Archives: BETs

A 52-year-old lady has presented to the Emergency Department with a suspected PE. This is confirmed by CT pulmonary angiography (CTPA). Consequently she requires anticoagulation. Hospital guidelines suggest the use of a low molecular weight heparin (LMWH) followed by 6 months of Warfarin therapy. You wonder whether Rivaroxaban, a novel oral anticoagulant (NOAC), would be a better treatment option for her and patients like her.

A 33 years-old itinerant comes to the emergency department after a long winter night outside. He has clear blisters on three of his right fingers. You diagnose moderate frostbite and you start a rewarming process. Then, you wonder what to give him to reduce the inflammatory cascade. Should you use aspirin or a non-steroidal-anti-inflammatory drug?

A 23-year old man presents to the emergency department because of pain and swelling of the left knee after a motorcycle accident that occurred the day before. Clnical examination suggested the presence of joint effusion in the suprapatellar pouch with sever pain in the affected knee. A radiograph of the knee showed no signs of fracture. Computed tomography (CT) of the left knee revealed an oblique fracture of the tibial plateau. As the treating clinician, you question the sensitivity of plain x-rays to identify fractures in the knee.

A 44-year-old diabetic male is diagnosed in the emergency department with acute pericarditis following a viral illness. He is allergic to nonsteroidal anti-inflammatory drugs. You wonder about the safety and efficacy of colchicine as stand-alone therapy for the prevention of recurrent pericarditis.

A 15 year old boy with type 1 DM is admitted to the ED unwell, with a BM of 29. O/E he is pale, sweaty and lethargic with a BP of 90/40 and pulse 120. Otherwise exam is unremarkable. You site an IV cannula and take a VBG which shows pH 7.1 and HCO3- 10. You give a 900ml 0.9% NaCl fluid bolus (20ml/kg) and are about to start a sliding scale when the paediatric SpR tells you that local policy is to hold off insulin for the first 2-3 hours as it may increase the risk of development of cerebral oedema. You wonder what the evidence shows.

A 20-year-old male is rushed to the Emergency Department after falling into a canal. He is unresponsive and suffers a cardiac arrest for which CPR is commenced. You wonder if therapeutic hypothermia may have a role in his management.

A 15-year-old male presents to the Emergency Department after falling into a canal. He was resuscitated at the scene and is currently asymptomatic. You wonder if performing a chest X-ray will help to provide diagnostic information.

A 10-year-old boy presents to A&E after falling into a river. He was rescued and resuscitated at the scene but now has a GCS of 7. There is no evidence of trauma. You wonder if a CT scan of his head will aid the management

A 23-year-old woman presents to the emergency department after falling into the canal. She was resuscitated at the scene but is now cold, pale and short of breath. You decide she needs fluids, but aren’t sure which would be best to give.

A 23-year-old woman presents to the emergency department after falling into the canal. She was resuscitated at the scene and is now fully recovered, apart from seeming a little short of breath. You wonder if a bronchodilator would help with her symptoms.

A 20 year old man presents to the Emergency Department after being pulled from the canal. He fell into the canal while intoxicated, and on arrival is unconscious. There are no clinical signs of serious injury. You wonder whether his cervical spine should be immobilised until imaging rules out trauma.

A 36-year-old woman presents to the emergency department after eating some unidentified wild mushrooms 12 h previously. She is complaining of abdominal pain and diarrhoea, which started 2 h before. The toxidrome leads you to suspect that the mushroom may have been Amanita phalloides. You are aware of the dire prognosis. You discuss the case with your consultant who suggests the use of silibinin. You wonder whether this would reduce her risk of death or need for liver transplant.

A 4-years-old boy with previous history of asthma presents to your Emergency Department with moderate asthma exacerbation. His condition improved with salbutamol and you are ready to discharge him. He already received one oral dose of dexamethasone. You wonder if there is enough evidence to discharge him without prescribing additional oral corticosteroid. You search the available literature.

A 62-year-old gentleman attends your Emergency Department with shortness of breath and chest pain. You suspect a pulmonary embolism (PE) and request a CT pulmonary angiogram. The radiologist reports an isolated subsegmental PE and you question whether this gentleman requires anticoagulation therapy given the size and location of his PE.

A 35 yrs old girl comes to the Emergency department with acute shortness of breath for last 6 hrs. The working diagnosis of pulmonary embolism is made. The D dimer was sent but will take 2-3 hrs for the results to be available. You wonder if arterial blood gas analysis can be used to diagnose the PE.

You see a middle age lady in the Emergency Department who has presented with nausea and vomiting. She continued vomiting despite ondansetron. One of the anaesthetists suggests that you try just intravenous fluids before giving further anti-emetics. You wonder if there is any evidence for this?

A 17 year old male found intoxicated on the street brought in by ambulance unconscious. Smelled of ethanol. Alcohol specialist team advised to give high dose multivitamins. Made me wonder if high dose intravenous multivitamin actually improves clinical outcomes in intoxicated patients

Patient seeking a relatively safe, non surgical cosmetic treatment to the lower eyelid.