Archives: BETs

A 45 year old man returns to the UK after spending 3 months working in Kenya. He complains of headache, myalgia and nausea. He is not vomiting, his observations are stable and his temperature remains below 38 degrees Celsius. Blood film confirms the presence of Plasmodium falciparum malaria parasites.

A 3-year-old boy is brought to your ED after falling top to bottom of stairs at home. Parents witnessed his landing and he did not lose consciousness. The child is distressed, and only his mother is able to have a reasonable rapport with him. Would having Clinical Decision Rule (CDR) help in clearing C-spine clinically, to avoid imaging?

A 67-year-old man known for alcoholic cirrhosis comes in with an upper GI bleed. While you order the appropriate management therapies to control the bleed, one of your colleagues comes in and suggests that you add prophylactic antibiotic coverage to prevent an infectious complication. You have not heard of such a practice and wonder if this should be done routinely in cirrhotic patients presenting with an upper GI bleed. You perform a thorough search of the available literature.

You are confronted with a patient who has been in a house fire. They are unconscious, hypotensive, and have sooty deposits around their mouth. You recognise that an elevated blood lactate of 12mmol/l makes cyanide poisoning as an important consideration. You wonder whether the administration of an antidote (hydroxocobalamin) could reduce mortality or improve clinical outcome.

A 40-year-old patient attends the emergency department having fallen down some five stairs. During evaluation, he reports pain over his left chest and tenderness is found on palpating of his ribs in this area. You consider sending him for a chest x-ray to diagnose fractured ribs but are advised against this by a senior colleague who says it is insensitive. You wonder if ultrasound is more sensitive than x-ray in detecting rib fractures.

You are leading the team resuscitation of a cyclist who was hit by a car. From the injury pattern you suspect she may have an open book pelvic fracture, and decide to apply a pelvic binder. One of your colleagues suggests there is no point unless the injury is shown on x-ray, and another thinks they are entirely pointless. You get the binder applied, but resolve to check the evidence before next time.

A six year old boy with an asystolic cardiac arrest is successfully resuscitated in the A&E department, but he remains comatose and on a ventilator. The paediatric retrieval team is on its way. The anaesthetic consultant asks you whether, as is the case in adult medicine, induced hypothermia should be initiated.

A 27-year-old female presents to the emergency department with shortness of breath. She is 26 weeks pregnant. The lower limbs Doppler ultrasound is negative. You must perform another diagnostic test to eliminate a pulmonary embolism. You wonder which test is the most appropriate for this patient: a Computed-Tomographic pulmonary angiography or a ventilation-perfusion scintigraphy.

79 year old patient with Parkinson’s disease and a history of falls. You wonder if an exercise programme would reduce the rate and risk of falls.