A 50-year-old male patient came to the emergency department with the symptoms of acute onset of severe rotatory vertigo, nausea, and postural imbalance. Physical examination revealed right-beating nystagmus in all positions of gaze but otherwise no focal neurological findings. After physical and neurological examinations, a clinical diagnosis of acute vestibular neuronitis was made. You wondered if steroids were useful to reduce his symptoms and improve time to recovery.
Archives: BETs
Emergency Physician bedside ultrasound for the diagnosis of cholelithiasis
A 40-year-old female presents to the emergency department with epigastric abdominal pain and nausea. Her WBC count and transaminases are within normal limits and her symptoms improve with pain medication and antiemetics. You wonder if performing bedside ultrasound (US) will be sufficient to rule-out cholelithiasis and hasten her disposition.
Prophylactic antibiotic use to prevent Weil’s Disease after immersion in water
A drainage engineer comes to the Emergency Department following a fall and total immersion in standing water. He is concerned about Weil's disease. You do not know whether prophylactic antibiotics are of any use in disease prevention.
A 70-year-old woman presents to the Emergency Department with urosepsis and requires intubation. You consider using Etomidate as an RSI agent, but wonder if it will increase morbidity and mortality secondary to adrenal suppression.
A 25 year old patient is subdued by law enforcement with the use of a Taser device. He is brought to your Emergency Department for further evaluation. You would like to know what type of cardiac monitoring is necessary (and for how long).
Do prothrombin complex concentrates improve outcomes in patients with life-threatening bleeding?
A 72 year old woman is brought in to Emergency by the paramedics after a fall from her own height at home. She slipped and hit her head on the edge of the bathroom sink and presents with a hematoma above her left eye. Her current Glasgow Coma Scale is 11 (E3M3V5), and she is only oriented to person (not place or time). She is on warfarin for atrial fibrillation and her other medications include metformin, gliclazide, ramipril, atorvastatin, metoprolol, nitroglycerin patch and furosemide. Urgent CT of her head reveals a left sided subdural hematoma. You want to reverse her anticoagulation with a prothrombin complex concentrate, but you are unsure of the evidence around their efficacy.
A 45 year old man presents with pain in the neck, wanting to know if he should be referred for Manual therapy (delivered by physiotherapists).
A 4 y/o boy presents to an urgent care setting with a 1 cm laceration across the volar aspect of his index finger just distal to the dip joint? The attending physician is debating whether to numb the laceration locally versus employing a digital block
A 13 year old boy attends the emergency department after a clash of heads on the rugby field. He has a mild head injury and is discharged home with a head injury advice sheet based on the NICE guidelines. He is not happy with the advice to abstain from sport for 3 weeks as he will miss the remainder of the season.
Honey for the Symptomatic Relief of Cough in Children with Upper Respiratory Tract Infections
A mother brings her 4 year old son to the emergency department with a cough, runny nose, and sore throat for the last 3 days. She requests medicine for the cough which has been keeping them up at night. You wonder if there is sufficient evidence to support the use of honey for the treatment of cough in children with URTIs.
Eccentric exercise in the treatment of Achilles Tendinopathy
A 31 year old male presents with a 3 year history of Achilles tendinopathy. You are planning to use standard treatments of electrotherapy, ICE and strengthening exercises to improve his symptoms. You have heard from a colleague about an exercise regime based on eccentric muscle contractions and you wonder if there is any evidence of greater efficacy compared to the other treatments.
Intracerebral Hemorrhage (ICH) Management in Anticoagulated Patients
A 62 year old female school teacher who lives alone presents with a headache. She has a history of atrial fibrillation and takes Coumadin daily. You order a MDCT (Multi-detector computerized tomography) head scan and find an intracerebral hemorrhage. During her time in the ED she becomes slightly confused. What is your management? Three Part Question: In [patients with AAICH (Anticoagulant Associated Intracerebral / Intracranial Hemorrhage) and elevated INR from VKA (Vitamin K Antagonist)], how useful are [Vitamin K, FFP (Fresh Frozen Plasma), PCC (Prothrombin Complex Concentrate) and rFVIIa (recombinant factor VIIa)] in [INR normalization, clinical outcome and hematoma reduction]?
A twenty-four year old man attends the emergency department with an anterior shoulder dislocation. You have heard of ketamine/propofol mixtures being used for sedation and wonder if you should consider using it for procedural sedation.
Is intranasal fentanyl better than parenteral morphine for managing acute pain in children?
A child presents to the paediatric emergency department in acute pain but you cannot give him intranasal diamorphine due to both a departmental and nationwide shortage. You are able to give them either IM or IV morphine but wonder whether you can use intranasal fentanyl instead
Should I use 2.5mg or 5mg Nebulised Salbutamol in Acute Exacerbations of COPD?
While working a busy nightshift in A&E, you see a patient with an acute exacerbation of COPD. They require bronchodilators & the nurse asks you if you want 2.5mg or 5mg of nebulised salbutamol. You usually administer 5mg however wondered if 2.5mg salbutamol would have the same effect?