Archives: BETs
The use of intrathecal analgesia in video assisted thorascopic surgery (VATS).
A patient has undergone a video assisted thorascopic surgical procedure and is returned to the cardiac HDU unit. Following surgery the patient requires analgesia and there is the potential for IV or spinal/intrathecal delivery of the analgesia.
A patient requires a thoracotomy for resection of a lobe of their lung is worried about pain relief post-operatively. You wonder whether it might be pertinent to provide them with an spinal block rather than prescribe IV analgesia for the immediate post-operative period.
The best treatment for partial transection of the thoracic aorta.
An adult patient arrives in the emergency department via ambulance and is unconscious and hypotensive following a car accident in which the patient was wearing a seat-belt. CT with contrast shows a transcection of their thoracic aorta which needs intervention.
Do patients with an asymptomatic sub-segmental pulmonary embolism need anticoagulation therapy?
A 49 year old male, who was previously fit and well, attended the Emergency Department as a trauma patient after being involved in a road traffic collision. He underwent whole-body computed tomography (CT) scanning and was found to have an incidental, sub-segmental pulmonary embolism (PE). You wonder whether this finding warrants anti-coagulation treatment as is protocol for larger, symptomatic pulmonary emboli, or whether the patient would have a similar outcome if they were to be discharged without treatment.
A 14-year-old boy sustains a brain injury and is admitted with a Glasgow Coma Scale score of 3/15. Imaging reveals evidence of diffuse injury. Approximately 12 months later, the patient is seen for a planned review in an outpatient clinic. Full reintegration into school has occurred and clear cognitive and physical improvements are evident. Despite this, the patient and his family explain that unprovoked episodes of agitation, aggression and emotional lability occur. These have not lessened in frequency and represent a clear departure from the patient's preinjury behaviour. Parental and school management of this concerning conduct is structured and consistent. You have heard that carbamazepine (CBZ) may be of value in managing post-injury agitation and aggression.
You are a Paediatric SpR in a busy DGH and a previously well 6yr old girl is brought into Paediatric resus by ambulance with blood sugar of 32 and a significant acidosis. You make a diagnosis of DKA and commence treatment in accordance with your local Paediatric DKA guideline. However, you notice that the rate of insulin infusion it instructs you to use is 0.1units/kg/hour, which is double that suggested by the South Thames Retrieval Service guideline(1) you had used in your previous hospital. You wonder what the evidence is for the possible benefits of using a lower rate and which is the more appropriate rate to use.
A 2.5 year old boy has presented 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 decided to order some investigations for identifying the possible aetiology of the global developmental delay including the biotinidase activity level. His consultant asked him to justify the test for biotinidase deficiency based on the prevalence of biotinidase deficiency in the population of pre-school children with developmental delay and the possible efficacy of treatment.
Safety of Radiation for Brain tumors in pre-existing Alzheimer’s disease.
It is rare for Alzheimer’s disease patient to present with brain tumor. You are working in a Radiation Oncology Clinic when the nurse informs you that a patient with CNS Lymphoma and Alzheimer’s disease has arrived. You wonder the safety of cranial irradiation in an Alzheimer’s disease patient and the management of this clinical challenge.
It is not uncommon for non-insulin dependent diabetes mellitus patients having the co-morbidity of cardiovascular disease. You are working in a busy Intensive Care Unit when the nurse informs you that a congestive cardiac failure patient with Hyperosmolar non-ketotic diabetes mellitus has just arrived. You wonder the management, as treatment of one condition is contraindication for the other. Cardiovascular disease complicating Hyperosmolar Nonketotic diabetes mellitus is not a rare phenomenon and lethal if not treated properly. Both diseases are treatable individually. Treatment of one condition being the contraindication to the other, clinical judgment on management is difficult, when one complicates the other.