Archives: BETs

A 32 year old woman presents to the Emergency Department with epistaxis which she cannot stop herself. First aid measures in triage cause haemostasis. She is haemodynamically stable, her observations are within normal limits and she is not taking any anti-coagulation or anti-platelet medications. This is her first episode of epistaxis. The Ear, Nose and Throat specialist advises you to prescribe anti-septic nasal cream for one week “to prevent recurrence or complications.” You are unsure whether this treatment will reduce the risk of recurrent epistaxis or infective complications.

You attend a cardiac arrest in a 48 year old female patient. The patient is in VF, and you follow the ALS algorithm but unfortunately you are unable to defibrillate the patient. You only have one defibrillator and so dual sequence defibrillation is not an option. Sadly, the patient never comes of VF, fading into asystole and then dies. At the debrief a colleague tells you that applying pressure to the pads reduces thoracic impedance and might be a way of improving the success of defibrillation. You wonder if this is true.

A 60 year old man presented to the A&E with a ~4cm dog bite laceration on the posterior thigh. He has already received all 3 doses of tetanus vaccine. It has been confirmed that the dog is up to date on rabies vaccination. The laceration is deep and requires sutures. Should you do primary closure of the wound?

A 40-year-old patient presents to the ED with epistaxis. They are otherwise fit and well with no signs of bleeding elsewhere. You wonder if a nasal clip will deliver more effective first aid than manual compression.

You are at a fireworks party with your young family. You wonder whether inserting a sparkler into a carrot may be safer and reduce the risk of injury.

An elderly patient presents to the emergency department (ED) with hip pain after a fall from standing. They are unable to weight bear. You notice extensive bruising around their left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve their outcome when they later undergo surgery.

An adult patient with a mixed background of asthma and chronic obstructive pulmonary disease (COPD) presents to the ED with worsening shortness of breath and wheeze. They report using their salbutamol inhaler multiple times at home, with little improvement. At present, they are not able to speak in full sentences, but their oxygen saturations are normal, and they show no signs of fatigue. You consider prescribing nebulised salbutamol but wonder if there is any evidence to support instead the use of a metered-dose inhaler with spacer.

A 32 year old patient presents with severe loin to groin pain. He is otherwise fit and well. CT KUB shows a 5 mm stone at the vesico-ureteric junction. You have read about intradermal sterile water injections being used in the context of labour pain and musculoskeletal injuries and wonder whether they may also provide benefit in renal colic.

A 33-year-old patient presents to the emergency department with right-sided flank pain and haematuria. The pain is described initially as 10/10 in severity. CT imaging demonstrates a 4mm non-obstructive stone in the right ureter. Despite intravenous ketorolac and morphine, the pain remains 9/10 in severity. The patient is otherwise well, and you wonder if an erector spinae plane block (ESPB) would be an effective alternative for analgesia.

A 44-year-old patient presents to the emergency department (ED) with a deformed and painful right shoulder after a hard tackle playing rugby. An X-ray confirms right anterior glenohumeral dislocation with no associated fracture. You would like to attempt a closed reduction. Unfortunately, your department is too busy for a full procedural sedation. You wonder what your likelihood of success would be using only inhaled methoxyflurane (Penthrox®) and whether this would facilitate a quicker discharge from ED.

You receive a major trauma patient to your emergency department. The history is of a 42 year old male who has fallen 8 foot from a balcony. On arrival, there is obvious evidence of head injury and Glasgow Coma Score is 4 (E1, V1, M2). You conduct a primary survey and find evidence of airway obstruction, but no other immediately life-threatening conditions. You undertake a drug assisted endotracheal intubation, which is uneventful. The patient is sedated, ventilated and escorted to radiology for definitive imaging. A full body trauma CT is reported within the hour as showing severe Traumatic Brain Injury (TBI) and 2 displaced right sided rib fractures. The case is discussed with the neurosurgical team who recommend admission to critical care for placement of an intracranial pressure bolt and a period of monitoring. As you are preparing for transfer, a colleague mentions recent evidence reporting that prophylactic antibiotics given within 12h of intubation can prevent subsequent pneumonia in patients with TBI. You have not heard of this before and are reluctant to prescribe anything, given the importance of antimicrobial stewardship. You escort the patient to Intensive Care, get a coffee and sit down to review any evidence on the topic.

A 14-year-old presents to the ED with acute flank pain and is found to have a 5 mm distal left ureteral calculus. There is no concern for significant hydronephrosis, renal insufficiency, or infected stone. Should tamsulosin be prescribed to help facilitate stone passage in this pediatric patient?

A 40-year-old police officer is exposed to a white powder after apprehending a suspect. He is concerned that he was exposed to fentanyl so he self-dosed with Naloxone and came to the Emergency Department. He is observed for 1 hour and discharged home.

An otherwise healthy 28-year-old male presents to the emergency department following a motor vehicle collision. The patient, brought in wearing a cervical collar, is obtunded upon arrival and intubated for airway protection. CT imaging shows a multifocal subarachnoid hemorrhage. The patient has signs of increased intracranial pressure (ICP) and despite maximal medical therapy continues to be severely hypertensive and bradycardic. CT of the cervical spine was negative, and you wonder if the patient’s cervical collar is contributing to the elevated intracranial pressure.