Archives: BETs

The mother of a 5-year-old boy with athetoid cerebral palsy complains of difficulties putting his Lycra suit on each day. She is keen to know if it actually helps improve his function and movement.

A 62 year old male emergency patient arrives in cardiac arrest. During resuscitation he is found to have pulseless electrical activity (PEA). Several rounds of ACLS are performed with no improvement in the patient's condition. You wonder if a rapid bedside cardiac ultrasound (echocardiography) would be of any prognostic or diagnostic utility.

A 73-year-old male with known chronic obstructive pulmonary disease (COPD) presents to the emergency department with dyspnoea. He is diagnosed with an acute exacerbation of COPD. Despite optimal medical management he fails to improve, his arterial blood gases demonstrate type II respiratory failure with worsening respiratory acidosis. He is offered a trial of non-invasive ventilation but refuses as. A decision is taken that invasive ventilation is not in the best interests of the patient. You wonder if the respiratory stimulant doxapram may improve the patient's respiratory failure.

A 55 year old male with no cardiac history presents for chest pressure with onset of about 2 hrs ago, now resolved. You question if new sensitive troponin assays will be able to more accurately rule in or rule out an acute myocardial infarction when compared with standard troponin assays.

A 26 year old otherwise healthy male presents to the emergency department with a dry cough that has been present for 5 days. He has tried over-the-counter medications in an attempt to improve his cough symptoms without success. He would like to know if codeine would be better.

A 50 year old patient attends the Emergency Department with a fever, and symptoms suggestive of a urinary tract infection. He has a T 39.1, HR 110, RR 20. As you are making your assessment, the staff nurse appears at your elbow, anxious to administer 1g paracetamol for his pyrexia. You muse that as pyrexia in response to infection is a result of thousands of years of evolution, it may well serve a purpose. You wonder whether treating pyrexia has a positive or detrimental effect on the body’s response to infection.

You are attending a paediatric patient in the Emergency Department. You note from the triage observations that the patient, a normally healthy 6-year-old, has a blood pressure of 80/40mmHg. You wonder if this is a little low, but cannot recall what the normal blood pressure for a child should be. You ask your registrar, who insists that you should use reference tables, while an eavesdropping consultant suggests using the formula from the APLS course - though he can't remember what it is. You wonder how best to ascertain the normal value.

29 month old boy had a representation with severe hives and vomiting 14 hrs from initial presentation with severe anaphylactic reaction to the Emergency department, you just wonder this child should be observed longer.

A 60 year old man is admitted to the stroke unit following a stroke. He has increased tone in the forearm flexors, causing malalignment of the wrist into flexion. You passively realign the wrist and facilitate activity during therapy sessions. You wonder if you should also provide a palmar resting splint to maintain the muscle length.

A four year old boy presents to the emergency department following a fall at school. He sustained a 2cm haematoma to his right forehead. His GCS is 15/15. His mum is concerned as he has idiopathic thrombocytopenia and has been advised to bring him to hospital as he is at risk of intracranial bleeding. You wonder whether this patient should have an urgent CT Brain scan in view of his thrombocytopenia.

A 5 year old child presents to the paediatric emergency department with a linear laceration to his forehead. There are no concerns regarding a head injury. The wound is linear, full skin thickness and occurred within the last 8 hours. You suspect that the child will require sutures to close the wound however his parents are very anxious about him requiring a “needle” whilst he is awake. You wonder if a topical anaesthetic gel could be used to allow closure and therefore prevent the need for him to return at a later date for a general anaesthetic.

A 36 year-old man presents to the Emergency Department with a painful, deformed left shoulder after falling from his bike on the way to work. Your clinical examination is suggestive of an anterior shoulder dislocation and shoulder X-rays confirm your suspicions. There is no associated fracture or neurovascular deficit. You are aware that there has been much debate about the best method of reduction of anterior shoulder dislocations and have recently been taught how to perform the FARES method. You wonder whether this method or the more traditional Kocher’s method would be the most effective and least painful.

A fifty eight year old man, who is medically well but relatively inactive, presents to the emergency department after feeling a painful snap at the back of his left heel while running for a bus. On examination you note swelling and ecchymosis over the achilles tendon with a tender and palpable gap. He has weakness of plantar flexion and is Thompson's test / Simmonds' test positive. After being informed of the pros and cons of operative and non-operative treatment he opts to be managed non-operatively. You wonder how he can be best managed.