Archives: BETs

A 3 year old with croup presents to A&E with inspiratory stridor. You want to treat with a steroid, and know dexamethasone is commonly used. Having recently used prednisolone in asthma, you wonder if this would be as effective as dexamethasone.

A 56 year old female presents to the emergency department after waking up with left sided weakness. She was normal when she woke up to use the bathroom in the middle of the night 4 hours ago. You wonder if she could benefit from air transport (about 30 minutes) to a stroke center which uses the Penumbra System for mechanical clot extraction.

You see a 9-year-old girl with stable cystic fibrosis in your outpatient clinic and review her treatment regime with regard to lung function. Over the last 4 months she has been on nebulised recombinant deoxyribonuclease (rhDNase) 2.5 mg once daily, but her lung function has not shown any improvement. She has also had one pulmonary exacerbation requiring intravenous antibiotics over this period. You are aware that although rhDNase is widely used in the management of lung disease in cystic fibrosis, approximately 50% of patients may gain no clinically significant benefit,(Fuchs, Ballman, Suri 2001) and studies have shown that response after a 3-month trial of therapy is a good predictor of longer term response (Davies, Suri 2004) Given that your patient may be a poor responder to rhDNase, you wonder if treatment with nebulised hypertonic saline would improve pulmonary outcomes.<br><br>

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient undergo another investigation, such as an MRI, there and then?

A 3-month-old child is seen in clinic because of a rapidly enlarging birthmark on his back. On examination it is seen to be a strawberry naevus measuring 45×25 mm. The parents want to know how much further it will enlarge and when it is likely to settle. A straw poll of staff at grand round reveals that it is reckoned that maximum size should be achieved by 13 months (median) and resolution should have occurred in half the cases at 5 years (median).

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient undergo another investigation such as a CT scan there and then?

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient undergo another investigation, such as an MRI, there and then?

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient undergo another investigation, such as an MRI, there and then?

A 25-year-old right-handed carpenter came to the Emergency Department (ED) with a recent history of a fall onto his outstretched hand. He complained of pain in the wrist and some tenderness was reported in the anatomical snuffbox. The subsequent X-ray showed no abnormality. Should the patient have immobilization with POP or functional splinting while waiting for further investigation?

A 24 year old man presents to the ED complaining of having injured his knee earlier that evening in a football match. He is in a significant amount of pain so you prescribe him diclofenac. A medical student asks why you prescribed diclofenac rather than ibuprofen, given its higher risk of gastro-intestinal complications. You inform the student that diclofenac is a better analgesic than ibuprofen but wonder if there is any evidence to support this.

A patient has received a benzocaine spray for pain relief during insertion of a nasogastric tube, soon after he becomes remarkably cyanosed. methaemoglobinaemia is diagnosed. What would be the best treatment option for him?

A twenty-three year old patient has a number of blood tests carried out within the emergency department, you notice a raised serum amylase, two weeks ago he received lipid emulsion therapy for an accidental local anaesthetic overdose, are these events related?

A thirty-three year old female has been accidentally administered a large dose of bupivacaine, she is in cardiac arrest and after a prolonged period of standard resuscitation the question is raised if there is any alternatives that may be affective?

Clinical Scenario A thirty-three year old male is goes into cardiac arrest after an accidental overdoes of tetracaine. Which drug would be most effective in the resuscitation of this patient?

While working for the neonatal transport team you are involved in the transfer of an extremely low birthweight preterm baby, 28 weeks' gestation, birth weight 800 g, on day 1 of life. The baby is ventilated with stable gases, minimal ventilator requirements and is not receiving any cardiovascular support. On clinical assessment you are concerned as the central capillary refill time (CRT) is prolonged at 4 seconds, despite normal cuff blood pressure. You wonder about the validity of prolonged CRT as a marker of poor organ blood flow in preterm newborns.

A young caucasian male who presented with a first episode of severe angioedema requiring steroids and adrenaline has had a complete resolution of his symptoms after 4 hours and is keen to go home.

A 21 year old ,ale with no family history of angioedema and no clear allergen exposure has an acute episode of urticaria, genital oedema and stridor which requires IV hydrocortisone and antihistamines in the Emergency Department. Would mast cell tryptase levels help to make a diagnosis?

A 45 year old female with known hereditary angioedema has a moderately serve acute attack which began 8 hours ago. Her sister died during an acute episode 1 year ago and she is very frightened herself. She has has C1 inhibitor in the past but has read about Icatibant on the internet.

A 50 year old female teacher with known hereditary angioedema presents to the Emergency Department 2 hours after a routine dental extraction with a rash and periorbital oedema.