The local ambulance service bring in a 22 year old male who was witnessed by shoppers to have a seizure in the town centre, but there are no longer any eye-witnesses available to give a collateral history. You wonder whether a prolactin level will help you to differentiate between an epileptic seizure and a pseudoseizure.
Archives: BETs
How soon after the onset of symptoms is point of care cardiac triple markers reliable?
A fifty year male attends Emergency Department (ED) with cardiac sounding chest pain 2 hours ago and the pain lasted for 30 minutes. Now he is pain free and there is no history of previous IHD. He is ex smoker but has no other risk factors for IHD. His ECG is completely normal. You wonder if Point of Care (POC) triple markers can be requested 2-3 hours after the onset of pain in such cases and ACS can be realibly ruled out to allow safe discharge from ED.
A nine year old child is brought to the emergency department with a tender, red swelling on her eyelid. You diagnose hordeolum (stye) and recommend treatment with warm compresses four times a day. A colleague later challenges your advice and asks what evidence there is for it.
Is ultrasound done by emergency physician,a usefull tool in screening for ectopic pregnancy?
on friday night in a busy ED, a 22 year old single female law student presents with lower abdominal discomfort and per vaginal spotting for 12 hours. She is primigravida, with unplanned pregnancy which happened while she was on oral contraceptive pills. She does not have any other significant medical history. She is afebrile. Pulse of 75/min, B.P is 126/79 with postural drop of 15mm(Hg). Abdominal examination is completely normal. Urine dip shows positive B HCG and blood test are completely normal. The timeliest appointment in early pregnancy unit is not available till Monday. You are concerned about sending this patient home. You have an ultrasound machine available in department. Can this ultrasound be used as a screening tool to risk-stratify this patient with any degree of certainty during first consultation in ED? What does the evidence say?
Is montelukast useful in the management of acute bronchiolitis?
It is mid-winter and a 4 month old boy has been admitted to the last bed in our acute admissions ward. He has typical signs and symptoms of moderate bronchiolitis and you wonder if there is a role for oral montelukast in his management.
The management of the acute traumatic subungual haematoma with an intact nail
A sixteen year old patient presents to the emergency department following a crush injury, with an acute traumatic subungual haematoma of the finger. The nail margin and nail are intact. There is an undisplaced fracture of the distal phalanx present.
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.
In children with simple finger lacerations does LAT gel provide safe local anaesthesia?
You’ve just seen a 6yr old little girl with a gaping laceration to the palmar aspect of her index finger. You feel it requires sutures but are unsure if LAT gel is safe to use in digits.
Congenital Nevocellular Naevi – Do we need to screen with neuroimaging?
A 3 day old neonate female was seen by the neonatologist and noted to have a large congenital melanocytic/nevocellular naevus. The neonate had no focal neurology and was otherwise well in herself following a normal vaginal delivery. There was no family history of note.
A 47-year-old woman self-presents to the emergency department complaining of a sudden-onset headache associated with vomiting, which had developed suddenly. Her only medical history is migraine with aura diagnosed and treated by a neurology clinic; but this felt different. Triage notes show that she is apyrexial and routine observations are within normal parameters (GCS E4 V5 M6). No neurological signs are present but she appears incredibly uncomfortable, in the absence of true photophobia. A CT scan is done and no abnormality is identified. The patient feels reassured and is keen to get home, where her husband would be able to keep an eye on her. This seems reasonable. However, you wonder whether or not there is evidence for any circumstances where not progressing to lumbar puncture +/- admission would be supported, despite the current consensus opinion that it is required for the added confidence when combined with CT, in excluding sub-arachnoid haemorrhage (SAH). Your thought is based on the fact that in your experience LP procedures on non-ambulance arrivals have not yielded positive results.
A child presents that requires rapid IO access after failed IV access. The paramedics want to use their bone gun to achieve access but the department only has the EZ-IO. You want to know which is most likely to achieve a successful and quick result.
A 38 year old man was brought to our Emergency Department (ED), one and a half hours following flame burns to his forearms while working in woods. He hadn't had first aid cooling. Partial thickness burns were diagnosed. I wondered whether delayed application of first aid cooling, as part of his treatment in ED, would improve his wound healing.
Management of adult patients with Icatibant in hereditary angioedema.
An 18-year-old woman self-presents to the emergency department with a 12 h history of light headedness, nausea and vomiting, severe abdominal pain, tachycardia and hypotension. She has had previous similar episodes of abdominal pain associated with swellings of her hands and feet which have become more frequent of late. There is no urticaria or pruritus. She is on oral contraception medication started 4 months ago. She mentions her father has had similar episodes. As you secure intravenous access, you wonder if there is any value in administering a bradykinin receptor antagonist you've heard a lot about.
A 50 yrs old man presents to the emergency department with central crushing chest pain, sweating and pain radiating to the left shoulder. ECG shows ST elevation in anterior leads. Your hospital is on take for PCI. You have referred him to the cardiology registrar informing that you have initiated the treatment with Aspirin, Clopidogrel and Fragmin. He tells you that he is taking this patient to the angiography suite in the next hour. He enquires if the department has Prasugrel, a new drug and tells you that Prasugrel is better than Clopidogrel for PCI with stent insertion. You wonder what this drug is and how this fares in comparison with Clopidogrel.