Archives: BETs

A 30 year old patient attends your department 2 weeks following a lateral malleolar ankle fracture. They complain of increased pain and cramping up the calf. The toes are swollen but there are no clinical signs of compartment syndrome. You are concerned about the possibility of DVT and arrange an ultrasound scan to investigate further. A junior doctor asks you what the incidence /pretest probability of venous thromboembolism is within this cohort of immobilised ambulatory patients. You tell them that is an excellent question. And that you will give them one week to find out the answer for you.

A 30 year old man is admitted to the Emergency Department with a history of an unknown drug ingestion. He is stuporous and unable to give a coherent history. His observations are abnormal and he undergoes emergency tracheal intubation to protect his airway due to a decreasing level of consciousness.

You are a neonatal Registrar and called by the nurse to review a 10 days old preterm baby born at 27weeks gestation for vomiting. Baby is otherwise well in self with normal systemic examination. Baby is receiving expressed breast milk with thickener. You planned to commence the baby on Ranitidine for suspected gastro oesophageal reflux. You wonder whether ranitidine can increase the risk of necrotising enterocolitis (NEC) in this baby.

A 30 year old male presents with 24 hours of right ankle pain, swelling and fever. You decide to perform needle aspiration of the ankle joint to diagnose a suspected septic arthritis.

An eight-year-old female patient arrives at the Emergency Department with her mother after being struck by a car while riding her bicycle. Her respirations are strained and she has an obvious deformity of the right shoulder. She is evaluated immediately by the trauma service. Possible interventions include the placement of a chest tube. Should her mother be removed from the room?

An 80 year old lady is referred to the Hospital and Community for community rehabilitation following her hospital admission. She has a diagnosis of dementia. She lives with her husband and he reports that she is struggling with activities of her daily living (ADLs). The Occupational Therapists wonder whether there is evidence that a cognitive rehabilitation programme will improve this lady's ability with her ADLs.

A 6 month-old-female is brought to the emergency department by their parents after what they describe as a fall from a bed to the floor. The child has several bruises that appear to be in various stages of healing and the parents seem very tense. I suspect non-accidental injury. How likely am I to see occult fractures on a standard skeletal survey?

A 34 year old female presents to the emergency department following an inversion injury to her ankle. An x-ray reveals a fracture, suitable for conservative management in a below-knee plaster cast. You are aware of an ongoing medico-legal case at your trust regarding a patient recently admitted with a pulmonary embolism, which was attributed to plaster cast immobilisation. You wonder if thromboembolic prophylaxis will significantly reduce the risk of subsequent VTE in your patient.

A 65 year old gentleman presents with his wife after collapsing at home. He is FAST positive with a clear onset time of 1 hour. On examination in the emergency department he has a dense right hemiplegia and expressive dysphagia. CT shows no bleed. Stroke thrombolysis is considered however the patient is unable to tell you how much he weights and his wife is unsure. The doctor and nurses looking after him think he is around 70kg. Is this an accurate enough estimation for drug dosing?

A 30 year old male gym enthusiast presents with a 3 week history of sudden onset of back pain, after lifting heavy weight, His pain radiates from the lumbar spine to the right posterior thigh lateral calf and foot and has associated mild paraesthesia. He has had treatment with Ultrasound (U/S) before for a different condition and he is asking if U/S could be useful in this case.

47year old gentleman presents to physiotherapy with a 6 month history of right heel pain, worse in the morning, particularly the first few steps. Previous conservative management failed. Physiotherapy including calf stretches, taping, activity modification and soft tissue techniques was unsuccessful. Insoles provided by podiatry were not effective. This patient has been told about shockwave therapy by a friend and would like to try it.

A patient is bought to the Emergency department with pelvic trauma. One of the members of the trauma team mentions that the new T-pod pelvic binder is better than the traditional wrapped sheet. You wander if there is any evidence to support this

A 52 year-old women presented to the emergency department with a history of sudden onset of hearing loss in her right ear, which came on over the preceding hour. She had no past medical history of note. Examination of the ear was unremarkable and Weber’s / Rinne’s tests suggested that her hearing loss was sensorineural in nature. A diagnosis of sudden onset idiopathic sensorineural hearing loss (SSHL) was made. The ENT surgeon on call was contacted and advised prescribing acyclovir. You wonder what the evidence is to support this strategy.

A 26 year-old male is brought to the Emergency Department after being struck by a car. His Glasgow coma scale on arrival is 8/15 with obvious evidence of head injury and thoracoabdominal trauma. He has a profusely bleeding scalp wound and is tachycardic. You decide to undertake a rapid sequence intubation (RSI) and begin drawing up ketamine as an induction agent. Your colleagues raise a collective eyebrow and ask you to defend your choice of agent. You offer cardiovascular stability and familiarity as two main indications. They remain concerned about the risk of raising intracranial pressure (ICP) and insist that Ketamine is contraindicated in head injured patients. They are unable to cite any evidence to support this view. You propose a BET to methodically examine the literature.

A 35 year old man has a dislocated shoulder that will need to be reduced. He will require sedation and will be monitored with standard monitoring (ECG, BP, SpO2). You wonder if addition of capnography would be beneficial for the patient?

A 23 year old man went on a skitrip in an extreme cold and windy environment. He protected his face against cold injuries by applying of a protecting emollient, but he got frostbite in the face anyway. When arriving at the emergency department, he asks you whether the use of emollients isn’t a good protection against frostbites.