Archives: BETs

A 34 week baby has been delivered following a uterine rupture and is pale and floppy with no heart rate. Resuscitation is started and the baby quickly responds. Apgar scores are 11, 25 and 410. One hour later, the baby develops abnormal movements consistent with a seizure. Blood gas analysis at this time shows: pH 6.90, PCO2 6.5, PO2 8.2, BE -14, Lactate 11. Although by gestation this baby is one week below the 35 week limit suggested in the national guideline for therapeutic hypothermia, should this baby be considered for cooling?

You are the emergency physician in charge of a busy Emergency Department (ED) in a large hospital. The department is experiencing overcrowding and you are investigating possible solutions. You wonder whether placing a senior physician at triage will help to improve flow through the department and reduce patient length of stay (LOS) and ED crowding.

A 5 year old child attends the ED with an acute respiratory tract infection that requires admission. A colleague mentions zinc supplementation is used in many rural areas in Asia for the prevention of respiratory tract infections. But is there evidence that zinc as an adjunctive therapy has a therapeutic role in the management of acute respiratory tract infections?

A 48 year old man presents to the Emergency Department with an exertional dyspnoea for a few days. He has no risk factors for PE and no signs of DVT, but his D-dimer comes back positive. Your respiratory physician colleagues suggest that an acute PE diagnosis is more likely if his oxygen saturation would drop on exertion. You wonder if there is any evidence to support the use of exercise induced hypoxia as a risk stratification tool for acute pulmonary embolism.

You attend a 60 year old male in cardiac arrest. A double crewed ambulance with a student observer and a rapid response vehicle are already on scene. The patient has ongoing CPR and with effective ALS you regain a pulse. At this point the decision is made to intubate the patient to secure their airway for transport. During the debrief intubation is discussed and the student asks about the training the paramedics at the scene received. There is considerable variation in the training received by the paramedics and the training the student paramedic is undergoing at present. This sets you thinking about how paramedics actually learn to intubate.

A 62-year-old women is brought to the emergency department (ED) with sudden onset left sided hemiplegia. Computed tomography (CT) scan of her head shows an acute right basal thalamic intracerebral haemorrhage (ICH). Her blood pressure in the ED is 195/100. You wonder whether you should treat this patient’s hypertension in the ED?

A patient presents to the emergency department (ED) with a suspected acute coronary syndrome. The ECG shows ST elevation, which almost meets the criteria for the diagnosis of ST elevation myocardial infarction (STEMI) when measured at the J point. If measured 60 ms after the J point, the ECG meets criteria for diagnosing STEMI. You wonder if there is any evidence to determine whether ST elevation should be measured at the J point, as stipulated in international guidance (Thygesen et al, 2012), or 60 ms after the J point)

A 45 year old cyclist is brought up into resus after being knocked off his bicycle by a lorry. He is in traumatic cardiac arrest. ATLS is in progress you wonder whether IV adrenaline would improve his chances of survival?

A healthy 3 year-old girl is brought into Emergency Department by her mother. She lifted her up on the couch by pulling on her left hand from this moment her daughter didn’t use her left arm. This little girl has a clear history of a ’’pulled elbow’’. You wonder whether supination-flexion or hyperpronation is the best technique for this reduction.

A patient who works as a model, presents to the A&E with dog bite lacerations to the hand and arms. You check tetanus status and clean and irrigate the wounds. Having recently read the Cochrane review on not providing prophylactic antibiotics in dog bites, you wonder whether this also means you can primarily close the wounds.

A 47-year-old man presents complaining of a painful gritty sensation within his left eye. He had been taking down a ceiling in his house and had not been wearing eye protection. You suspect a corneal foreign body. You are about to instil local anaesthetic drops when your registrar suggests that this is not necessary since, if there is a foreign body and it is subtarsal it could be removed without the need for the drops. She points out that installation of local anaesthetic drops is not without risk. You wonder if there is any evidence to support her pragmatic view.

A 56yr old man with a chronic history of intermittent low back pain presents to your ED. It hasn’t been right since a motorcycle injury ten years ago and when his pain is exacerbated, as it has been this time for three weeks now, it affects his gait and daily functioning, with stiffness, difficulty standing from sitting, pain on movement, worse on rising. No red flags in history or exam. He is on co-codamol and difene as per his GP, and has tried agents for neuropathic pain previously but felt they were ineffective. No red flags in history or exam. Your consultant advises you to give him a prescription for a lidocaine patch and to get him out the door. You know that the patch is only licensed for post-herpetic neuralgia and wonder if you are just wasting the patient’s time and money with this measure.

You call the surgical SHO to refer a patient whom you suspect has acute appendicitis and he asks you what the patient's lactate is? You wonder the significance of a serum lactate in the diagnosis of acute appendicitis.

A patient is brought into the emergency department with a severe acute head injury. You remember that there was recent trial in the hospital on the use of progesterone in head injury and wondered if it would be in the patients best interests?