Archives: BETs

A 48-year-old male with a history of type 2 diabetes presents to the emergency department with left knee pain. On examination, his left knee is erythematous with an effusion and tender to palpation. He is very painful with both passive and active range of motion. You would like to rule out a septic joint in the most reliable and least invasive way, and consider which laboratory tests to order.

A 19-year-old male presents to your ED after a generalised tonic-clonic seizure. He has never had a seizure before and is otherwise fit and well. You conduct a full neurological examination and request several bedside investigations. You wonder whether you should also request a CT head scan. More broadly, you wonder whether your department should be scanning all patients who present with a first seizure.

A 25-year-old athlete suffers a first-time anterior shoulder dislocation. After reduction in the emergency department, you wonder whether immobilizing the shoulder in external rotation instead of internal rotation could better prevent recurrent dislocations.

A 45-year-old male with a past medical history of prior open appendectomy, presents to the Emergency Department (ED) with a chief complaint of abdominal pain with associated nausea, vomiting and inability to pass flatulence. Imaging of the abdomen demonstrates loops of bowel with a transition point, consistent with small bowel obstruction (SBO). The patient refuses insertion of the nasogastric tube (NGT).

A 72-year-old woman presents to the emergency department (ED) with hip pain after a fall from standing. She is unable to weight bear. You notice extensive bruising around her left hip and an X-ray confirms a neck of femur fracture. You wonder if giving tranexamic acid (TXA) in the ED would improve her outcome when she later undergoes surgery.

A two-year-old healthy male presents to the emergency department with his parents after a witnessed fall from a chair. Parents say he was initially irritable but mostly himself. An age-appropriate neurologic exam is reassuring but you notice he has a temporal hematoma. You are deciding whether to complete a head computed tomography (CT) in this child to rule out skull fracture and traumatic brain injury by reviewing decision making algorithms, such as the Pediatric Emergency Care Applied Research Network (PECARN) head injury algorithm. CT is unavailable at your hospital at this hour and the patient would need to be transported to a different center. While trying to decide, you wonder how sensitive and specific point of care ultrasound (POCUS) is in detecting skull fractures in children

A 46-year-old female patient presents to the emergency department with a warm to touch, painful, and erythematous rash on their right leg. No previous methicillin-resistant staphylococcus aureus colonization documented in the past. You are considering which outpatient oral antibiotic strategy would be most appropriate for this patient for suspected cellulitis.

A 65 year old man who has a history of AF on apixaban presents to the emergency department with a minor head injury (GCS 15, no loss of consciousness, no neurological deficits) after a trip and fall on the street. He does not have a headache, did not vomit, there were no haematoma or laceration wounds on his head. Does he need to be admitted for 24 hours neuro-observation?

A 35-year-old man was sent to the emergency department after being hit by an electric car. He complained of right chest pain, no tenderness in the ribs and normal chest X-ray, but the patient still unwell consider sending him for a chest CT but your colleague told you that you could first scan the chest ultrasound for diagnose occult pneumothorax. You want to know whether patients with negative chest X-ray can diagnose the presence of occult pneumothorax by ultrasound.

A 5 year old boy is brought into the Emergency Department by his mother. He complains ofconstipation. You consider ordering an AXR to rule out intra-abdominal pathology and guide management.

A 60-year-old male with noncontributory past medical history presents with two weeks of productive cough. His initial course of illness included additional upper respiratory tract infection symptoms, all of which improved within the first five days apart from the cough. He has an albuterol inhaler and Tessalon Perles available at home though has not perceived any significant benefit from these therapies. The patient has stable vitals, unremarkable exam apart from frequent productive cough, unremarkable basic labs (COVID negative), and chest x-ray negative for consolidation. He is diagnosed with uncomplicated acute bronchitis. He is frustrated with the frequent coughing and asks if there are any other available therapies. Oral steroids are considered.