Archives: BETs

An 89-year-old woman presents to your emergency department following a fall. She is complaining of severe pain in her right hip area. A plain radiograph shows a neck of femur fracture. A fascia iliaca nerve block with bupivacaine is the opioid sparing analgesia of choice in your department. You have heard that magnesium can prolong the duration of action and effectiveness of the local anaesthetic. You wonder if there is any evidence for this adjunct in fascia iliaca nerve blocks.

A patient is referred for voice therapy with dysphonia. There are many exercises available which will facilitate efficient phonation. Is the use of semi-occluded vocal tract exercises using a straw likely to lead to improvements in the quality of the person’s voice?

You are taking some time after your CT3 year to learn some extra skills that would be useful to your job as an EM consultant. One of the jobs you felt would be useful is palliative care. Intuitively, you feel that uncontrolled pain is an emergency we often see and personally you feel there is much for you to learn in the appropriate management and subsequent referral pathway of palliative care patients. You feel pain management is one of our biggest roles, in common with end of life care specialists. You have no evidence base to show to others how Emergency medicine doctors feel about their knowledge in palliative care and if an Educational intervention would lead to increased knowledge of and confidence in this area and hence a better patient experience.

A 74-year-old woman presents to the emergency department following a fall. She can’t remember how she fell, but thinks she must have just tripped over. You want to perform the necessary initial investigations and predict her risk of subsequent falls before she is discharged.

An 80 year old man with a history of atrial fibrillation on warfarin presents to the emergency department after a ground level fall. He reports hitting his head, but denies loss of consciousness. Vital signs are stable and within normal limits at presentation, GSC is 14. Physical exam is unremarkable. Initial head CT scan is read as negative for acute abnormality without evidence of intracranial hemorrhage. Can the patient safely be discharged home?

You are working as the middle grade leading a trauma call. Your patient has multiple rib fractures as well as a flail chest and is clearly in pain and has somewhat laboured breathing. The anaesthetist is getting ready to induce and then intubate the patient to take him upto ICU for mechanical ventilation. You wonder if it is a good idea to be this aggressive and if more conservative management would result in a better outcome. You do not however have any evidence to hand to prove things one way or the other.

20 year old student radiographer is brought to emergency department by ambulance after being involved in a RTC a few hours earlier. It’s a busy Friday afternoon and she’s been sat in waiting room. You call her through to be seen and you notice she obviously has difficulty walking; her concerned looking mother helps her in to a nearby wheelchair and brings her through. She is complaining of lumbar back pain. On examination you are concerned by your neurological findings in her lower limbs: clonus, 4/5 power throughout and some subtle paraesthesia. You explain you would initially like to perform an x-ray and that she may require a CT. She asks her mum to go and get her a drink of water and quietly reveals to you she’s 8 weeks pregnant. You think that MRI is likely to be safer but are not sure if there any significant risks?

A 42-year-old previously healthy woman presented to the emergency department with chest pain and was found to have an ST elevation myocardial infarction. Cardiac catheterization revealed a dissection in her left anterior descending artery. You wonder what is the prevalence of spontaneous coronary artery dissection (SCAD) in patients with acute coronary syndromes.

A 68-year-old female presents to your emergency department with chest pain and dyspnea. Her ECG reveals sinus tachycardia and slight ST elevation in leads I and aVF with reciprocal ST depression in leads I and aVL. Before activating the cardiac catheterization laboratory, you consider the other causes of ST-segment elevation.

A 20 year old patient presents to the ED with low mood and suicidal ideation. The patient has been assessed and is for admission by the psychiatric team once medically cleared. You wonder whether the use of mandatory screening studies in the ED actually affects morbidity and mortality in such patients.

In the emergency department, you saw a young woman with severe symptoms of urinary urgency and burning. After your thorough evaluation, your diagnosis is a urinary tract infection. Before leaving, she asked you if you could give her something to relieve her symptoms while waiting the antibiotics to kick in ? You heard about phenazopyridine before but you wonder if it will really be helpful?

A 25-year-old man presents to the emergency department (ED) with a fracture dislocation of his ankle. His ankle needs reducing, and you intend to use conscious sedation to facilitate this. You wonder whether bispectral index monitoring (BIS) would help achieve an appropriate level of sedation, thereby reducing the risk of respiratory depression while maintaining comfort. .

You are training a number of prehospital care providers airway management skills. You want to know how many times they will need to insert a supraglottic airway device before gaining competence in this skill.

A 4-year-old boy presents in A&E with sudden onset facial paralysis and hemiplegia. CT scan followed by MR angiogram diagnose stroke as a result of thrombosis to Middle Cerebral Artery (MCA). The GP trainee who has worked in Medicine has seen thrombolysis being used in adult patients with stroke. He wonders whether thrombolysis should be carried out for this child.