Archives: BETs

Your consultant is about to operate on an urgent in-patient referral with left main stem disease who has long-standing diabetes and hypertension with atheromatous changes in the aorta. You ask him if he will use the single cross-clamp (SC) technique for coronary artery bypass grafting (CABG). He replies that he has not seen any convincing papers that prove that this will protect the patient from stroke and he is concerned that this technique may unnecessarily increase the myocardial ischaemic cross-clamp time. You decide to look up the evidence for his statement.

A 20 year old man presents to the ED following exposure to an unknown chemical. On route to the ED he has a cardio-respiratory arrest. You are waiting to greet the patient wearing full PPE - you wonder what the best method of obtaining circulatory access is.

a patient presents with pleuritic chest pain, hypoxia and dyspnoea. A CT pulmonary angiogram confirms significant PE. The patient is haemodynamically stable but you are aware of the mortality and long-term sequelae associated with PE. Should you proceed to thrombolysis or anti-coagulate?

A 42-year-old man arrives at the Emergency Department with four days of chest pain. He has no cardiac risk factors including diabetes, tobacco use, hypertension, abnormal lipids or family history of coronary artery disease (CAD) and his EKG demonstrates equivocal ST elevations in anterior leads. He wants to go home and states he is “only here because my wife made me.” You wonder if more than 48 hours of chest pain is sufficiently reliable to exclude ACS in a patient with no other risk factors and an equivocal EKG.

A 60 year old man presents to the emergency department in cardiorespiratory arrest. Numerous attempts to secure peripheral intravenous access are attempted without success. You decide to attempt intraosseous (IO) access to deliver resuscitation drugs and fluids. You have equal experience in using both a manual needle and the EZ IO battery powered IO insertion device for achieving IO access and wonder which method is best.

A 36-year-old man presents to the emergency department following ingesting one bottle of OTC diphenhydramine. A friend found the patient down with the empty bottle next to him. The patient was last seen in his normal state of health over 24 hours before his discovery. In the ED, the patient is awake, has a GCS of 14, but is extremely agitated. He also exhibits anti-cholinergic signs and symptoms, such as tachycardia to 118, mydriasis, flushing, absence of perspiration, dry mouth, and decreased bowel sounds The patient was given benzodiazepines for his agitation and started on IV normal saline. The patient had a BMP completed, as well as a CKMB. The patient had a Creatinine of 2.6, elevated from previous data from 0.9 and a CKMB of 38,000. During his treatment, his CKMB continued to elevate to 43, 000 and his renal function continued to decline, reaching a Creatinine of 3.1. An EKG showed tachycardia and NSR. You have heard of sodium bicarbonate use and mannitol use in the treatment of rhabdomyolysis, but you wonder if there is any data supporting their use and if they have been found to decrease morbidity, such as acute renal failure.

A 7 yr old boy presents to the trauma bay in the emergency department after a high speed motor vehicle collision. He is alert, talking, and moving all extremities. During his secondary survey, you wonder if a digital rectal exam would be of any prognostic or diagnostic utility.

You are the Oncology registrar on call. A 38 year-old man with relapsed Acute Myelogenous Leukemia (AML) who is receiving induction chemotherapy presents to hospital with fever. On clinical assessment he has a temperature of 101°F (38.3°C) and a neutropenia (absolute neutrophil count(ANC) is 150 cells/mm³). He also has a mucositis, hypotension and pallor. He is classed as a high risk febrile neutropenic patient and admitted in isolation on the wards. He is commneced on Timantin and Amikin antibiotic therapy. Your inquisitive medical student asks you about the role of colony stimulating factors in febrile neutropenia and you send her off to search for the evidence...

A twenty four year old woman attended clinic after a routine referral from her GP. She had become ill at home and presented to the GP the following day with partner. Her partner was a witness to what had happened and explained how she had said she had felt dizzy and then all of a sudden fell to the floor, with all four limbs shaking, which lasted for around fifteen minutes. There was no tongue biting and no incontinence. As soon as the shaking ceased she sat up and was able to hold a conversation. She was orientated in time and place and didn't seem to be confused, however she was fairly drowsy. In clinic she was given a diagnosis of non epileptic attack disorder. Her partner was wondering whether there was any evidence to support behavioural treatments as a means to reducing seizure frequency.

A premature baby born at 24 weeks gestational age is admitted to the neonatal unit having been born in poor condition and receiving cardio-pulmonary resuscitation (CPR) with adrenaline in the delivery room. Considering the available evidence, is the use of CPR at delivery of extremely premature infants associated with very poor outcomes such that CPR in these infants may be inappropriate? Does the administration of CPR provide these infants with a chance of survival free of disability?

You are involved in close contact management with a patient with possible influenza A(H1N1) and are advised to wear personal protective equipment. This involves wearing the FFP3 filtering facemask. You wonder how effective it is at protecting the wearer.

A 30 year old man presents in the emergency department with an influenza-like illness. You wonder whether or not antibiotic prophylaxis would be of overall benefit to them with regard to duration of illness and incidence of bacterial complications.

A 30 year old man attends the emergency department who has suspected Influenza A(H1N1). You know that the m2 ion channel blocking antiviral drugs amantadine and rimantadine are cheaper than the neuraminidase inhibitors. You want to know if they have similar or greater efficacy and need to take into account possible adverse effects. The intention is for treatment and not for prophylaxis.

A 30 year old man attends the emergency department who has suspected Influenza A(H1N1). You cannot decide which antiviral drug is more effective, oseltamivir (tamiflu) or zanamivir (relenza). You also want to consider adverse effects and bacterial complications rates associated. The intention is for treatment and not prophylaxis.

A 10 year old female with DKA is being resuscitated with fluids in the Emergency Department. After a thorough assessment of hydration status and calculation of her maintenance requirements, you decide to calculate the hourly fluid rate for her treatment. However, you are aware that you gave the patient fluids as soon as she was admitted in order to quickly resuscitate the patient and correct peripheral circulation. The paediatric registrar arrives and tells you that you need to subtract your resuscitation bolus from the maintenance and deficit requirements. You wonder if there is any evidence for this if the risk of cerebral oedema would increase without the subtraction of the fluid bolus.

A 10 year old boy comes to the Emergency Department with dehydration, polydipsia and polyuria. He is unwell. A provisional diagnosis of diabetic ketoacidosis is made. IV access is gained and fluid resuscitation is commenced. You wonder whether the venous BM reading of 25 is accurate enough to commence insulin or whether you should wait for a formal lab glucose.

A 59 year old man presents to the emergency department with a four hour history of worsening central abdominal pain. He has a history of vascular disease and you suspect an Abdominal Aortic Aneurysm. His vital signs remain stable and you wonder if ultrasound scan or CT would best confirm your diagnosis.