Archives: BETs

A 75 years old man presents at the ED with a pneumonia and severe sepsis. The patient is also known for cardiac failure. After being intubated and having received few liters of fluids, the patient does not seem to get better. The physician wonders if the ultrasonography of the inferior vena cava would help him to know if the patient is fluid-responsive or not.

An 8-year-old female is hit by a car while riding her bike. Upon arrival to the emergency department she is hypotensive and tachycardic. Multiple intravenous attempts were made en route to the hospital but have been unsuccessful. You question if a powered intraosseous insertion device would provide access as safe and effective as intravenous access?

A 4 year old boy presenting to Emergency department with high pyrexia of 39.5C and on going generalised clonic tonic seizure. No IV access is immediately obtainable. You have identified that the child requires urgent first line treatment for initial seizure control.

You are providing on site medical cover at a large music festival. There has been an incident and a 26 year old man is brought to the medical tent after being stabbed. He has a sucking chest wound. Should you use the fancy chest seal device in the medical box or make your own three sided dressing while you wait for the ambulance to arrive?

A specialist registrar in a district general hospital receives a call from a health visitor who has seen a 2-week-old baby who is struggling to breastfeed adequately and who has a marked tongue tie. The parents are extremely anxious and after searching the internet are now requesting a tongue division as they are certain that this is the cause of the problem. The health visitor can also recall many success stories after this procedure and is concerned that without it the mother will abandon breastfeeding altogether. She asks you to refer the baby to the ENT specialists with a view to division.

A 12-year-old boy was admitted to our department as part of our epilepsy surgery protocol. He was admitted for video EEG and for ultimate consideration for vagal nerve stimulator (VNS) insertion. He had a background of intractable epilepsy which had not responded to multiple antiepileptic medications.

A 42-year-old man presents to the emergency department following an injury to his right index finger. Whilst at work approximately 2 hours ago, he sustained a significant crush injury to his right index finger. Examination reveals a swollen, bruised and erythematous distal phalanx with a deep laceration proximal to the nail fold. Radiographs confirm the diagnosis of an open fracture of the distal phalanx. You wonder whether prescribing a course of oral antibiotics, in addition to thorough wound toilet, will reduce the likelihood of infection developing.

A 2-year-old girl presented with 1-day history of temperature, off food and “not herself”. Clinical examination showed a slightly irritable child with a temperature of 38.8°C, mildly congested throat and doubtful neck stiffness, with no other apparent focus of infection. Urine was clear. A full septic screen was performed including lumbar puncture. C reactive protein was 38; cerebrospinal fluid (CSF) showed glucose 3.6 mmol (blood glucose 4.8 mmol), protein 0.6 g/l, white blood cell count 4 with no bacteria on Gram staining. The child was observed with a diagnosis of viral illness without any antibiotics. We wondered: can meningitis occur with initial normal CSF?

A child presents to the Emergency Department with a history of witnessed coin ingestion in the last 24 h. He is asymptomatic and clinical examination is unremarkable. Chest x-ray reveals a coin lodged in the oesophagus. You wonder whether to observe the child, hoping for spontaneous passage into the stomach or to refer him for removal/assisted advancement of the coin.

An 8-year old child presents to the Emergency Department within six hours of an unclear incident at home which left nonspecific bruising and acute change in mental status. Fundoscopic exam reveals retinal haemorrhages, and a CT scan done later into the work-up demonstrates a small subdural haematoma. While you consult an ophthalmologist to verify your findings and concentrate on maintaining supportive care, you remember that brain injuries in adults, both hypoxic and traumatic, are increasingly treated with therapeutic hypothermia, and you wonder if this could result in a better outcome for your paediatric patient.

Your relative has returned from their general practitioner with a prescription for antibiotics. They ask you if there is anything they could take to prevent diarrhoea following the antibiotics, as, on occasions, it has resulted in them stopping the antibiotics early. You have some recollection regarding the use of probiotics and wonder whether there is evidence to support their use in this manner.

It is 7:45am and you are just winding down with a coffee before the end of a shift and the doors to the Emergency Department (ED) burst open. Lying on a stretcher is a young, obese lady who is screaming in agony. She has an obvious fracture dislocation of the ankle. Just when you thought things couldn't get any worse the paramedics inform you that she has no visible peripheral veins. While you evaluate your options of escape you ask yourself the question: "Would intranasal fentanyl be as efficacious as intravenous morphine in the reduction of pain from this broken ankle"?

A 56 yr old man presents to the emergency department one week after an initial blunt left sided chest injury. Initial investigations showed no haemothorax and he had been discharged with analgesia. On his representation he was complaining of new chest pain and shortness of breath on exertion. His repeat Chest x-ray showed a haemothorax. The question was posed as to whether the correct treatment should be drainage or not.

A 32 year old patient with a history of HIV attends the emergency department with acute onset of shortness of breath. A chest X-ray reveals a right sided large pneumothorax. You wonder whether prophylactic antibiotics will improve his survival rate.