Archives: BETs

You are assessing a wound on the forearm of a 4 year old boy who fell whilst playing football. There does not appear to be any deeper structure involvement but you feel the wound is likely to require suturing. Your department does not currently perform paediatric sedation and therefore the vast majority of young children presenting with wounds requiring suturing are referred to specialty teams for general anaesthetic for wound closure. You have worked in a department where topical anaesthetic is applied to wounds in children to facilitate closure and wonder whether the use of this in your department would reduce the number of children referred for closure under general anaesthetic.

A seventeen-month-old boy attends the Emergency Department with his mother following a head injury after tripping over at home. He has an obvious large and "boggy" scalp haematoma. He appears very well and has no clinical signs to suggest intracranial injury. You are unsure if a CT scan is needed and would like to know how much emphasis you should put on this one clinical sign.

You are at the scene of a car crash with a medical team. The driver is showing signs of hypovolaemic shock, and the limited access and poor light make vascular access difficult. You elect to insert an intraosseous needle, but while preparing the proximal tibial site a paramedic suggests that using the humerus will allow for faster fluid infusion. You wonder if there is any evidence for this?

A 72 year old man with a history of hypertension presents to the emergency department with acute onset of sharp chest pain. There are no acute ischemic ECG changes. Thoracic aortic dissection is certainly one of many diagnoses in the differential. You wonder if there is a clinical risk score than can be calculated to categorize the risk of having an aortic dissection.

13 years old boy attends clinic with uncontrolled epilepsy-Idiopathic generalized epilepsy- on lamotrigine having failed to respond to sodium valproate in adequate dosages. Prior to onset of epilepsy from primary school he had sustained elements of hyperactivity and impulsivity which on observations and connors questionares were thought to be ADHD. These have escalated and now need treatment with stimulants in their own right. Question is whether stimulants are safe in the presence of especially uncontrolled epilepsy.

A 65 year old male presents having returned from a two week holiday. Whilst on holiday he experienced a tearing pain between his shoulder blades, which has been slow to resolve. Examination reveals no abnormal findings. However, his blood pressure in both arms is measured at 135/80. An x-ray reveals a slightly enlarged mediastinal shadow; a CT aorta is performed which confirms the diagnosis of an uncomplicated type B aortic dissection.

A 43 years old man presents to the emergency department with a moderate cellulitis with lymphangitis of the forearm following a trivial skin trauma in the previous days. The patient is not known for any health problem nor does he have any risk factor for CA-MRSA. You wonder if daily intravenous cefazolin following oral probenecid is as effective as two or three times a day intravenous cefazolin treatment.

A 43 years old man presents to the emergency department with a moderate cellulitis with lymphangitis of the forearm following a trivial skin trauma in the previous days. The patient is not known for any health problem nor does he have any risk factor for CA-MRSA. You wonder if daily intravenous cefazolin following oral probenecid is as effective as two or three times a day intravenous cefazolin treatment.

A 25-year-old healthy man presented to a semi-urban trauma unit with a minor head injury (MHI). After thorough assessment and following UK National Institute for Health and Clinical Excellence (NICE) guidelines, you ascertain that the patient does not require CT brain scan and can be safely discharged home. A neurosurgical colleague, having recently returned from a European conference, had adopted protein S100B sampling as a neuroimaging triage tool for the department. He suggests this is a more accurate measurement of the extent of brain injury. On following his departmental policy serum S100B sampling yielded a positive result, but subsequent neuroimaging reveals no intracranial pathology. You wonder what the clinical utility of protein S100B actually is in MHI and also whether integration of this blood test within clinical guidelines might provide improved, more cost-effective care?

A 56-year-old female presents to the emergency department complaining of intermittent nausea, she is now also experiencing angina, dyspnea, and diaphoresis. EKG shows signs concerning for myocardial ischemia. Interventional cardiology prepares to take the patient to the cardiac suite for coronary angiography.

A 37-year-old woman presents at the emergency department with a left-sided headache. She has a past history positive for migraines and she describes the current episode as identical to her migraines. Your resident wants to prescribe prochlorperazine to treat her migraine, but you usually prescribe metoclopramide for patients with acute migraine. You wonder which of these dopamine antagonists is better for the treatment of a patient with acute migraine.

A patient is bought to the Emergency department with pelvic trauma. One of the members of the trauma team mentions that the new T-pod pelvic binder is better than the traditional wrapped sheet. You wonder if there is any evidence to support this

A patient is brought to the Emergency Department with pelvic trauma. One of the members of the trauma team mentions that the new T-POD pelvic binder is better at controlling internal haemorrhage than the traditional wrapped sheet. You wonder if there is any evidence to support this?

A 34 years old female presents to your emergency department with acute migraine refractory to acetaminophen, NSAID and triptans. Your colleague talk to you about the use of propofol in migraine and you wonder if propofol would improve the chance of a complete resolution of her headache.