Archives: BETs

There are 65-80 lower limb amputations in our trust annually. It is considered good practice that amputees remain in a wheelchair until fitted with prosthesis. However, this practice has little evidence base. A wheelchair poses problems for accessing all areas of property. May be easier if patient could hop a few steps. Recurring patient question from unilateral amputees; can I have crutches or a zimmer frame and hop around my home?

A three year old boy presents to his local district general hospital with a one day history of fever and shortness of breath. He is admitted to the paediatric ward for on-going observation and management. The nursing staff calculate a paediatric early warning score, based on physiological parameters, with each set of nursing observations. The student nurse on the ward notices that your chart is different to the one used by the paediatric ward on her last placement. She asks you how accurately paediatric early warning systems predict serious clinical deterioration, particularly cardiopulmonary arrest, paediatric intensive care admission or paediatric high dependency care admission.

A 75-year-old man with a known history of chronic obstructive pulmonary disease and type 2 respiratory failure presents to the emergency department with a 2 day history of productive cough and shortness of breath. There are no signs of cardiovascular shock. He refuses radial arterial blood gas sampling due to pain and discomfort from previous attempts and asks whether an alternative site for sampling can be used. You ask a colleague who recommends the brachial artery—a vessel you have avoided in the past having been told that distal ischaemia can result. You wonder whether your worries are evidence based.

The aim of the bet was to establish whether Graded Motor Imagery was a useful tool in managing Phantom Limb Pain in amputees. In addition, to established and moderately successful modalities such as medication, hypnosis and accupuncture.

In the physiotherapy department you see two 50-year-old female patients who have both sustained ankle fractures 12 weeks ago and are mobilising with crutches. One has been conservatively managed and the other has had an open reduction–internal fixation. You wonder whether hydrotherapy would be a viable treatment option for either patient. A literature search is required in order to ascertain whether hydrotherapy is an appropriate intervention for either patient.

A 23 year old male is brought in to your emergency department after ingesting a handful of pills in an attempt to kill himself. His friends bring in an empty bottle of the only medication he took, the benzodiazepines he takes for intermittent anxiety. You wonder what symptoms he exhibits puts him at a high risk for complications from his ingestion.

A 22 year old male had a right elbow ORIF following a fall on an outstretched hand whilst skateboarding. There were no complications with his surgery, however he has significant restriction in active range of movement at the elbow on initial assessment. tYou are aware of the possible complications of heterotopic ossification, so you refer back to previous research conducted in 2007 that highlighted no available relevant evidence to support the development of this complication. You wonder if there are any recent developments in the literature to a support this notion.

A 2-year-old child is acutely admitted at night to a district general hospital following a prolonged focal seizure. A CT scan of the head without sedation fails as the child is too active and distressed, and as the on-call paediatric registrar, you are requested by the radiographer to prescribe a sedative. The NICE guideline for sedation in children and young people advises that midazolam or chloral hydrate can be used to sedate for painless procedures. You wonder which of these drugs is the most effective and safe and which has the least side effects.

You are working a shift in an Emergency Department (ED), and you receive a call from prehospital providers requesting advice in management of a violent and incoherent patient with strength far in excess of expected for his size. This seems consistent with reports you have read of Excited Delirium Syndrome (EXDS). You recall reports of sudden death in these patients and wonder if you can prevent this.

You are a paediatric registrar carrying out your shift in paediatric Accident and Emergency. You see a 12 year old girl presenting with an acute onset of right sided stroke. She was admitted to the Children’s ward and on further investigation she was found to have an ischemic stroke involving the left middle cerebral artery territory. Her cardiac evaluation was normal. The Paediatric Neurologist advised commencing her on Aspirin. The family are anxious about the efficacy and safety of Aspirin. You have heard that Aspirin has been proven to be beneficial in strokes in adults with arterial ischemic infarcts. However, you are not sure if there is enough evidence to justify its use in paediatric age group. You decide to find out the evidence

A 74 year old male patient with known COPD presents acutely breathless with widespread wheeze. He refuses an arterial blood gas (ABG) and complains that last time he was here it took a long time to get the sample and it was very painful. You have already obtained a venous blood gas which has a PaCO2 of 5.5kPa. You wonder if this is sufficient to rule out arterial hypercarbia, and therefore, is an ABG in this patient an unnecessary test?

A young adult was paddling on a sandy shoreline during their summer holiday; they think they may have been stung by something in the water. They are showing local signs of envenomation including erythema and swelling. Ambulance crews have given no treatment as they were unclear as to what action to take. You wonder if warm water immersion will be an effective therapy for reducing the symptoms.

Avoiding emergency hospital admissions is an important subject, and this audit aims to seek whether patients were triaged appropriately, according to established guidelines, for admission on the Medical Assessment Unit (MAU). The importance of doctors making a correct diagnosis will also be analysed, therefore seeing whether the decision making process by doctors have an impact on avoidable admissions.

A 34-year-old woman is discovered hanging from a noose around her neck. When a family member discovers her, she is in respiratory arrest and comatose. The paramedics provide artificial ventilation. After several minutes, the patient\'s breathing returns but she remains unconscious. On arrival at the emergency department, she is haemodynamically stable, normothermic and unresponsive. You are aware of the evidence for therapeutic hypothermia following return of spontaneous circulation for a cardiac arrest associated with a shockable rhythm. Given the potential neuroprotective effect of therapeutic hypothermia, you wonder whether a superior neurological outcome can also be obtained in comatose patients following asphyxia.