Archives: BETs

A 12-month old child is admitted into the pediatric ward requiring peripheral venous access for the administration of fluids and medications. The parents are fretful of the procedure and has refused further attempts as multiple junior medical staff have failed on previous occasions. How do you minimize the number of attempts and time required, thereby improving patient confidence and satisfaction.

A 25-year-old man presents to the ED complaining of pleuritic chest pain and shortness of breath. He is afebrile, has no other symptoms, takes no medications and has never had any surgery. You wonder whether a clinical decision rule such as the (PERC could help exclude PE without the need for D-dimer testing.

A 49 year old man with acute lumbodynia for more than 2 weeks for which he received 2 non-steroidal anti-inflammatory drug tablets daily, but with no other health relating conditions, comes to the emergency department referring meleana dejections. In the laboratory tests haematocrit is discovered to be 27%, thus a transfusion is obligatory. You wonder whether the premedicasion transfusion could prevent the appearance of any allergic or febrile non-haemolytic transfusion reactions.

A 62 year old man is brought in to hospital with a 48 hour history of breathlessness, a productive cough and fever. He is tachypnoeic and hypoxaemic with SpO2 on air of 89%. His oxygen saturations correct to 98% with high flow oxygen via a facemask. However, he is confused and uncomfortable and repeatedly removes the facemask resulting in recurrent desaturations. You wonder whether there is an effective alternative to face mask oxygen that he is more likely to tolerate.

A multidisciplinary supported discharge team (Physiotherapists, Occupational Therapist, Rehabilitation Assistants) notice an increase in referrals for patients in the early post-op phase (2-6 weeks) following CABG. The team provide short-term rehab (up to 6 weeks) to patients in their own homes. Team physiotherapists are unsure what form of intervention is most effective at improving exercise tolerance in this patient group.

You are part of a mountain rescue team that has been called to a 22 year old climber who fell from a rockface at a height of 8metres. He landed injuring his left leg. His thigh is deformed, swollen and painful and he is unable to weightbear. You suspect a femoral fracture. Are you able to splint the leg in a box leg splint or do you need to call other team members to bring up a traction splint?

An 30-year-old female is brought to your Emergency Department by ambulance with a chief complaint of drug overdose. The patient has intermittent tonic-clonic seizure activity and decreased responsiveness. In her pocket, you find several tablets later identified as party pills (or piperazine derivatives). As she is admitted to the hospital, you wonder what her prognosis will be.

You see a 12 year old girl with Graves’ hyperthyroidism in the clinic. She has relapsed on titration of her carbimazole. Hence, the Consultant changes her treatment regimen to block and replace ( combination of high dose carbimazole and thyroxine ) . You wonder whether block and replace regimen (combination of high dose anti thyroid drug with thyroxine replacement ) is better than dose titration regimen ( low dose anti thyroid drug ) at reducing relapses and achieving long term remission ( greater than 2 years ).

A 19 year old male who has been using crack cocaine for the past few days presents to the emergency room with chest pain and a wide complex tachycardia. He is quite agitated, hypertensive and uncooperative. You know that benzodiazepines are the recommended drugs for cocaine overdose, but what is the best medical treatment for cocaine induced arrhythmias.

A 26 year old man attends the emergency department with a first-time headache of moderate to severe intensity, with no clinical course of vomiting. It is however of a sudden onset. Neurological examination was unremarkable. He has no history of trauma and has no relevant previous medical history. You wonder if it would be safe to rule out sub-arachnoid hemorrhage without an emergent CT scan.

A 52-year-old woman presents to your emergency department with a severe gastroenteritis. She is moderately dehydrated and is nauseated. While you prescribe intravenous rehydration and metoclopramide as antiemetic medication, one of your colleagues comes in and suggests that you add prophylactic diphenhydramine to prevent metoclopramide-induced akathisia. You wonder if this should be done routinely and perform a thorough search of the literature.

A 1-year-old child presents to the emergency department in cardiac arrest. His mother does not speak English; through an interpreter, you learn she gave an unknown cold medication, but she is not sure if she gave the correct amount because she did not understand the English instructions. You wonder whether the cause of the cardiac arrest is more likely to be the underlying condition or over the counter medication.

A 41-year-old woman with a history of intravenous drug abuse and hepatitis C is brought to the emergency department with altered mental status. She is somnolent but opens her eyes to loud verbal stimuli and localises pain. She is breathing spontaneously with good effort. She has evidence of track marks along her upper extremities. The nursing staff are having difficulty obtaining intravenous access. The respiratory technician happens to be walking by the room and asks you if there is anything he can do to help—he has heard of patients having nebulised naloxone when in this state. You wonder if he is right.

A 3 month old term male infant of Somali background presented with a history of recurrent left axillary abscess, 1.5 cm in diameter, following BCG vaccination at birth. Swelling of the left axillae was noted at age 1 month along with keloid scarring of the injection site and this was diagnosed as BCG lymphadenitis at 2 months of age, supported by ultrasound scanning. The patient remained afebrile and otherwise fit and well, and there was no family history of Tuberculosis (TB) infection or recent travel and both parents had received the BCG immunisation. At 3 months of age the patient was admitted via the emergency department due to worsening of symptoms; this resulted in incision and drainage of the abscess alongside a short course of oral Co-Amoxiclav. Histopathology showed acid fast bacilli, though swab cultures were negative on Ziehl Nielson staining. A fortnight later the patient re-presented with increased exudate and erythema of the surgical site, alongside presumed viral gastroenteritis. He received a further short course of intravenous Co-Amoxiclav and was discharged with advice on conservative management.