Archives: BETs

An 18 year girl went hiking for the first time. Unfortunately she had to interrupt the trip because she suffered from several friction blisters on her feet. When arriving at the emergency department with an infected blister, she asks you whether she could use antiperspirants in order to prevent blisters the next time.

A 23-year-old female presents to your department following a fall and is diagnosed with a Weber B ankle fracture by one of your junior colleagues. They arrange plaster immobilisation and fracture clinic follow-up for 1 week later. Before discharge they approach you and raise the question of thromboprophylaxis. The patient is a smoker and on the combined oral contraceptive pill, but otherwise has no clear risk factors for venous thromboembolism (VTE). You wonder if there is any means of predicting the patient's risk for subsequent VTE in order to help make an evidence based decision regarding thromboprophylaxis.

A 70-year-old man encountered several episodes of hypotension when standing after bending over to tie his shoes. Last time, he lost consciousness transiently. He asks you for an easy way to prevent passing out, as he lives alone. You once heard about the effect of leg crossing and you wonder if leg crossing actually prevents syncope caused by orthostatic hypotension.

Blood gas analysers are typically preset to assume a patient’s temperature is normothermic at 37 degrees centigrade. In clinical practice the temperature of the patient is infrequently taken at the time of sample or entered into the analyser. With emergency departments exposed to patients presenting with temperature extremes, you wonder whether the temperature entered into the gas analyser has a significant effect on results and subsequent clinical management.

A 72-year-old woman presents with a minor head injury (MHI). Her INR was 2, and she has no amnesia or loss of consciousness, therefore not strictly fulfilling the National Institute for Health and Care Excellence (NICE) criteria for a scan. The radiologist on call does not want to scan the patient unless her INR had been >2.5, and so the request is denied. You wonder why the radiologist had chosen an INR of 2.5 and want to find out more about relevance of the INR in the WHI patient, and specifically to question the reassurance that a therapeutic or even subtherapeutic INR could bring for the otherwise asymptomatic MHI.

A term baby girl is admitted to the neonatal unit following concerns regarding abnormal movements noted on the postnatal ward. She is reported to have had tonic posturing of the limbs and back-arching at 10 h of age. As the neonatal registrar on the night shift, you are asked to review the baby and you wonder whether cerebral function monitoring (CFM) of the baby would be an effective and accurate method of detecting seizure activity.

A premature infant (30 weeks) weighing 1050g was recently admitted to the NICU after an uncomplicated delivery. You have spoken to 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 adequate intake of macro 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.

Three-day-old twins are reported to have persistent bilious vomiting on the postnatal ward. You suspect midgut malrotation and it is suggested by a colleague that a Doppler ultrasound might be a better investigation than an upper gastrointestinal (UGI) contrast study, as it does not involve radiation and is non-invasive. You are uncertain which test is best.

Recently, Drug Safety Update (a monthly newsletter from the Medicines and Healthcare products Regulatory Agency (MHRA) and the UK Commission on Human Medicines) issued an alert on the antiepileptic drug (AED) phenytoin (PHT) regarding an increased risk of Steven–Johnson syndrome (SJS) associated with the presence of the HLA-B*1502 genetic variant in patients of Asian origin. Likewise, the US Federal Drug Agency (FDA) recommended genotyping for the allele in all Asian patients before starting carbamazepine (CBZ). We wanted to explore the implications of this for our clinical practice.

A 7-year-old boy presents to the accident and emergency department with cough, a high temperature and signs of respiratory distress. An x-ray shows pneumonia. Does this child require intravenous antibiotics, or would oral antibiotics be sufficient?

A 30 year old patient presents to her general practitioner, she has been suffering from postprandial dyspeptic symptoms after dinner regularly. You have heard that a walk after dinner offers some benefit in such cases and wonder if there is evidence to support this.

Scenario: A 6 week old boy has been investigated for failure to thrive. After further work up with sweat chloride testing he was diagnosed with cystic fibrosis. He is currently being seen at a paediatric out-patients clinic for follow up. As it is the beginning of RSV season the medical student asks the consultant whether Palivizumab prophylaxis would be beneficial.

A 28 week preterm boy required intubation after vaginal delivery. He received a dose of surfactant and was mechanically ventilated for less than 24 hours. He was subsequently weaned off continuous positive airway pressure (CPAP) support. Serial cranial ultrasounds showed a persistence of periventricular flares. The parents want to know whether this finding is significant in regards to their child’s development.

A 20 year-old female is brought into the emergency department in respiratory failure from severe asthma. Her symptoms do not respond to beta agonist, steroids, magnesium and she requires intubation. Despite intubation, paralysis and sedation she becomes increasingly hypercapnic, difficult to bag with elevated peak inspiratory pressures and poor air-exchange. You have heard of external chest compressions to improve ventilation and wonder if this will help the patient.