Archives: BETs

An elderly man attends the emergency department with a clinical fracture dislocation of the ankle after a fall. He has got significant co morbidities and a history of recent myocardial infection. You have read that ankle fracture-dislocations can be reduced with intra-articular lidocaine (IAL). You wonder if IAL is as effective as intravenous analgesia and sedation (IVAS) in facilitating reduction and providing adequate analgesia.

A 55-year-old female patient is brought into the Emergency Department in cardiac arrest. She is intubated but you cannot get peripheral or central venous access. You wonder if intraosseous access is worth a try to deliver drugs and if this will improve outcome.

A young 23 year old fit healthy male patient is brought in by ambulance with agitation to emergency department.His friends give a history of cocaine use whilst he was out partying.while you are examining he has a generalised tonic clonic seizure

A 7-year old girl is brought in the ED by her father who is concerned about a petechial rash over her face and neck only. She developed a dry cough the day before. Her observations and are normal and the child looks well. You have heard about petechiae developing in the distribution of the superior vena cava secondary to increased intrathoracic pressure and wonder if it is safe to discharge the patient without further investigations.

A 45 year old man presents with a painful swollen ankle. No fractures are seen on X-ray and he is diagnosed with an ankle sprain. He has a history of duodenal ulcers and gastrointestinal bleeding treated with proton pump inhibitors for the last 5 years. You wonder whether the topical non-steroidal anti-inflammatory drug (NSAID) patch, diclofenac epolamine topical patch (DETP) 1.3% (FLECTOR® Patch, King Pharmaceuticals® Inc., Bridgewater, NJ, USA), can be prescribed to manage pain instead of an oral NSAID formulation.

A 46 year old man presents with a painful erection lasting approximately 4 hours. Your attending physician recommends giving oral terbutaline to the patient, but cannot recall the effectiveness of this drug in the treatment of acute priapism.

A 30 year old woman has been bitten by a venomous snake. In anticipation of emergency medical care, a bystander tied a compression bandage and a splint. You wonder if a compression bandage combined with immobilisation is a safe and effective first aid measure to reduce the effect of envenomation.

A 42 year old woman attends the emergency department after having been stung by a bee on her shoulder. You examine her and find marked local reactions. The woman tells you that she used tweezers to remove the sting. You wonder if the method of removal might have affected the reaction to the bite.

An 74 year old lady presents to the emergency department following a fall at home. She complains of pain in her right shoulder. An x-ray confirms an isolated first rib fracture. I wonder if I need to investigate further to exclude associated injuries.

You start at a new hospital and find that there is a protocol in place to guide the treatment of patients with sepsis. It states that if the patient's blood glucose is found to be greater than 7.8 mmol/l then insulin should to be started to keep it tightly controlled . You wonder if some degree of hyperglycaemia is not such a bad thing, given that it is part of a natural physiological response to stress and glucose is required for brain metabolism. A quick review of the literature throws up contrasting results and so you decide that you should really examine the evidence in a more systematic manner.

You have just seen a 6 year old child who is complaining of a painful left elbow after falling off a trampoline, plain x-rays are inconclusive and you wonder if an ultrasound has any value in detecting a fracture of the elbow joint in young children.

A 20 years old gentleman presents with a swollen ankle after an inversion injury. Clinically you suspect a fracture of lower one third of fibula. Radiograph confirms a Weber A fracture which is treated conservatively in a below knee back slab and crutches. You refer him to fracture clinic and very well know that operative fixation is highly unlikely and he will be changed into a full plaster soon. You wonder if giving him low molecular weight heparin might prevent development of deep vein thrombosis.

The standard practice to increase the likelihood of yielding a positive blood culture is to obtain blood specimens at or around the time of a temperature spike. This is based on the principle that the presence of organisms in the intravascular space leads to the elaboration of cytokines, causing body temperatures to rise. In clinical practice this is not always possible, so I want to determine whether it is necessary to obtain blood sample for culture when a patient is febrile.

A 50 year old male presents to the emergency department with signs of head injury, a GCS of 14 and heavily intoxicated with alcohol. He had similar presentations in the past needing a head CT scan repeatedly. His GCS is 14 after 2 hours. A CT scan is indicated and is normal. Could this CT scan have been avoided by using a serum S-100B blood biomarker test?

An elderly woman attends your Emergency Department following a mechanical fall. She takes warfarin for atrial fibrillation and has a small occipital haematoma. Her Glasgow Coma Score (GCS) is 15; she has no amnesia and a normal neurological examination but did briefly lose consciousness. The INR (International Normalised Ratio) comes back within the therapeutic range at 2.9 and a computed tomography (CT) scan is requested according to the National Institute of Health and Clinical Excellence (NICE) guidelines. The scan is reported as normal, and her social circumstances are adequate in that she lives with her husband who can keep an eye on her. You wonder, though, whether it is safe to discharge her or if there is a possibility of delayed intracranial haemorrhage due to her coagulopathy, and therefore she should be admitted for a period of neurological observation so that it can be identified and acted upon at the earliest opportunity.

A previously well 60-year-old gentleman attends your Emergency Department in acute urinary retention (AUR) for the past 10 hours. On closer questioning he reveals a history of preceding lower urinary tract symptoms. Following the uneventful passage of a urethral catheter, the production of a residual volume <1000ml and the finding of normal renal function, you wonder whether starting a short course of an alpha-blocker prior to discharge from the Emergency Department may increase his chance of an early trial without catheter (TWOC).