Archives: BETs

A 53-year-old unrestrained driver who has been involved in a head-on collision arrives at the emergency department. He is immobilised on a spinal board and is wearing a semirigid cervical collar. As he has had opiate analgesia and might have had a head injury you are worried about the risk of vomiting (and subsequent aspiration of gastric contents). A junior member of the team asks whether antiemetic agents could be used prophylactically in all trauma patients, in order to limit the risk of vomiting. Interested in the result you set them the task of researching current literature and returning later in the week with the answer.

A 78 years old lady presents to the Emergency Department with right lower quadrant abdominal pain for 2 days. She is known hypertensive and take bisoprolol 5 mg every morning. Clinical examination showed very slight tenderness in the right lower quadrant and suprapubic area, there is no guarding, masses or organomegaly. Urine dip and bowel sounds were normal. General examination is otherwise normal with temp of 37 degree Celsius, pulse of 58 beat per minute. You wonder if you can rely on normal blood tests to be able to exclude appendicitis.

A 65 year old female presents to the Emergency Department acutely short of breath. You diagnose an acute exacerbation of COPD. You take an arterial blood gas, but wonder whether a venous one would have sufficed.

A 54-year-old man has suffered an out-of-hospital cardiac arrest. The Paramedic Emergency Service have instituted ALS—administering a defibrillatory shock and managing his airway by insertion of a laryngeal mask airway device. Spontaneous circulation has returned but the patient still required airway and breathing support. The resuscitation team leader is just having a conversation with the anaesthetist about securing the airway with an endotracheal tube when the patient has what appears to be a fit. During the tonic phase of the fit, he clenches his teeth and occludes the laryngeal mask airway device. His airway is obstructed, and he subsequently develops pulmonary oedema. You wonder whether these complications could have been prevented with a bite guard.

A 64 years old woman is suddenly unresponsive and pulseless. A few minutes after prompt cardiopulmonary resuscitation initiation by her husband, the paramedics arrive on site. Defibrillation is performed twice with an external defibrillator. Return of spontaneous circulation is achieved but she stays unconscious. On emergency department arrival, her vital signs are stable and she is normothermic. The electrocardiogram is not showing any ST-elevation. You decide to put this patient on therapeutic hypothermia. You ask yourself if a coronary angiography with or without percutaneous coronary intervention could improve her chances of survival.

35 year old builder presented to A&E after having bleach spashed into eyes. Does the new solution Diphoterine offer better visual outcome compared to normal saline when used to irrigate acutely contaminated eyes?

A 79 years old man presents to the Emergency Department with acute onset of central abdominal pain and one attack of bloody diarrhoea. The pain is severe and not relieved by simple analgesia. Abdominal examination shows central abdominal tenderness but no guarding. On general examination the pulse was 110/minute irregular but other examination was unremarkable, serum amylase was also normal. The patient gave a history of hyperlipaedemia, hypertension, smoking and peripheral vascular disease. You started titrated doses of morphine to relive the pain. You suspect acute mesenteric ischaemia and wonder if any blood test can help in supporting or excluding the diagnosis.

Mrs. Jones is a 25 y/o F with reccurent shoulder dislocation who presents with anterior shoulder dislocation. After your second attempt using traction counter-traction under sedation with Propofol x-ray confirms failed reduction. You wonder should I have started with a different method.

A 6 year old boy was admitted for 60% full thickness body surface area burns. His stay in pediatric intensive care unit (PICU) was complicated with recurrent episodes of sepsis hampering the progress of enteral nutrition. The team wondered if beta-blockers can be used in this patient to reduce his hypermetabolic state.

A 29 year old male postman is referred from the acute knee clinic to physiotherapy 4 weeks following a clinically diagnosed ACL rupture. He feels his knee is regularly giving way and asks whether rehabilitation will ease and prevent his recurrent instability.

A 56 year old palliative care patient with transitional cell urothelial carcinoma presents with excruciating cancer related pain in the Emergency Department (ED). He is no longer responsive to opioids for moderate pain and now requires management of his severe cancer related pain. He has experienced constipation, nausea, vomiting and decreased cognition since being placed on morphine (70 mg/day) previously and would like to avoid significant side effects of his medication and focus on maintaining a good quality of life.

A 60-year-old female attends the emergency department complaining of floaters and visual loss affecting her right eye. You are concerned that she may have suffered a retinal detachment but are unable clinically to gain a clear view of the fundus. You wonder if ocular ultrasound would be helpful in diagnosing retinal detachment.

A 56 year old is brought to the ED suffering from a STEMI. He is hypotensive and suffering from cardiogenic shock. He has been started on dobutamine but he has failed to respond to this initial treatment. The Cardiologist asks if the ED has levosimendan as he would like this started on the patient since there is already another patient in the Cath lab. You wonder whether there is any evidence for this treatment.

A patient in your ED requires endotracheal intubation due to respiratory failure, refractory to non-invasive ventilation. The patient is preoxygenated with non-invasive ventilation on 100% oxygen prior to anaesthetic induction and until apnoea. During the intubation attempt, the oxygen saturation falls significantly. This leads you to consider if additional strategies alongside optimised preoxygenation may have provided more time before desaturation during apnoea. You decide to search and appraise the currently available literature to see if the use of the so-called apnoeic oxygenation would delay critical desaturation.