Archives: BETs

A thirty six year old man is brought into the emergency department by ambulance with a suspected opiate overdose. He has pinpoint pupils and bradypnoea which is reversed by administration of naloxone. However there is no evidence of IV drug abuse such as needle track marks. You wonder if naloxone can be used to reverse and therefore diagnose any other conditions.

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 six year old boy attends the Paediatric Emergency Department. He has area of broken eczematous skin that appears to be infected. He has been treated with Flucloxacillin but it appears to have made no difference. You wonder if other bacteria may be present or if there is antibiotic resistance and what antibiotic to use.

A child attends the Paediatric Emergency Department with an exacerbation of atopic eczema. You ask the mother about their current medications and usage. You find that the mother is confused as to what the diagnosis means and is struggling to comply with the emollient regimes. She has frequently been to the GP who alters the lotions and indicates that the instructions are labelled. You are very busy in the Emergency department and try to impart some knowledge with regards to the condition and the treatment regime before discharging them. You wonder if a educational session would help improve the situation.

A 60 year old gentleman presents to the emergency department with a spontaneous epistaxis. The bleed is anterior, from one nostril and stops with simple pressure application The patient is extremely concerned about this happening again asks what can be done to stop it? You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?

A five year old child presents to the Paediatric Emergency Department with a moderate exacerbation of atopic eczema. They have leukaemia and are likely to be immunocompromised. Usually you would give a mid-potency hydrocortisone cream but know they are only recommended by NICE in non-immunocompromised patients. You wonder whether any complications such as herpetic infection are increased when using potentially immunosuppressing drugs in immunocompromised children.

An 8 month old boy with atopic dermatitis attends the Paediatric Emergency Department. His mother's main concern is his itching which is causing him to become distressed and areas of skin to become broken down despite the use of emollients. You know that in older children the use of sedating antihistamines is recommended. You wonder if there is anything available to treat this infant's pruritus.

In the primary care setting, sore throat is a very common cause for consultation. However, the cause of tonsillitis is not known in many cases. Relying on clinical presentation and history alone is unreliable in differentiating streptococcal from viral tonsillitis, creating the problem of unnecessary and ineffective use of antibiotic therapy in many situations. Microbiological culture is the best way to establish an aetiological diagnosis, but is time consuming. The question therefore arises whether inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) can differentiate streptococcal from viral tonsillitis.

2 years old boy presented to A&E after a fall and was not weight bearing since. The clinical examintation revealed some tenderness at the junction of middle and lower 1/3 of anterior aspect of tibia. xrays did not reveal any fracture of tibia or fibula. Would you treat him in above-knee or below-knee cast for presumed toddler's fracture?

A 28 year old male is referred to physiotherapy with a 18 month history of right patella tendinopathy. You plan to use a eccentric exercise programme and wish to know what the efficiency of this treatment is against other non-invasive treatments is.

A patient enters the Accident and Emergency department. They are clearly distressed and do not respond to verbal pleas to calm down. They begin to act in a violent and threatening manner toward the staff, themselves or the other patients. You wonder how you should objectively assess this patient's level of agitation and aggression in order to best treat them.

An aggressive and/or hostile patient in the Accident and Emergency department requires a dose of olanzapine as a sedative measure. You wonder whether administering the drug orally or intra-muscularly is the best option to bring about safe and effective sedation.

An agitated 24-year-old patient with a history of schizophrenia enters the emergency department, and becomes aggressive and hostile towards staff and patients. De-escalation techniques fail, and the patient will not take oral medication or allow intravenous cannulation. You wonder whether intramuscular (IM) haloperidol or olanzapine is the best drug to rapidly, safely and effectively calm the patient.

A twenty-five year old female receives an axillary block allowing a procedure may be carried out pain free. Ten minutes after receiving a dose of bupivacaine she becomes unresponsive and goes into cardiac arrest. What is the best treatment option in this situation?

A fifty-five year old male is administered a dose of local anaesthetic for an interscalene block in preparation for shoulder manipulation. Shorty after the drug is given he suffers a tonic-clonic seizure, after reading a local anaesthetic guideline recently published you question which action you should now take?

A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using tympanic thermometry.

A previously well, term 4 day old female neonate presents to the emergency department. On examination she is febrile with a temperature of 39.1 oC, tachycardic, tachypnoeic and has no focus for her fever. You decide to do a full septic screen and one of the things you need is a urine sample. You wonder whether a supra-pubic aspiration would be the best method for obtaining a sample in this neonate?

A previously well, term 10 day old female neonate presents to the emergency department. Her parents say she feels like she is ‘burning up’ and is irritable. On initial inspection you agree that she looks unwell, her temperature as taken with a axillary thermometer is 37.7oC. She has no focus for her fever on examination. You would like to know how accurate axillary temperatures are and whether you should check the temperature using rectal thermometry.

A previously well, term 20 day year old male is brought into the emergency department one evening. His mother reports that he is hot, irritable and not feeding. Examination does not find a source of infection but his observations show that he is febrile with a temperature of 38.1 degrees and his heart rate is raised at 190 bpm (normal range 120-160 bpm). You wonder if his raised heart rate increases the likelihood that this neonate has a serious illness?