Archives: BETs

A 5-year-old female presents to the emergency department after a fall from playground equipment. Parents are concerned about significant head injury. You perform history and physical exam and would like to use a pediatric head injury algorithm to help guide your need for advanced imaging and you hope to avoid unneeded imaging. You wonder how accurate your exam is for pediatric skull fracture.

A 34-year-old female comes to the emergency department due to acute episodes of dizziness. The history and physical exam are most consistent with diagnosis of posterior canal benign paroxysmal positional vertigo (BPPV). You wonder what is the most effective treatment at resolving her symptoms.

A 25 y/o male has sustained a femur fracture and is attended by Paramedics. I know IV Morphine will reduce pain and distress to facilitate the application of a Kendrick Traction Device, but will analgesic doses of IV Ketamine achieve this quicker?

You are working in an Emergency Department during the Influenza season. You see a patient who has presented with typical symptoms of influenza. Their point of care influenza test is positive, but they don’t have ‘high risk’ clinical features making Oseltamivir (Tamiflu) an appropriate option. You wonder whether, for [patients with suspected or proven influenza], whether [products containing Echinacea Purpurea extract] might reduce the [clinical symptoms or duration of illness] compared to [placebo or Oseltamivir].

38-year-old female, 30 weeks of gestation with her 3rd child, had 1 miscarriage a year ago due to pre-eclampsia. At her last doctor's visit, she was placed on medication to keep her blood pressure under control. The patient is staying 4 hours away from the closest rural hospital. The patient was educated on hypertension and instructed to keep track of her blood pressure daily. The patient called one night and stated that she ran out of her blood pressure medications two days ago, and her blood pressure reading has been increasing since this morning and is now reading 170/116. The closest airport is 10 minutes away from her, and the flight time is 1 hour. The aircraft was activated immediately. Would oral nifedipine be better than labetalol in stabilizing this patient pre-hospital?

The mother of a 3-year-old boy, who was in excruciating pain and distress, accompanied him to the emergency room. The mother recounts the sequence of events: The boy's goal was to get his cereal from the cupboard. In order to reach it, he stood on a chair, which unfortunately toppled over, causing him to strike the underside of his chin against the corner of a table. When medical staff entered the room, the child would cry out loud, and the mother said that the boy had a large, heavily bleeding cut under his chin. Out of two medications you may use to sedate the youngster before examination and therapy, which would you prefer: nasal ketamine or nasal fentanyl?

A 39 year old man is experiencing acute on chronic non specific lower back pain, this is the second such episode he has had despite being active and a regular attendee at the gymnasium. His current employment requires a reasonable level of fitness and he is struggling without constant topical analgesia. A colleague suggests pilates, upon research he wonders if a certain style/type is more effective at reducing symptoms and preventing future episodes.

As we are aware, trauma to elderly patients is significantly worse in terms of outcome compared to a younger adult. I wanted to investigate if the benefit would out weigh the risk for administering tranexamic acid to all 'silver trauma' patients.

A 38y/o male presents with persistent shoulder pain, after manual clinical assessment and ultrasound it is confirmed he has a rotator cuff tear. The patient expresses concerns and wants to know what his long term treatment options are.

A family have concerns over their 56 year old family member who has presented with sudden on-set coordination/gait problems, who has also vomited twice. An ambulance is called and the patient has been assessed as FAST neg. Despite this, the gentleman was transported to the local emergency department. When in the emergency department he was further assessed and found to also have ataxia and problems with vision. CT head revealed the patient was suffering with an ischemic stroke effecting a posterior artery.

A patient you are treating is suffering with acute, moderate to severe pain. The patient does not have any reasons why they cannot take oral paracetamol. You wonder if the intravenous (IV) presentation is superior to its oral counterpart at reducing pain and wonder what route of administration is best for treating your patients pain.

Paramedics often perform cardiopulmonary resuscitation in out-of-hospital setting. Dynamic yet stressful environment may hinder them to perform quality cardiopulmonary resuscitation.

Following a failed extubation on day 3 of life on a neonate born at 25 weeks gestation, an echocardiogram was performed that showed a hemodynamically significant patent ductus arteriosus (PDA). A clinical decision was made to treat the PDA with intravenous paracetamol. A recent review article showed an association between prenatal and neonatal use of paracetamol with adverse neurodevelopmental outcomes. Can this be true for paracetamol use for PDA closure?

A 7-year-old girl has been bought in by ambulance to the emergency department having being involved in a motor vehicle collision. She is tachycardic, has abdominal bruising over her left upper quadrant, and is generally tender and guarding on examination. A venous blood gas on admission demonstrates hypocalcaemia. Since the ionised calcium level on a blood gas measures the physiologically active component of calcium (as opposed to total calcium which includes albumin bound calcium), you wonder whether the ionised hypocalcaemia might be related to adverse outcomes.

A 78 year old man with chest pain presents to the ED accompanied by his daughter. He is recluctant to wear his hearing aid and is reliant on his daughter to communicate. You wish to be confident in assessing his level of chest pain and wonder if there were tools to get a more accurate pain score direct from the patient

A 72-year-old man is seen in the prehospital setting following an out-of-hospital cardiac arrest with successful return of spontaneous circulation. He has received prehospital emergency anaesthesia (PHEA) for the indication of ventilatory failure / inadequate oxygenation. You wonder whether bispectral index (BIS) monitoring would reduce the risk of inadequate depth of anaesthesia in prehospital care.

A 40 year old male patient is brought to the hospital after being lost while snowmobiling for 3 days where the average temperature was -32 Celsius. After ensuring he is stable, you noticed he has frostbite on his feet. Despite appropriate rewarming, his toes and portions of his feet look very dark and you're worried about possible amputation. You wonder whether thrombolytic therapy could salvage his toes and feet.