Archives: BETs

A 19 year old Afro-Caribbean male has received IM adrenaline and IV hydrocortisone for acute swelling of his tongue and face. He has shown no improvement after one hour and has begun to develop a hoarse voice.

A child requires a surgical procedure and therefore must be kept nil-by-mouth for several hours prior to the operation. This precaution reduces the volume and acidity of gastric contents, thereby reducing the risk of aspiration. Although surgery may increase blood glucose via a systemic stress response, the period of pre-operative starvation may cause children to become profoundly hypoglycaemic(as they are less able to regulate their blood sugars effectively than adults). This problem is contributed to by the fact that the fasting period is often longer than planned because of bigger surgical lists or poor planning. Are current fasting practices getting the correct balance between prevention of complications and safe blod sugars?

A child with diabetes requires a surgical procedure. Most recent hospital guidelines recommend the use of a ‘sliding scale’ for insulin delivery only in those children undergoing major or emergency operations. Administration of insulin intravenously as opposed to subcutaneously may facilitate tighter control of blood sugars throughout a procedure. Would this delivery method be beneficial for all diabetic children having surgery?

A 20 year old female patient presents to the ED of a busy acute hospital with swelling of face and lips and difficulty breathing. She has no previous history and has become suddenly unwell over the last hour.

A 30 year old male patient with known allergic angioedema presents with acute angioedema with severe abdominal pain and stridor.

You performed an LP on a middle aged male patient and you were very pleased with the negative result. Forty-eight hours later the same patient returns with disabling headache associated with nausea and vomiting. After your clinical assessment it all fits into a post lumbar puncture headache (PLPH). You decide upon conservative management as a blood patch requires real expertise. You think you saw an anaesthetist using caffeine for a similar case and you wonder whether you should use it.

A 11 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache. She is a known migraine sufferer, but her headaches have become more frequent in the last 2 months. After history and clinical examination, a diagnosis of migraine is made with possible secondary aetiology. You feel that neuroimaging is appropriate and wonder whether MRI would be better than CT at detecting any abnormalities.

A 9 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache and two episodes of vomiting since the onset. She is a known migraine sufferer, who has had several similar episodes with associated nausea and vomiting in the past. After history and clinical examination, a diagnosis of migraine is made. You wonder if referral to neurology is necessary to rule out underlying aetiology.

A 12 year old girl presents to the Emergency Department with a one hour history of a severe throbbing headache and an episode of nausea and vomiting 20 minutes previously. She is a known migraine sufferer, and her last episode was one week ago. After history and clinical examination, a diagnosis of migraine is made. You wonder whether Chlorpromazine would be effective in relieving her symptoms.

A 9 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache that she has described to be at the 'back of her head'. She has experienced headaches in the past, but is unsure if she has always felt it in the same place. After history and clinical examination, a diagnosis of occipital migraine is made. You wonder if you should refer her to neurology for investigation.

A 13 year old boy presents to the Emergency Department with a three hour history of a severe throbbing headache. He has taken nasal sumatriptan two hours previously and has obtianed little relief, he is currently extremely uncomfortable. He is a known migraine sufferer and has had two other episodes in the last month. After history and clinical examination, a diagnosis of migraine is made. You wonder if the use of an opioid would be appropriate to resolve his symptoms.

A ten year old boy presents to the Emergency Department with a history of a severe throbbing headache which has started one hour ago. He is a known migraine sufferer and has had previous attacks, the last being two weeks ago. After history and clinical examination, you diagnose him with migraine, and decide that over the counter analgesics are the most appropriate. You wonder whether ibuprofen would be better than paracetamol for pain relief.

An agitated and/or hostile patient enters the emergency room. You wonder if there is an underlying non-organic cause to their heightened state of aggression and perform the Mini Mental State exam to identify or exclude these causes.

A 45 year old male presents at the emergency department with apparent acute confusion. He has no obvious signs of respiratory distress and the routine bloods have not come back yet. You wonder whether to order a chest x-ray next as you know some chest pathologies can cause delirium.

A 42 year old female presents at the emergency department with signs of apparent acute confusion. You wonder which is the best cognitive function test to diagnose her with delirium.

A 46 year old male patient presents at the emergency department with signs of acute confusion. He is being disruptive in the waiting room and you worry he will hurt himself or others. You wonder which out of Haloperidol and Risperidone would be better to sedate him effectively and safely.

An elderly female patient of 82 presents to the emergency department with acute confusion of unknown cause. She is too delirious to take a history from and has no family present to give a collateral history. There are no focal neurological signs but you still wonder whether to perform a CT or MRI scan to rule out intracranial pathology as a cause of her confusion.

A 82 year old female presents at the emergency department acutely confused, with no obvious signs as to the cause. You wonder whether to test her urine to aid to the diagnosis of her confusion.

A 55 year old male presents at the emergency department with apparent confusion. There are no obvious signs as to the cause. You wonder if it is due to infection.

A 22 year old female presents to the emergency department with apparent acute confusion. You know thyroid dysfunction is a cause of delirium and wonder whether to check her thyroid levels or not.