Archives: BETs

A 9 month old infant is brought to the Emergency Department by his mother with a 3 day history of coryzal symptoms and increasing difficulty breathing. Ausculation reveals widespread wheeze and crepitations, and you make a clinical diagnosis of bronchiolitis. You wonder whether a chest xray is indicated to confirm this diagnosis and assess its severity.

You are in the resuscitation room with a complex trauma case that has significant external bleeding. The wounds are dressed tightly with cotton gauze and bandages that are soaked through in spite of standard measures. You wonder if there are alternative dressings that will reduce the amount of blood lost before definitive management is organized.

A 1-year-old boy presented to emergency department with fever. History and Physical examination suggested upper respiratory tract infection. You want to prescribe paracetamol(acetaminophen) for the fever, but the boy kept on crying and oral route was not possible. You wonder if oral route is more effective than rectal administration.

A 35 year-old man presents to the Emergency Department (ED) 15 minutes after having experienced 30 minutes of central chest pain that resolved spontaneously. He has no previous medical history. Physical examination is unremarkable and the ECG is normal. You know that current rapid rule out protocols have limited sensitivity and are not recommended by the European Society of Cardiology or the International Liaison Committee for Resuscitation. You wonder whether heart fatty acid binding protein (H-FABP), an intracellular constituent of cardiac myocytes that appears in plasma soon after the onset of acute myocardial infarction (AMI), could be used to facilitate rapid exclusion of AMI in the ED.

A five year old child is rushed into the Emergency Department in cardiac arrest in the early hours of the morning. The circumstances leading to this are not clear. The paramedics have tried and failed to intubate the child. Two further unsuccessful attempts at intubation are made in the department. The paediatric anaesthetist has been called and is on her way but will not be there for some time. Reasonable chest expansion is possible using bag and mask ventilation although there appear to be a lot of secretions in the upper airway. You wonder if it is better to persist with bag and mask ventilation or if placement of a laryngeal mask would allow superior ventilation.

A 26-year-old man presents to the ED with a history of blunt trauma to the left trunk. Clinical signs are inconclusive and a supine chest x ray (CXR) demonstrates no pneumothorax. A subsequent CT scan demonstrates a left anterior pneumothorax. You have heard that focused thoracic ultrasound can detect pneumothorax and wonder whether this imaging modality is superior to plain x ray and whether there is any evidence to support this.

A 28 year old male with a gunshot wound to the leg presents to the emergency department in hypovolemic shock. Among other things, you place the patient in the Trendelenburg position, with the body tilted so that the feet is higher than the head. You wonder whether this position actually improves hemodynamics.

60 Lady presents with headaches < 72 hours in duration and vague neurological signs. you are not sure what the diagnosis might be and think of cavernous Sinus thrombosis . You get a CT head which is normal . You think if a D-dimer levels were low could you exlude Cavernous sinus thrombosis a dangerous cause of Headaches.

You are a paediatric registrar in a clinic. A mother comes in concerned about the shape of her 6-month-old infant’s head. She has previously been advised that counter-positioning and physiotherapy might help. She has heard from a friend about using helmets to correct the head shape. She wants to know if this therapy would benefit her child. You wonder if there is any evidence for the use of helmet therapy in correcting positional plagiocephaly.

A 45 year old male presents to the emergency department after feeling a wrenching sensation in his shoulder when lifting a box onto an overhead shelf. He cannot actively elevate his arm and radiographs reveal no fracture. You suspect he has a full rotator cuff tear, but wonder what is the best clinical test to confirm your suspicions.

A 34 year old gentleman presents to the department with a cut to his right arm caused by a knife which slipped during a D.I.Y accident. The wound needs closure with sutures and you wonder if using an absorbable material would provide a more convenient and equally as safe option.

An asthmatic patient is admitted to the emergency department with severe asthma. Despite conventional treatment they are not improving. You wonder if the use of inhalational anaesthetic would have any benefit in outcome.

A 20 year old university student presents to the ED with two day history of a hot, swollen joint. She reports no prior knee swelling and no recent trauma or knee surgery, illegal drug use, rash, uvetis or risky sexual behavior. On examination, she is afebrile and has a left knee effusion. Her WBC, ESR and CRP are all raised. The joint aspirate reports an elevated WBC and negative gram stain and culture. You wonder what value knowing the WBC and differential of the joint aspirate will give you in making a diagnosis and ruling out SA?