Archives: BETs

You have been asked to evaluate a previously very fit 65 year old ex-mountaineer for aortic valve replacement(AVR). He first presented to the cardiologists in pulmonary oedema 2 weeks ago although he tells you that he has been getting gradually worse for 3 years. The transthoracic echo revealed an effective orifice area (EOA) of his aortic valve of 0.7cm2, left ventricular ejection fraction of 30%, and mean transaortic pressure difference of 25mmHg. The cardiologists performed a dobutamine stress echocardiography(DSE) that revealed a minimal rise in the systolic velocity integral (15%) and no increase in the EOA. The cardiologists feel that he is beyond the point at which an AVR would help him, but would value your opinion.

A patient is brought to the emergency department following a motor vehicle accident. He is tachycardic, hypotensive, with decreased breath sounds on the left. The airway is patent. You place a chest tube and there is a sudden rush of air. Vital signs improve. CT of thorax revealed tube postioned in the lung fissure and a small hemothorax. The chest tube has drained 300 ml. You wonder if a chest tube placed in the fissure is adequate for drainage of a hemopneumothorax.

A 60yr old lady presents to A and E complaining of wrist pain following a mechanical fall. X rays reveal a Colles fracture. You wonder if manipulation of the fracture will actually improve her functional outcome?

A patient who has suffered a traumatic brain injury (TBI) is admitted to your rehabilitation hospital. Other therapists have used body weight supported treadmill training (BWSTT) with patients post stroke. What evidence supports the use of BWSTT in a TBI population?

A 25 year old man attends A&E in the early hours with a deep knife wound to his forearm. The plastic surgeon wants to take him to theatre for exploration the following morning and asks for a betadine (povidone-iodine) dressing to be applied. The wound looks clean and you wonder if this is likely to alter the likelihood of the wound becoming infected.

A very low birth weight baby is born at 27 weeks gestation.She is now fully stable and 10 days old requiring low flow oxygen via the nasal prongs, is on full enteral feeds. Her Hb is slightly low at 13, her biochemistry is otherwise normal. Her saturation alarm limits are kept at mid 80s to low 90s, which is the local policy. Is there good evidence that this reduces complications to her eyes and future development of chronic lung disease or may actually be harmful by inducing an element of chronic hypoxia?

70 years old patient has been brought in to the resuscitation area with an exacerbation of COPD. Nebulizers and steroids have been given and had little effect. You wonder if you could use intravenous magnesium sulfate to improve his airflow.

A 60-year-old man with fever for 5 days is brought to the emergency department by his family. He has no other somatic symptoms except for fever. The results of the physical examination are within normal limits except for a moderately enlarged prostate. Laboratory studies including chest film and urine analysis show no specific findings. You wonder whether serum prostate specific antigen level would assist in the diagnosis of acute prostatitis.

A 28 year old male attends at 7.30am having dislocated his shoulder again, this time when making the bed that morning. He states he is awaiting an elective orthopaedic procedure planned later this year. This is his 3rd non traumatic dislocation in the last 2 months. The shoulder is clinically relocated with ease using morphine and entonox only. A pre-reduction x-ray was not taken as the diagnosis was clinically obvious. You are confident that the shoulder is relocated and wonder if a post reduction film is still required.

A 39 year old man referred to the PT clinic with a 3 weeks history of low back pain. There is no history of back pain or work-related back injury. At the L4-L5 level, there is herniated nucleus pulposus without nerve root compromise as shown in the MRI images. He has limitation of lumbar spinal mobility without red flags. He is normally fit and well. He is extremely afraid that any physical activity might damage his back. You wonder how to plan a rehabilitation program that will help to reduce his fear along with pain and risk of disability.

A 21-year-old male presents to the emergency department after taking few Ecstasy tablets on a night out. He is agitated, sweaty with a body temperature of 42.5°C. Reduction of the hyperthermia is initiated by stripping the patient, applying cold packs, and later using cold IV fluids and Paracetamol. Would the use of Dantrolene be of any benefit in the management of this case.

A 65 y.o. presents tachycardic, hypotensive and decreased LOC. ECG reveals ventricular tachycardia. As your staff places the pads for cardioeversion you discover he has been on digoxin for the past three years. You remember Digoxin Fab fragment, not cardioversion, is the treatment for digoxin induced ventricular dysrhythmias; however, you wonder if there are other therapies that maybe beneficial to your patient.

A two year old has a witnessed cardiopulmonary arrest whilst in your Emergency Department. You are able to ventilate the child using a bag valve mask (BVM) and oral pharyngeal airway, but notice his stomach is becoming inflated. In cardiac arrest in adults you know that a LMA or iGel is now the advised airway to use (ALS guidelines 2011), but you wonder if this could apply to children as well.

A 21-year old man attends the emergency department after a night out. He is intoxicated and has an occipital head injury. He apparently lost consciousness for 10 minutes and has vomited 4 times since arriving in the department. You decide to request a CT scan of his head. Local guidelines allow you to interpret this yourself. You wonder how robust this is compared to the old system of requesting the scan through the radiologist on call

Paramedics may be exposed to incidents in uncontrolled environments, managing potentially critically ill patients, other people, and other emergency services. In the presence of these factors, can paramedics still conduct drug calculations with a high degree of accuracy?