 52 year old male presents to the orthopaedic knee service with gradual onset of knee pain and effusion. He finds walking is now limited to 2 hrs and he struggles to play a full round of golf. Knee X-ray findings confirm moderate signs of degenerative joint disease. He is not yet at the stage to consider a joint replacement. He has tried physiotherapy and relative rest but now is keen for an ‘injection’. Should he be offered a corticosteroid or hyaluronic acid injection?

A 30-year-old male involved in a high-speed motorcycle accident is attended to by a prehospital critical care team. On scene the patient is moribund and in a shocked state. As the reversible causes of shock are addressed you wonder if resuscitation with blood products rather than crystalloid would improve the patient's chances of survival. Major haemorrhage protocols are used in hospital and intuition would suggest potential benefit if these protocols were administered at the point of injury, in order to reduce the later incidence of coagulopathy.

A normally fit and well 26-year-old man presents to the emergency department with a sudden onset headache. It came on 2 h ago, and is the worst he has ever had. He has taken paracetamol without success. The headache made him feel very unwell, but he has no neurological symptoms. His Glasgow Coma Scale (GCS) is 15 and clinical examination is normal. You are concerned that he may have had a subarachnoid haemorrhage (SAH) and want to rule this out. He has a CT scan within 6 h of the onset of the headache. It is reported as normal. You wonder if this excludes a diagnosis of SAH.