Archives: BETs

You treat a cutaneous abscess in young adult male in the emergency department with incision and drainage. You dress the wound and discharge him however wonder whether you should prescribe a course of antibiotics.

You review a young adult (or child) in the emergency department with a soft tissue infection. Upon clinical examination you are unsure whether there is a cutaneous abscess present. You wonder whether bedside ultrasound will help you make a definitive diagnosis.

A 69 year old woman presents to the emergency department patient with acute onset of chest pain and dyspnea. Symptoms began while she was attending her son’s funeral service. Her electrocardiogram shows characteristic ST-segment elevation over the anterior precordial leads with a small elevation in troponin T. While paging the cardiologist, you wonder is this patient has a myocardial infarction or stress induced cardiomyopathy (apical ballooning syndrome or Takotsubo cardiomyopathy).

A 62-year-old man presents with an acutely swollen left calf. You suspect that he may have a deep vein thrombosis (DVT). Can a 2-point bedside compression ultrasound, performed at the bedside by an Emergency Physician confirm or refute this diagnosis accurately?

A 19-year-old male is brought via EMS to the emergency department for seizure like activity, agitation, and anxiety after reported ingestion of multiple Monster Energy Drinks. Following a negative urine drugs of abuse screen you question whether his symptoms could be caused from toxicity from energy drink use?

A 35 year old patient is hit in the chest with a baseball bat sustaining multiple rib fractures and a haemothorax that requires insertion of a chest drain. You wonder if interpleural block is more effective than standard care at providing analgesia.

A previously healthy 8-year-old boy, with a three-day history of flu-like symptoms presents to your emergency department. He was admitted with dehydration and hypothermia in the context of persistent vomiting. The following day he developed heart failure secondary to viral myocarditis.

You are a junior doctor in the neonatal intensive care unit. A preterm neonate has a loud murmur with bounding femoral pulse. Echocardiogram shows a haemodynamically significant patent ductus arteriosus. He is ventilated, but is otherwise well and has been tolerating full enteral feeds for a few days. A decision is made to commence intravenous Ibuprofen. You wonder whether oral Ibuprofen could be used and whether this would be as safe and efficacious as the intravenous route.

A 62 year old male emergency department patient presents with an acute pulmonary embolism. Patient is tachycardic and requiring supplemental oxygen. You debate over where to place the patient (ICU, progressive, general floor). You consider whether elevated plasma lactate (greater than or equal to 2 mmol/L) might be a good prognostic indicator of death or clinical deterioration.

A 58 year old woman with a history of DVT attends A&E with pleuritic chest pain. She is haemodynamically stable with normal saturations, ECG and chest x-ray. D-dimer is positive. You would like to rule out a pulmonary embolism. You wonder whether it would be safe to discharge the patient home overnight before the CTPA, which is booked for tomorrow morning.

A 40-year-old man is brought into the emergency department in cardiopulmonary arrest. It is agreed by the cardiac arrest team that endotracheal intubation is now appropriate to manage the airway. You usually use end-tidal CO2 (ETCO2) waveform analysis to confirm tube placement—but are aware that it is not so reliable during cardiac arrest. You wonder if transtracheal ultrasonography is a good tool to confirm endotracheal intubation in this situation.

A 30-year-old woman comes to the emergency department presenting with sore throat and low-grade fever. Physical examination reveals a non-toxic-appearing woman with mild trismus and uvular deviation. As you consider whether the symptoms represent cellulitis or a true abscess, you wonder if using intraoral ultrasound could help establish a definitive diagnosis and assist in needle aspiration.

A multi disciplinary team working with diabetic and non diabetic patients who have had a lower limb amputation. A challenging area for the team is whether the diabetic patients can mobilise/weightbear after a partial foot resection. Situations have arisen in the past where consultant teams have had opposing views over the weightbearing status of the patient; non weight bearing or partial weight bearing with appropriate footwear.

A 36 year-old gentleman presented with pleuritic chest pain to the emergency department of St Vincent’s Hospital, Melbourne. He was low-risk for pulmonary embolism with a modified Well’s score of 0 but had a raised d-dimer of 0.7 mcg/ml. A CT pulmonary artery scan (CTPA) was performed, showing a subsegmental pulmonary embolus . He was subsequently admitted to hospital for anticoagulation and investigation of underlying risk factors. The prospect of systemic anticoagulation for three months was unappealing for him. He was otherwise clinically well and was a young person with an active lifestyle. This raised the question of whether the use of oral anticoagulation was justified in this gentleman, or whether the potential harm would outweigh the benefits.

A male patient presents to the emergency department with acute urinary retention requiring urethral catheterisation. You ask the nursing staff where the local anaesthetic gel is and they tell you that it has been removed following a safety alert as it contains chlorhexidine, which may cause anaphylaxis. You catheterise the gentleman who appears to suffer a lot of pain with the procedure. Following this you decide to look at the evidence for the use of local anaesthetic lubrication in catheterisation.