Archives: BETs

A 60 year old male, brought in by ambulance crew,with the complaint of sudden onset severe right flank pain. He is also known to have cardiac problems and is on several medications. On examination his systolic blood pressure is 100 mm of Hg and the pulse rate of 65 per minute. The immediate concern is a ruptured AAA. Can ultrasonography by emergency physicians detect accurately the presence or absence of an abdominal aortic aneurysm,AAA and affect the immediate management strategy in this patient?

A 39 year old man presents to A&E with a loin pain that is diagnosed as renal colic on clinical grounds. In particular the consultant suspects an obstructive uropathy. However, you wonder if non-obstructing renal stones can cause similar pain to obstructive uropathy.

A 43 year old gentleman presents to A&E with left loin pain, which radiates to his left testicle. The doctor on call immediately suspects renal stones due to this “classic” presentation, however you wonder how sensitive this symptom really is.

A 45 year old man presents with acute renal colic, with no signs of infection or renal failure. You consider discharging the patient with analgesia and an out-patient urology appointment but remain concerned about the safety of this approach.

A 35 year old male presents to the emergency department with loin pain. The consultant emergency physician performs an ultrasound (US) scan and confirms diagnosis of renal calculi. The FY1 wonders if emergency physicians are competent at performing US scans.

After working on the A&E department for 4 months, you are presented with your umpteenth patient with renal colic. You notice that this is the third patient in a row who has presented in the morning and consider if there is a link between the Circadian rhythm and renal stones.

A 42 year old gentleman presents to the ED with loin pain radiating to the groin. Investigations confirm the diagnosis of a small renal stone. You wonder if, instead of invasive therapy or medical expulsion, the stone can simply be “washed out” with fluid and diuretics.

A 51 year old presents to A&E with loin pain and macroscopic haematuria and a diagnosis of renal calculi is made. The patient’s pain is adequately controlled and the decision is discharge with Medical Expulsive Therapy (MET) – but you don’t know whether to prescribe alpha-adrenergic antagonists or calcium channel blockers.

A 42-year-old female with a diagnosis of fibromyalgia is assessed by a physiotherapist in an out-patient department. The patient is presenting with widespread pain, which is impairing her function. You wonder whether acupuncture is an effective treatment to use with your patient to decrease pain.

A 44 year old man presents to the emergency department with severe epigastric pain. With a working diagnosis of acute pancreatitis, the result of serum amylase were inconclusive. As urinary trypsinogen have been recommended as an adjunct in supporting the diagnosis of pancreatitis, you wonder if it would be worthwhile performing a urine dipstick for this purpose.

A 50 year old gentleman has just been admitted to the emergency department with a working diagnosis of severe acute pancreatitis. Fluid resuscitation was given to replace losses but you do not understand the rational behind giving oxygen and wonders if there are any evidences to support the reason behind oxygen supplementation.

Following the diagnosis of acute pancreatitis, a 50 year old man awaits treatment in the emergency department. With advantages of being simple to perform with only 5 parameters to consider and a quick prediction at 24 hours following admission, you are unsure if BISAP score is accurate in predicting clinical severity in acute pancreatitis when compared with the more established Ranson's/modified Glasgow score.

A 50 year old gentleman has just been admitted to the emergency department with a working diagnosis of severe acute pancreatitis. According to recommended guidelines, it has been advised to withhold oral dietary intake and you wonder why this is so.

Following the diagnosis of acute pancreatitis, a 50 year old man awaits treatment in the emergency department. As the right course of action is determined by severity, it is uncertain whether if Matrix Metalloproteinase/Metallopeptidase-9 (MMP-9) can be used to assess the degree of severity in the early stages acute pancreatitis.

Your Trust launches an updated Acute Pain Policy which states that IV morphine should be given by a Doctor as a 2mg bolus at 5 minute intervals. Your ED has been using 1-10mg titrated for over 10 years without significant incident but the Trust Risk Management Committee require evidence that what you do is safe and effective. You wonder what the evidence is for your pratice.

An 85 year old female patient presented to emergency department with a hip fracture. She has been on bisphosphonates for the past few months. You know that with recent fractures bisphosphonates should be stopped so as not to disturb bone healing but you wonder how soon the patient should restart them.