Archives: BETs

A 32 year old man presents to the Emergency Department having landed on his knee whilst playing football. His x-ray reveals a closed vertical fracture of his patella. You wonder if a cricket pad splint is as good as a plaster cylinder for immobilisation.

A 54 year old female smoker with a history of hypertension presents to the emergency department with a complaint of heart fluttering and shortness of breath. Her vital signs reveal a blood pressure of 145/80, a pulse rate of 207, a respiratory rate of 18, and a pulse oximetry of 100% on room air. Her exam revealed tachycardia but it was otherwise within normal limits. An ECG was obtained and it revealed supraventricular tachycardia (SVT). While you treat the patient’s heart rate, you wonder if a troponin level would be useful in evaluating the presence of coronary artery disease.

26 day-old male is transferred to OHSU ED for further work-up of 1 d h/o fever and a UA showing elevated WBC and bacteria. Blood cultures were drawn, and an LP was performed. The newborn was given tylenol for fever. He was admitted to the pediatric inpatient service for ROS. There was question as to whether to begin empiric therapy with either gentamicin/ampicillin or cefotaxime/ampicillin.

A 55 year old man has presented to the emergency department with a dislocated shoulder. As you prepare to sedate him the nurse puts on 5LO2 via a face mask. You know that the advantage of supplemental oxygen is that it permits a longer period of normal oxygenation in the event of apnoea or respiratory depression. However oxygen may also negate pulse oximetry as an early warning device and respiratory depression. You wonder if supplemental oxygen can limit the incidence or severity of hypoxia without masking the presence of underlying respiratory depression.

Term baby with moderate HIE being re-warmed after 72 hours of cooling developes seizures.

A 27 year female has had PF pain for several months following an atraumatic onset. As well as the standard muscle exercises to the thigh and calf, you wish to instigate some hip muscle exercises, but the patient is surprised that she may have weak hip muscles and she wants to know if this weakness is recognised and has been investigated.

A 28 year old female presents with a four month history of ‘tennis elbow’ (lateral epicondylitis). You want to treat her with a form of electrotherapy and you wonder if one form is better than another.

During a camp trip in a remote area, a 32-year-old man has burned his hand and arm in the camp fire. As he had neither a first aid kit nor bandages or dressings to cover the wounds, he used cooked potato peels for this purpose. When you see him some time later in the emergency department you are very impressed by his innovative use of vegetables, though somewhat less sure of their efficacy and safety in burns. Before you dismiss the idea completely, however, you wonder if there is any published evidence.

A 30-year-old woman had swallowed an overdose of pills. Her husband asks you what he could have done to help his wife while waiting for the emergency medical services to arrive. You wonder whether he could have laid her in a particular position to ensure that the poisoning would have less detrimental effects.

A 6-year-old girl presents for a routine asthma follow-up appointment. She takes 200 µg per day of inhaled budesonide and uses her salbutamol 3–4 times per week. She has been in hospital three times in the last 2 years. The medical student in clinic asks whether you intend to offer a written management plan as these are used widely in adult practice.

A 36-week 3550 g neonate is admitted to the intensive care unit and commenced on intensive phototherapy for known Rhesus haemolytic disease. In spite of intensive phototherapy, the bilirubin level approaches the exchange transfusion threshold by hour 16 of life. The specialist registrar orders a crossmatch of blood and arranges for central line insertion in preparation for an exchange transfusion. The new registrar queries why intravenous immunoglobulin is not being used first in an attempt to avoid exchange transfusion.

You are the paediatric senior house office running the prolonged jaundice clinic. A urine sample from a baby was collected via the "clean catch" method and has a mixed (contaminated) growth on culture. You need to recall the baby for repeat urine culture and wonder whether it is best to perform a suprapubic aspiration to minimise the chance of another contaminated sample or whether an in–out urethral catheter sample would be as good.

A 3 year old girl presents to the Emergency department with 48 hr history of low grade fever, anorexia, malaise and lesions to her hands, feet and oral mucosa (buccal mucosa, gingiva and tongue). Her mother states she is now refusing to eat and drink due to her painful mouth ulcers. Upon physical examination you diagnose her with Hand-foot and mouth disease and deem her to be mildly dehydrated. You wonder if administering a topical anesthetic (i.e. viscous lidocaine) to her mouth lesions would result in an improved oral fluid intake.

A 4 year old girl with a known history of asthma presents in the emergency department with a two-day history of increased wheezing. She has been using her albuterol inhaler more frequently but is still symptomatic. Her symptoms improve after two nebulizer treatments, and as you prepare for her discharge you wonder if an IM dose of dexamethasone before discharge would be as effective as an oral course of prednisone at home.