Archives: BETs

A young woman presents to the emergency department (ED) with a number of vague, non-specific complaints. The team suspect she may be suffering domestic abuse. Upon enquiry, the patient discloses a recent history of abuse by her current partner. What ED-based interventions will be most effective in improving the management of such a patient to reduce her risk of further abuse?

You are a paramedic assessing a patient with difficulty in breathing. On auscultation you think you hear a third heart sound. You wonder how accurate paramedics are at identifying abnormal heart sounds.

A 64 year old patient with a history of epistaxis presents to the emergency department with a 3 hours history of spontaneous epistaxis. Simple first aid measures have been ineffective, and nor has the application of ice. You wonder whether there is any evidence base behind the use of topical vasoconstrictors or decongestants in the management of adult patients with epistaxis.

A child attends the emergency department with a life threatening exacerbation of asthma. Despite the use of standard therapies the patient continues to deteriorate. You are aware of the bronchodilatory properties of ketamine and consider whether it may be of use as an additional therapy.

A parent of a 9 year old male suffering from myopia came to the clinic wondering if using contact lenses would slow the progression of myopia in her child as she read in the Internet.

A 74-year-old male presents to the emergency department with out-of-hospital cardiac arrest. Paramedics administered epinephrine prior to arrival to the hospital. The patient is unresponsive but has a faint pulse. You wonder about the long-term benefits of epinephrine which is still recommended by the American Heart Association.

A 25 year old football player patient presents with a 24 hour history of delayed onset muscle soreness affecting his gluteal and hamstring region following an intense gym weight training session which included loaded squats, deadlifts, stiff leg deadlift and lunge exercises. He is due to train today and tomorrow before a game in three days’ time, although he feels he is too sore and stiff to be able to participate in training. You have heard from a colleague who works in sports medicine that application of localised laser therapy can help improve pain, function and the reduce recovery time, and therefore wonder if it should form part of your management plan to enable the player to return to training as soon as possible.

As a new attending in a regional hospital, you constantly search for new indications to use your brand new ultrasound machine. You see a 23 years old man with facial trauma after a ski accident and suspect a nasal bone fracture. You ask yourself if an ultrasound would be as sensitive or even more than your standard CR to confirm a clinical diagnosis of nasal bone fracture in adults.

A 35 year old gentleman presents to the Emergency department complaining of painful left eye with foreign body sensation. Slit lamp examination demonstrates a corneal abrasion. You apply topical anaesthesia and he feels instantly better. He then requests to take the drops home. Your consultant tells you that it is dangerous to give topical anaesthetics because patients will go on to develop corneal ulceration and impaired healing. You wonder if there is any evidence to support this.

A 34-year-old male is brought by EMS as a trauma activation s/p MVC. He was an unrestrained driver with +LOC. En route, vitals deteriorated to the following: 80/45, 125, 28, 96%. He was intubated for airway protection. On arrival to the ED, GCS is 3T. As 2L crystalloid are being infused through 2 large bore IVs, ETT is confirmed to be in place, breath sounds are CTAB, carotid and femoral pulses are 1+ and thready bilateral. On exam, he has a seatbelt sign and initial FAST is positive. Trauma blood transfusion is initiated. Initial labs are drawn in the ED and he is taken straight to the OR by trauma surgery. You know that TEG is useful in transplant and cardiac surgery and wonder if a TEG-directed transfusion strategy will improve this patient’s clinical outcome.

One Friday night you decide to leaf through the 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes. You note that the guidelines recommend chewable aspirin yet the majority of departments you have worked in use soluble aspirin. You wonder if there is any evidence to back the use of chewable aspirin?

A 4-year-old boy presents to your local ED with a 72-hour history of mild fever and cough. While you order a CXR to confirm your suspected diagnosis of pneumonia, you remember that the radiology department of your hospital has introduced a policy to limit children radiographs to a single frontal view. You wonder if the omission of the lateral view will risk missing an infiltrate on your patient's X-ray.

An 8-year-old boy presents to the emergency department with right lower quadrant abdominal pain with features suggestive of appendicitis. The surgeons are not immediately available and suggest imaging of the right iliac fossa. There is a delay before either ultrasonography or CT scanning can be carried out by the diagnostic radiology department. You wonder if point-of-care ultrasound (POC US) might result in a quicker decision and therefore a shorter length of stay (LOS) for the child.

A mother attends the Emergency Department with her breastfed 8-week-old baby girl who is crying inconsolably. History and examination point towards a diagnosis of infantile colic. You wonder whether you should suggest a proprietary over-the-counter remedy or whether you should just say that this is a self-limiting condition. A passing paediatrician notices your dilemma and suggests probiotic therapy to reduce the baby's distress. You wonder if there is any evidence to support her advice.

A 40 year-old male patient presents to your emergency department with a five days history of sudden onset low back pain irradiating to the posterior aspect of his left leg. You perform a straight leg raise test, confirming the diagnosis of sciatica without any classic back pain red flags. In addition to standard analgesia, you wonder if a single-dose systemic corticosteroids could help relieve his pain.