Archives: BETs

A 25 years old woman presents to the ER with a chief complaint of first trimester vaginal bleeding. Her vitals are unremarkable. You perform a transvaginal ultrasonography using a condom on the probe and confirm the presence of an intrauterine pregnancy. Once the exam is completed, you clean the probe. You wonder if probe sheaths and low level decontamination were studied regarding microbial contamination.

A 70 year old man presents with back pain and collapse. His pulse is 120 and BP 90/63. CT shows a ruptured abdominal aortic aneurysm. You wonder whether giving tranexamic acid would reduce his risk of death.

Phantom Limb Pain is the sensation that an amputated or missing limb is still present and attached to the body. Phantom limb pain or phantom sensations are usually painful and can be an extremley troublemsome phenomenon.

In community paediatric clinic you review a 4 year old boy with Down’s syndrome with attention difficulties. Parents report no concern with his sleep. At a recent meeting you remember a respiratory physician discussing screening for OSA in children with Down’s syndrome. Polysomnography is difficult to access in your area, you wonder whether overnight pulse oximetry would be an appropriate alternative. You realise you require three main questions answered: 1.tWhat is the baseline prevalence of OSA in children with Down’s syndrome? 2.tHow accurate is pulse oximetry in diagnosing OSA in children with Down’s syndrome? 3.tWhat is the post-test probability of OSA using pulse oximetry in my patient with Down’s syndrome?

A 4 year old girl with DKA on fluid and insulin therapy in children's ward developed altered sensorium & unequal pupils. The registrar advised to commence her on mannitol (20%) to treat cerebral oedema. Intensivist from the transport team insisted on hypertonic (3%) saline. You wonder whether hypertonic saline is better than mannitol in treating cerebral oedema in children with DKA.

A 46 year old lady attends the Emergency Department with significant epistaxis from the right nostril - this started spontaneously. Her nose is packed using a Rapid Rhino. She feels better and would like a hot cup of tea - you know the policy is to avoid hot food and drink for 24 hours to prevent further bleeding, however you would if there is any evidence to support this?

A70 year old man presents with pleuritic chest pain. A D-dimer taken at triage is mildly elevated from the standard positive threshold. You feel he is at low risk of pulmonary embolism based on his wells score, and proceed to CTPA. CTPA shows no evidence of pulmonary embolism. You wonder whether an age adjusted D-dimer level would have excluded PE in this gentleman without the need for further investigations.

A 23 year old patient presents with a two day history of an acute grade 2 hamstring tear which occurred toward the end of the first half of a football match. The patient has been using the standard protection, rest, ice, compression, elevation (PRICE) acute injury management regime and referred for physiotherapy. You plan to begin an active exercise based rehabilitation programme following day 5 post injury. You have heard from a colleague who works in sports medicine that application of localised laser therapy can help improve pain, function and the quality of the repair site, and therefore wonder if it should form part of your treatment plan.

In the middle of the night, a 48 years old male is brought to your emergency department after a car accident. His seatbelt was fastened and he complains of moderate to severe sternal pain. He is alert, has no shortness of breath, his vital signs are normal and your secondary survey is otherwise negative for any other injury. You suspect your patient has an isolated sternal fracture. After ordering an electrocardiogram, cardiac enzymes and administering medication to relieve your patient, you wonder if bedside ultrasound would perform better at diagnosing sternal fracture than standard chest and sternal x-rays.

A 65 years old male, with known liver cirrhosis, portal hypertension and oesophageal varices, present with hematochizia at your emergency department. Given the probability of a upper gastro-intestinal bleeding in this patient, you want to perform a diagnostic aspiration with a nasogastric tube, but wonder if the risk of triggering a variceal bleeding with the tube because of mechanic trauma really exist or if it is only a myth.

You are the medical officer intern on-call for paediatrics in a small district general hospital in rural Kenya. You are called to see a young girl with meningitis who is actively convulsing. Her blood sugar is normal. She has already had one dose of IV diazepam 5 minutes ago. The nursing staff ask about giving her a second dose dose as per the Kenyan paediatric protocol book, but you are worried about the risk of hypoventilation in a hospital without high dependency or intensive care facilities. What do you do?

A 66 year old man presents to emergency department with cough, shortness of breath and pedal oedema. Clinical examination reveals bilateral fine basal crepitations. You wonder if he has got pneumonia or cardiac failure. He has a background history of cardiovascular risk factors.

A 35 year old male is brought to the emergency department with severe pain due to a fractured humerus. Intravenous access is available, and you wonder whether the use of intravenous paracetamol would decrease the amount of morphine analgesia he will need and provide better pain relief with less potential adverse effects.

A 34 year old man has been fishing on a Sunday afternoon at his local pond. He has lost his footing and fallen in. A passing dog walker has seen him struggle and managed to pull him out, unconscious. He is resuscitated at the scene. He is brought to the Emergency Department still coughing up brown water, but not obeying commands. One of your colleagues, nearing retirement age, suggests a barbiturate-induced coma.

A 74-year-old woman presents to the emergency department with significant primary epistaxis. She struggles to tolerate nasal packing. A passing orthopaedic registrar suggests that tranexamic acid may be beneficial since it works in other haemorrhage scenarios. You wonder if he is correct and whether there is any evidence for a role for intravenous tranexamic acid in the management of her epistaxis.

A 40 year old male presents with moderate obstructive sleep apnea. He is frustrated and non-compliant with his continuous positive airway pressure (CPAP) and does not want to have surgery. There are no complicating factors.