Archives: BETs

You diagnose a 5-year-old boy with autistic spectrum disorder. His examination is unremarkable and there is no family history of learning difficulties. Should you perform a molecular genetic screen for fragile X?

Adam is an 8-year-old boy with attention deficit hyperactivity disorder (ADHD) who you see with his mother in your paediatric outpatient clinic. She explains that life is being made increasingly stressful for the whole family as Adam is having difficulty getting off to sleep. It often takes him several hours to calm down and go to sleep, and the next day he gets angry and seems to be tired all the time. Adam’s insomnia is causing him and his mother to become frustrated and exhausted. She is at the end of her tether, but has recently seen on a television programme that melatonin may be effective in improving sleep pattern in children with ADHD. She asks you whether it would work in Adam. Are the television producers correct? If melatonin is prescribed for Adam, will it be harmful or helpful in improving his sleep?

You suspect appendicitis when a 20 year old female, 25 weeks pregnant, presents with right lower quadrant abdominal pain, vomiting, and low grade fever. An abdominal ultrasound is performed, but the appendix was not visualized, and the study is read as inconclusive. Knowing that there is a 25-50% negative laparotomy rate for appendicitis in pregnant patients you are hesitant to recommend surgery. You wonder if an MRI would be helpful in clarifying the diagnosis.

A pediatric patient presents to the Emergency Department with pyelonephritis. You would like to use a fluoroquinolone antibiotic, but are concerned about its safety in this patient population.

A septic hypotensive patient required an arterial line for early goal directed therapy but bilateral radial pulses were weak and multiple attempts were unsuccessful. A radial artery catheter was eventually secured under ultrasound guidance.

A 3-year-old boy presents to Emergency Department having pushed a nut in to right nostril. The foreign body is easily visible in his nose but the child is very uncooperative for you to remove it. While you are about to refer the child to ENT, your colleague asks you to try parent’s kiss and you wonder whether it will work?

A 33 year-old male is brought into the emergency department with an episode of acute breathlessness following a syncopal episode. His left leg is in a cast and he tells us that he returned from Australia recently where he broke his lower limb during a trek. He is tachycardic, tachypnoic, hypotensive, sweaty and clammy: he is in a peri-arrest situation. You wonder if bedside transthoracic echocardiography could rapidly confirm or exclude your presumed diagnosis and support your decision-making process with regard to treatment.

A patient presents with a few days history of pleuritic chest pain. All clinical findings and investigations are normal except for a raised d-dimer. A high probability V/Q scan confirms the diagnosis of pulmonary embolism. The patient is very keen to be discharged. You are aware that right ventricular strain is associated with a poor outcome in pulmonary embolism and you also know that B natriuretic peptides are raised in the presence of ventricular strain. You wonder if a low B natriuretic peptide level could be used to confirm the absence of ventricular stain and low risk of death or serious complications, therefore suggesting suitability for outpatient management.

A 29 year old man presents to the emergency department with a first-time, left anterior shoulder dislocation. A detailed history and exmaination post-reduction does not suggest a fracture, but you are not clinically certain the joint is relocated. You wonder if ultrasound technology could be used, as an alternative to plain film X-ray, to determine if reduction was successful.

A 36 hour old well baby born at term is jaundiced at their baby check and the serum bilirubin is 270 millimoles/litre (above treatment line according to Canadian PaediatricSociety guidelines, 2007). The baby is put under phototherapy but how much under the treatment line should the bilirubin be before the phototherapy can be stopped to prevent the baby needing to be readmitted for phototherapy.

A 3yr old girl is brought to emergency department by mother with a wound on the left knee.Child was playing and fell on glass peice.There is a visible laceration of 3cm length and moderate depth.xray didn't show foreign body.You decide to go forward and suture the laceration under Ketamine Sedation.In the previuos hospital you worked sedation was always given IV route but in the current hospital you are working ketamine sedation is done IM route .You go through the hospital protocol for ketamine sedation and finish the procedure.Next while discussing this case with one your seniors they suggest the reason for using ketamine IM is that it is assocaiated with less complications and longer duartion of sedation.You wonder what is the evidence.

Mrs B. brings in her 8 month old son with a 3 day history of mild fever and nasal congestion. You diagnose an acute URTI and provide advise on supportive measures. Mum mentions that her neighbour was given saline drops by the GP for their child and asks if you can prescribe the same. You wonder if there is any evidence of saline drops helping babies with colds

A 30 yr old man who has been involved in a car crash has been brought to your ED. His GCS is 7 and he was intubated in ED and underwent trauma series CT. His CT cervical spine has been reported as normal. He is about to be transferred to ICU and you are wondering whether CT cervical spine alone can exclude unstable ligamentous injury?

A 78-year-old female with long standing heart failure (New York Heart Association grade 3) is brought to the Emergency Department (ED) with respiratory distress and reduced conscious level. Arterial blood gas analysis demonstrates that the patient has type 2 respiratory failure and she scores 5/15 on the Glasgow Coma Scale (GCS). An opinion is sought from the Intensive Care Unit (ICU) physicians regarding the prospect of invasive mechanical ventilation (IMV), but they decide that the patient is not suitable for IMV. You consider instituting non-invasive ventilation (NIV). However, a depressed level of consciousness is traditionally thought to be a contraindication to NIV. This makes you wonder whether it would be an appropriate management strategy in this situation.