Archives: BETs

A previously health 25 years old man present to the A&E department with a chief complain of vomiting a small amount of fresh blood. You consider doing a risk assessment for outpatient treatment in him, but wonder whether the use of Glasgow-Blatchford risk scoring system is sensitive in recognition the need for admission?

A 55-year-old male patient came to the emergency department with the symptoms of acute onset of severe chest pain with radiation to the back, cold sweating, and nausea. He had mild shortness of breath and his pain was most severe at onset. Physical examination revealed blood pressure: 210/120mmHg, heart rate: 101/min, respiratory rate: 20/min (SpO2 97% at room air), irregular heart beat without murmur, and clear breathing sound over the bilateral lung fields. The electrocardiogram (ECG) revealed atrial fibrillation with rapid ventricular response. Chest computed tomography showed a dissecting aortic aneurysm, from the descending thoracic aorta to the left common and external iliac artery. Therefore, a clinical diagnosis of aortic dissection, Stanford B was made. We wondered whether nicardipine was suitable to control his blood pressure and improve the outcome.

A 33 year old office clerk presents with a painful wrist swelling which he noticed a few months ago. The lump is interfering with his daily activities at work. Clinically it is a soft cystic mobile lump on the anterior aspect of the wrist. You wonder whether to aspirate the cyst in the department or refer him for surgical excision.

A 30-year-old man attends your emergency department after a deliberate overdose of his father's atenolol tablets. He is bradycardic, hypotensive and has had seizures. Despite fluids, atropine and a glucagon infusion, he remains hypotensive and you start treatment with inotropes. He remains unresponsive to treatment and very hypotensive and you wonder if an intravenous lipid infusion would help.

A 30 year old female presents to the emergency department with a swollen, bruised and painful wrist following a hyperextension injury. After examination and appropriate investigation you diagnose a wrist sprain. She asks you if she can have a splint to wear. You are unsure whether a period of immobilisation in a splint or early mobilisation is the best option.

A patient with tricyclic antidepressant overdose is treated in the Emergency Department. He is hypotensive and drowsy and has prolonged QTc on electrocardiogram. Blood gas shows metabolic acidosis. He is given intravenous fluids and sodium bicarbonate boluses until his pH becomes 7.6. However, he remains hypotensive. His rhythm then changes to VT. You remember that intravascular lipid emulsion (intralipid) has been used for overdoses of lipid-soluble drugs and you wonder whether it could be effective in this patient.

A 34-year-old patient presents to the Emergency Department with altered level of consciousness from a suspected intracranial bleed. The decision is made to intubate him. You predict a difficult airway. As you gather your equipment, you wonder whether use of a new GlideScope device will help achieve better success at intubation as opposed to traditional direct laryngoscopy.

a patient presents in A/E with Severe Acute Upper Gastrointestinal bleeding. After conservative management, how urgent should endoscopy be performed? Is there is benefit from very early endoscopy?

You are looking after a previously healthy 3-year-old girl, who was admitted with radiographically confirmed lobar pneumonia 3 days ago. She was started on intravenous penicillin and remains clinically stable but continues to be febrile. The laboratory informs you that Streptococcus pneumoniae has grown from her blood culture and that the isolate is penicillin-resistant (minimum inhibitory concentration (MIC) 1 μg/ml). You are uncertain whether this has any implications for her clinical course and wonder whether you should change her antibiotic treatment on the basis of this information.

A 57 years old male complaining of unstable angina was submitted to single Left internal mammary artery (LIMA) to Left anterior descending (LAD) artery on-pump grafted distally to a twice stented, severe proximal stenosis. After weaning from Cardiopulmonary bypass (CPB), LIMA was judged well functioning on the basis of finger palpation. Ventricular tachicardia occurred before sternal closure and patient was transferred to intensive care unit under lidocaine infusion. Few hours later a low cardiac output syndrome with LIMA occlusion diagnosed at angiography led patient to emergent surgery. On cardioplegic arrest LIMA was found totally dissected with LAD occlusion at proximal site of anastomosis. A saphenous vein graft was used to revascularize LAD. Intraortic Ballon Pumping was necessary to wean the patient. The anterior myocardial necrosis prolonged hospital stay. On the basis of risk management protocol you carry on a literature survey in order to demonstrate clinical usefulness of Transit-Time flow measurement (TTFM) in coronary graft verification.

A thirty year old man is brought to the Emergency Department (ED) having called the ambulance claiming to have taken a massive overdose of amitriptyline. He is noted to be hypotensive and this remains refractory to intravenous fluids and sodium bicarbonate. You know that amitriptyline is lipid soluble and wonder whether lipid emulsion is likely to be of benefit.

A patient present with a simple corneal abrasion detected using fluorescein and the slit lamp. They are symptomatic and you prescribe an antibiotic ointment and an ocular lubricant. You wonder whether there is any evidence to use both items and cost your trust more money