A 35 year old male patient attends the emergency department with acute onset pain in left flank that is constant and radiating anteriorly. You speak to the radiologist to request a non-contrast CT scan to identify the cause of his pain, but the request is declined on grounds that the radiation dose is high and not justified and other imaging is advised. You wonder whether the dose reduction is possible and propose a bet to methodically examine the literature.
Archives: BETs
You receive an emergency call to a 75 year old male in a nursing home who is terminally ill. On examination you find the patient is peri-arrest with an irregular pulse and hypotensive at 57/35 and the nursing home staff state that the patient has a DNAR order but they are unable to produce the relevant documentation. You commence oxygen therapy, gain iv access and start fluid resuscitation before rapidly transporting to hospital. Afterwards you wonder what you would have done had the patient gone into cardiac arrest in the absence of a written Advance Directive.
Mr. Roberts is a 70 year old male that presents to the ED from a nursing home after feeling short of breath and unwell. A note from the nursing home states that Mr. Roberts has been quite fatigued and abnormal with his interactions with the nursing staff. Lab investigations reveals a urinary tract infection and CXR reveals a possible pneumonia. Talking to Mr. Roberts, he is unable to answer basic orientation related questions and appears quite withdrawn. There is no history of Dementia on his medical record, however you suspect a possible cognitive impairment. You wonder which clinical screening tool would be most sensitive, accurate and convenient to use on Mr. Roberts before attending to the many other patients in the waiting room.
Is abdominal pain when asked to hop suggestive of appendicitis in children?
A 9 year old presents to the ED with acute abdominal pain; is pain on hopping/jumping indicative of appendicitis?
A 47-year-old man attends the emergency department with a 12-h history of palpitations and slight chest tightness. On examination he is found to be in atrial fibrillation with fast ventricular response. He is haemodynamically stable. You decide to cardiovert the patient as he is symptomatic. After successful cardioversion he is feeling well and remains stable. His cardiac markers and electrolytes are also normal. You wonder whether he can go home immediately or if he needs to stay in hospital for a further period of observation.
Working on Trauma orthopaedics you routinely use cryocuff to reduce swelling before operations. A nurse asks you how to use the cryocuff and if keeping it on longer than 20 minutes would be more effective in reducing swelling. Your unsure of this and therefore decide to check the evidence.
Acupuncture vs Corticosteroid injection for recent frozen shoulder patients
A 55 year old female patient presents to with a 7 week history of a gradual onset of pain and a range of movement limited in a capsular pattern confirming adhesive capsulitis. Her pain is limiting your treatment options to restore movement. You are unsure if a course of acupuncture or a corticosteroid injection may help to decrease her pain and assist with restoring her range of movement. You wonder if there is any evidence to help you choose.
A 4 year old child is brought to the Emergency Department by her parents. She presents with protracted seizures. It proves difficult to gain intravenous access for administration of IV Lorazepam, which is the standard of care. You wonder whether intranasal administration of Lorazepam may be an acceptable alternative.
When should we do coagulation testing in paediatric patients with spontaneous epistaxis?
A four year old girl is brought to the Paediatric Emergency Department by her family with her second episode of spontaneous epistaxis in a month. The bleeding resolves within 30 minutes and she is otherwise fit and well. Her parents are requesting blood tests to look for an underlying cause but you are uncertain as to whether this is justified.
A 3-week-old baby presents with cough and episodes of apnoea. Nasopharyngeal aspirate is negative for common respiratory viruses. You consider the diagnosis of pertussis and take a full blood count to assess the lymphocyte count. You wonder what the sensitivity and specificity of the lymphocyte count is for pertussis in infants.
The Pedi-Cap device (Covidien, Mansfield, Massachusetts, USA) is frequently used in neonatal resuscitation to check the position of the endotracheal (ET) tube in term and preterm neonates. As a paediatric trainee having worked in various regions of the UK you note a huge variability in this practice. Clinical assessment of chest expansion and air entry, with improvement in saturations, colour and heart rate have been used for decades and work well. Is the Pedi-Cap superior to clinical assessment for checking the position of the ET tube?
A premature infant (30 weeks) weighing 1050g was recently admitted to the neonatal intensive care unit after an uncomplicated delivery. You have spoken to the mother regarding the benefits of expressed breast milk (EBM) compared to premature formula milk, including the decreased risk of necrotising enterocolitis (NEC), and this is being administered via a nasogastric tube. At the ward round the consultant suggests the addition of EBM fortifier to ensure the baby has an adequate intake of macronutrients and micronutrients and to maximise extra-uterine growth. You wonder if the addition of a cow's milk-based fortifier to EBM will confer an increased risk of NEC and decide to find out more.
What is the efficacy of duct tape as a treatment for verruca vulgaris?
An 8-year-old girl attends a general paediatric outpatient clinic for medical review and it is noted that she has duct tape on her finger. When asked about it, her mother states that duct tape was recommended by a dermatologist for the treatment of verrucas on the girl's fingers and toes. You wonder what the evidence base is for this treatment.
What is the incidence of biotin deficiency in preschool children with global developmental delay?
A 3-year-old girl presents in clinic with mild to moderate general delay in all areas. There is no other relevant history, no family history and clinical examination is normal. The paediatric registrar decides to order some investigations, including the biotinidase activity level, to identify the possible aetiology of the global developmental delay (GDD).
You are a community paediatric registrar carrying out an outreach community clinic. You see a 12-year-old child who has difficulty settling down to sleep. You give his mother the usual sleep hygiene advice and discuss the importance of a good routine including having a period of ‘quiet time before lights out’. He currently plays computer games in his room before turning off the light. As part of your discussion you suggest that he stops playing computer games before bed. His mother, who is a staff nurse, asks what evidence there is to support this advice. You decide to examine the evidence.
Platelet Transfusion in Patients with Traumatic Intracranial Hemorrhage on Antiplatelet Therapy
An unconscious 67-year-old male involved in a motor vehicle accident is brought to the emergency departmentby paramedics. The head CT shows a frontal contusion. The patient is on Clopidogrel. You wonder if the antiplatelet therapy reversal with platelet transfusion would improve patient’s survival.