A ten year old girl is admitted with a widespread petechial rash and bleeding gums. A full blood count demonstrates a platelet count of 3,000/mm3 and a diagnosis of idiopathic thrombocytopenic purpura is made. You decide that she warrants medical treatment but have seen both steroids and intravenous immunoglobulins used previously by colleagues. You wonder which treatment is most effective.
Archives: BETs
A 50-year-old man attends the emergency department with a history of cough, shortness of breath and purulent sputum production. He is hypoxic and shocked. He requires intubation and ventilation, and his post-intubation chest X-ray is consistent with bronchopneumonia. Following appropriate fluid resuscitation, he remains hypotensive and norepinephrine is commenced. Despite rapidly escalating norepinephrine, additional fluids and corticosteroids (for their catecholamine sparing effect), he remains shocked. A bedside transthoracic echocardiogram demonstrates left ventricular dysfunction which you feel may be attributed to septic myocardial depression. You wonder whether he might benefit from the addition of levosimendan.
Ruling out Acute Aortic Dissection in non-traumatic chest pain with D-dimer.
A 56 years old male, who is a smoker and known case of hypertension not on any medication as well as known case of severe Gastro-eosophageal reflux disease attended emergency department with sever tearing pain retrosternally radiating to back. Examination did not reveal anything significant, and he remains heamodynamically stable through-out . Serial ECG and troponine are negative. Chest x-ray does not show any widening of mediastinum or any other evidence suggestive of Aortic dissection. Still the possibility of aortic dissection was considered due to the nature of the pain hence; D- dimer was send and the result was negative. I was wondering is it sensitive enough to rule out aortic dissection?
The prophylactic antibiotic in acute pancreatitis and its effect on the outcome.
A 45 years old man came to emergency department with sever epigastric pain and vomiting, he was tachycardic and hypotensive, immediate fluid resuscitation stabilized his hemodynamic status. Labs revealed high lipase and amylase suggesting acute pancreatitis; he was kept NPO on intravenous fluid and was treated with analgesics and anti-emetics. The case was referred to gastroenterologist for admission who on further discussion, was enquiring why antibiotic was not started in ED for a better outcomes? This stimulated my thought, if starting prophylactic antibiotics in case of acute pancreatitis improve the outcome in term of morbidity and mortality.
Acute Non Traumatic abdominal pain in the elderly, who is at higher risk?
An 87 years old man presents to the Emergency Department with acute onset of central abdominal pain.. The pain is mild and was relieved by simple analgesia. you noticed that he had a temp of 37.8 and whit cell count of 13,000 with elevated neutrophil count. examination revealed no tenderness, guarding or rigidity and there was no masses but bowel sounds were sluggish. You wonder if this patient can go home or need to be admitted for observation and if so why?. The patient's medical history included hyperlipaedemia, hypertension, and that he is a smoking 10 cigarettes every day for the past 55 years..
Ultrasound guided fascia iliac block in the hands of ED physicians.
A 69yrs female comes after a fall with right hip pain; x rays confirm the diagnosis of fracture neck of femur (NOF). She is very hard to cannulate and you have read an article about anaesthetists putting ultrasound guided fascia iliaca block for NOF fractures. We want to know how good it is in the hands of ED physicians.
nX-Ray versus CT to confirm diagnosis of triplane fracture n
A 12 year old girl who has been brought with inversion injury to the left ankle while playing football. She was unable to bear weight. On examination there was swelling and tenderness over the lateral malleolus and anterior joint line. Left ankle X-ray showed Salter Harris Type 3 fracture of the distal tibia. You discussed with the orthopedic Specialty registrar on call; who was very kind to accept the patient and requested to carry out CT scan of the left ankle in order to rule out Triplane fracture. You wonder what is the sensitivity and specificity of x-ray to rule out Triplane fractures against CT scan being the gold standard.
“He needs stitches? Will they dissolve? We're going to Disneyland tomorrow!” asks the anxious mother of a 3-year old who presents to your ED with a 2cm vertical forehead laceration. You ask yourself if you can use absorbable instead of non-absorbable sutures for closure for the same results.
Is there any evidence for Kinesiotaping neurologically weak ankles?
A five year old girl presents with mild vincristine neuropathy (peripheral neuropathy of common peroneal nerve) affecting bilateral Tibialis Anterior muscles. She is able to actively dorsiflex but walks with an affected gait. You wonder whether kinesiotaping would be of benefit to facilitate these muscles and retrain gait.
An adult patient presents to your emergency department with a severe exacerbation of asthma. Despite multiple rounds of salbutamol and ipratropium with prednisolone and oxygen supplementation the patient continues to deteriorate and plans are made to intubate the patient for mechanical ventilation. You are aware ketamine is the induction agent of choice and wonder if a ketamine infusion may obviate the need for intubation and mechanical ventilation.