A pregnant woman presents to the ED with symptoms describing a PE. A D-Dimer test you order is unequivocal so you wish to order further investigations. At that time helical CT and V/Q scanning are available, you wonder how reliable they are in pregnancy.
Archives: BETs
A 3 year old child accompanied by his mother presents to the emergency department with symptoms of pulled elbow following a minor slip on the stairs where he grabbed the bannister. Mum is quite annoyed when you examine the child as you reduced the same elbow 5 days previously. Happy that the elbow was in full use before the initial discharge you wonder if splinting the elbow in some way would have prevented recurrence.
Oral steroids are just as effective as intravenous steroids in acute exacerbations of COPD
A 73yr old man with COPD is seen in the Emergency Department. You give him salbutamol and atrovent nebulisers but he remains breathless. You wonder whether giving intravenous or oral steroids would reduce length of hospital stay and his risk of death.
Heart rate for prediction of complications following tricyclic antidepressant overdose
A forty year-old homeless man presents to the Emergency Department claiming to have taken ten of his dothiepin tablets two hours ago. His ECG shows normal QRS duration and normal QRS axis, his blood pressure is 130/85 and he is fully conscious. He therefore appears to be at low risk of complications but his heart rate is 110 beats per minute. You wonder if this is a useful predictor of complications.
Using ultrasound to detect peritoneal fluid in a pregnant patient with abdominal trauma
A pregnant patient in her 3rd trimester is brought in by ambulance following an accident in a car where she was the driver. You wonder how effective ultrasound would be in detecting the presence of peritoneal fluid in such a late stage of pregnancy.
Emergency caesarean section in cardiac arrest before the 3rd trimester.
A pregnant patient who was the restrained passenger in a motor vehicle accident was brought in my ambulance 10 minutes ago unconscious, all of a sudden she goes into cardiac arrest. CPR is commenced and you wonder if the next thing to do would be a caesarean section but she is only 24 weeks pregnant.
A pregnant woman of 32 weeks gestation is admitted to the ED after a fall. She has blunt abdominal trauma and is having what seem to be uterine contractions. You wonder whether you start tocolytic therapy to try to prevent or delay a premature delivery and so prevent some of the possible complications for both mother and baby.
Is a normal CRP sensitive enough to rule out septic arthritis
A 48 year old with a presents with a one day history of red, swollen right knee. On examination she is febrile, has decreased range of movement and a left knee effusion. You order bloods and the CRP comes back within normal range. You wonder what benefit CRP gives in ruling out SA?
Is a negative gram stain in suspected septic arthritis sufficient to rule out septic arthritis
A 30 year old Nurse 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 a negative gram stain. You wonder if negative gram stain is enough to rule out septic arthritis?
Is Cervical spine protection always necessary following penetrating neck injury
A 23 year old male is brought to the ED after an alleged assault. He sustained a gunshot wound to his neck, is haemodynamically stable, and currently there is no bleeding from the wound. Your secondary survey does not reveal any neurological deficit. The ambulance crew has not immobilised his cervical spine, and you wonder if you should apply cervical spine immobilisation.
The use of ultrasound for diagnosing paediatric wrist fractures
A 4-year-old boy attends the emergency department (ED) complaining of a painful wrist following a fall. You suspect a torus fracture. However, his mum is pregnant and he bursts into tears when you tell him she cannot go into the x ray room with him. You wonder whether ultrasound can be used to diagnose a fracture of the paediatric wrist accurately?
Do wrist splints need to have a thumb extension when immobilising suspected scaphoid fractures?
A 23 year old man presents with a painful wrist following a fall on outstretched hand. On examination he has diffuse wrist pain and is tender in the anatomical snuffbox. His wrist and scaphoid views do not demonstrate a fracture. You organise a two week follow up appointment in the ED clinic and give advice regarding analgesia. You have decided to immobilise the wrist in a splint, but wonder if one with a thumb extension is better than a standard splint at immobilising suspected scaphoid fractures.
The Negative Predictive Value of Absence of Fever in Excluding Septic Arthritis in Children
A 4 year old child present to the childrens area of the accident and emergency department with a painful tender hip joint. There is no history of trauma. His observations are normal and he has a temperature of 36.8C He has a normal xray and has has an ultrasound of the hip which shows a small effusion. He is awaiting blood tests. The mother feels blood tests are unnecessary. She asks you how necessary the blood tests are.
Use of intravenous omeprazole in gastrointestinal patients before endoscopy
A 55 year-old woman presents to the emergency department with fresh malaena. She is haemodynamically unstable. You wonder whether early use of intravenous omeprazole (prior to endoscopy) could reduce her rebleeding rate after emergency upper gastrointestinal endoscopy.
Should all patients with acute conjunctivitis be treated with antibiotics?
A healthy 25 year-old male presents to the emergency department with acute conjunctivitis. You suspect that it is likely viral in etiology, but you cannot rule out a bacterial source. You wonder if he should be started on antibiotics.
The management of agitation following tricyclic antidepressant overdose: Is sedation safe?
A burly thirty year-old man presents to the Emergency Department having taken a significant overdose of tricyclic antidepressant drugs. He is agitated and confused and it is not possible to treat him effectively. You wonder whether it will be safe to sedate him, given that you will depress his conscious level and the tricyclic antidepressants will delay gastric emptying, increasing the risk of pulmonary aspiration.
A 34 year Jamaican man attended the Emergency Department after having his back tattooed. He had gross urticaria and swelling to his lips and face. His tongue was large and inflamed. You looked at the tongue and wondered if you could put a tablet of adrenaline under it and whether it would work as well as an intramuscular injection. You remember from your student days that sublingual and rectal absorption of tablets is much faster than intramuscular injection.
A 20 year Arabian girl presents to emergency department having stung by a bee in her garden. She has urticaria and lip swelling. You offer her injection of adrenaline into her thigh, but she demands female doctor and adds that she will take injection only in her arm. You wonder whether there is any difference in the absorption and effect of adrenaline between the thigh and the deltoid.