Archives: BETs

A fifty-six year old woman presents at your Emergency clinic with a twenty-four hour history of sudden onset of left sided sensorineural hearing loss. She has no associated co-morbidities. Following a normal examination, a diagnosis of idiopathic sudden sensorineural hearing loss (ISSNHL) is made. You think that she would benefit from a course of steroids as first line therapy but are unsure of the best method of delivery. You discuss the options with your colleagues, one advises oral steroids whilst the other advocates the use of intratympanic delivery. You wonder what would be the best course of action.

A 7 year-old boy presents to the emergency department with acute onset abdominal pain. His symptoms are not entirely classical for acute appendicitis but you are concerned this could be the start of its presentation and refer him to your surgical colleagues. The surgical registrar on call asks you to arrange an abdominal ultrasound for him which is carried out whilst he is waiting for a hospital bed. Unfortunately the report is returned as “unable to visualise the appendix”. The surgical team say they will adopt a “wait and watch” approach but his parents are unhappy with this as their son is in pain and ask you if there are any other investigations that can be performed. You are reluctant to request an abdominal CT due to radiation exposure and wonder if there is any evidence for the use of MR scanning in diagnosing appendicitis in children as you have seen it used to diagnose appendicitis in pregnant women.

A 54-year-old man attends the emergency department complaining of a rapidly progressive pain and swelling in his right arm. He is mildly tachypnoeic and tachycardic. His arm is very tender and painful even at rest but is only slightly erythematous. He can move his hand, wrist and elbow with complete range of motion. You suspect a necrotising fasciitis. You wonder whether an ultrasound of the soft tissue night help to differentiate between cellulitis and a necrotising fasciitis.

You see a 6 year old boy in clinic with nephrotic syndrome who is on low dose alternate day prednisolone. He has coryzal symptoms but is otherwise well, with 1+ proteinuria and no oedema. You know that he has previously relapsed following a viral infection and you wonder what you can do to prevent a further relapse. You ask the consultant who suggests increasing his prednisolone dose to daily and you wonder what the evidence is for that.

36 years old patient was transferred to emergency department following a severe blunt trauma in a road traffic accident. When deciding about initial diagnostic investigation, you wonder which one is associated with better survival: whole-body CT or conventional diagnostics.

The trauma team including the cardiothoracic surgical department discusses at a grand round meeting the introduction of a new “adult thoracic trauma” management protocol after patients with thoracic trauma have been stabilised in the emergency department. This protocol involves the use of Video-Assisted Thoracoscopic Surgery (VATS). You are not sure whether VATS is a safe and effective technique for managing thoracic trauma so you decide to look up the evidence yourself.

A 60-year-old man presents to the emergency department with symptoms of lower oesophageal food bolus impaction. You have previously seen intravenous glucagon used in an attempt to relieve lower oesophageal impactions but wonder if there is any evidence for its use. You wonder if there is any evidence to support use of intravenous glucagon to treat lower oesophageal food bolus impaction.

You are the emergency department consultant who attends an adult who has been brought in by HEMS following a high speed RTC. He suffered loss of consciousness and was intubated at scene with a GCS 6. He has a sustained a severe closed head injury. You consider if there is any benefit for this patient in receiving combination progesterone and vitamin. D therapy for potential neuroprotection post- traumatic brain injury. Would this therapy improve clinical outcomes for the patient? You resolve to search the literature.

A 22 year old student is sent from the Walk-In Centre because she has complained of pleuritic chest pain. In the referral letter the GP asks you to rule out a Pulmonary Embolism. She is low risk, has no abnormal chest signs and has a normal chest X ray. To your great surprise her d-dimer is reported as >10,000. She has a V/Q scan which is reported as low probability for a PE. You wonder whether her raised d-dimer could be caused by menstruation?