Archives: BETs

A 25 years old lady presented to emergency department screaming with pain due to superficial burn and scald to her left hand. She dropped the full kettle of boiling water and in trying to hold it she spilled all the boiling water on her left hand. She was scared to put her hand under running tap water as it was painful but agreed to put her hand in saline in a tub. She had some blisters and was asking for antiseptic dressings on it. You wonder whether simple petroleum gauze impregnated dressing would be better than using antimicrobial or iodine dressing?

It's 6 a.m. The standby phone goes and the ambulance service tell you there bringing in a chap with severe heart failure, low sats and a low BP. You attempt to stabilise him in resus. BIPAP is instituted to compensate for the respiratory failure; a small dose of IV nitrates is infused and a catheter is passed. Despite your best efforts, he remains dyspnoeic and hypotensive. You call up to ICU looking to steal some enoximone or milrinone, having previously used these agents with success, but a consultant intensivist suggests using dobutamine instead as "it does the same job". After initiating dobutamine therapy and successful transfer to CCU, you resolve to go home and find out if he's right or not.

A 71 year old pleasant man presented to the Emergency Department complaining of dark urine, urgency, occasional dysuria, suprapubic pain and foul-smelling urine for 1 month. No frequency, haematuria or flank pain was reported. He has a past medical history of diverticulitis with lower gastro-intestinal bleeding in the past. You wonder whether all cases of colovesical fistula have to be managed surgically.

A 30-year-old woman suffers a witnessed out-of-hospital cardiac arrest. You lack experience with ETI and wonder what evidence supports routine use of LMA compared to ETI or bag mask ventilation for airway management in cardiac arrests.

A 15 year old boy was admitted to paediatric intensive care unit, with bilateral otitis, mastoiditis and clinical features of meningitis. He was bradycardic And hypertensive. He had nausea, photophobia and neck stiffness. He went to operating theatre for bilateral tube myringotomy. He had a bolt inserted to monitor his intracranial pressure. You wonder whether intracranial pressure monitoring improves outcome in central nervous system infective process.

An SHO performing a baby check on the postnatal ward feels that one of the hips is “clicky”. There are no risk factors for developmental dysplasia of the hip (DDH). As the Registrar on call, you have to go and examine the baby. If the hips are stable and located on clinical examination, it is hospital policy for no further investigations or follow up. You wonder what the evidence is for performing hip ultrasound scans in all babies and whether or not a policy should be implemented locally to do this.

A 60 year old man presents to the Emergency Department (ED) with chest pain. The ECG shows an ST elevation MI. You give him oxygen, nitrates, aspirin and morphine and also start thrombolysis. You wonder whether giving him clopidogrel as well would be beneficial.

A 34 year old male with a large right MCA infarct presented with left shoulder subluxation causing pain. Information booklets around the use of surface neuromuscular electrical stimulation has mentioned that it can be used to help reduce shoulder subluxation, however very little was known around current research and literature regarding this. Would treatment with surface neuromuscular electrical stimulation reduce shoulder subluxation in his hemiplegic shoulder?

You are a physiotherapist working in acute elderly medicine on an acute hospital ward. The team practices a multidisciplinary approach to falls prevention and rehabilitation according to current UK guidelines, consisting of multidisciplinary assessment and multifactorial interventions. A significant part of your caseload consists of patients with dementia who have been admitted following a fall. You wonder which interventions within the scope of physiotherapy practice are effective in improving falls outcomes (number of falls, severity of falls, balance related outcome measures) in patients with dementia who have fallen.

A 40 year old male, with a history of IV drug use, comes to the emergency department with five days of back pain. He has no history of trauma, fevers, or neurologic complaints. As an IV drug user, he has a risk factor for a BSEA, but is afebrile and is neurologic exam is non-focal. Does he need an MRI?

An adult with an acute onset of severe, colicky, left-sided loin pain presents at your emergency department. Your clinical examination and laboratory results suggest a diagnosis of ureteric stone disease. As the majority of renal calculi will pass spontaneously, the focus of acute management should be rapid pain relief. While opiates can offer pain relief by subduing patients' awareness of these stimuli, NSAID's can actually treat the pathophysiological mechanisms that cause them in the first place.

An eighteen month old boy presents with flu-like symptoms for one day. Other than shortening the length of symptoms, does antiviral therapy prevent risks of secondary pneumonia?

You have just successfully defibrillated a 66 year old man who attended the ED with chest pain and suffered a VF arrest. He is maintaining his own airway,and starting to speak, with BP 159/77. His ECG shows an anterior MI and multiple ectopics. You are concerned he will suffer another pulseless arrthythmia and wonder whether prophylactic loading with magnesium would be useful. Your consultant says you should wait for his levels before commencing the infusion as this was not a torsades de pointes. You wonder if there is any evidence that magnesium would be beneficial here.