Archives: BETs

A 28 year old female is brought to the Emergency Department by ambulance after being in a road traffic accident. She is GCS 15 and on examination she is complaining of abdominal pain on palpation and has an abdominal seatbelt sign. You want to know how likely it is that a significant intra-abdominal injury (IAI) finding will be found on CT.

Your Head of Department is considering the implementation of psychological support for staff with poor resilience. He is wondering whether the COVID-19 pandemic worsens the level of resilience of frontline nurses during the COVID pandemic.

A 55-year-old woman presents with shortness of breath, sinus tachycardia and low oxygen saturations. She is COVID-19 positive.

A 62-year-old gentleman attends thoracic outpatients with end-stage emphysema for consideration for lung volume reduction surgery. Imaging has identified heterogenous emphysematous areas in both upper lobes with minimal perfusion, and the patient is keen to discuss surgical options. You wonder what surgical approach would be most beneficial to the patient, bilateral or unilateral LVRS. You decide to undertake a review to investigate post-operative improvement following each procedure

A 66y female presents to the ED. She has been unwell for 3 days with SOB, cough and lethargy. Her PMH includes hypertension, for which she is on Lisinopril. She looks unwell with a pulse of 112, RR 26/min, BP 106/45 and O2 sats of 92% on air. She has clinical and radiological signs of a left basal pneumonia. You begin treatment for a community acquired pneumonia, including oxygen and antibiotics. As well as routine haematology and biochemistry, you are aware that other blood tests may assist in prognostication and treatment planning, but are unsure which blood tests are best in this regard.

A 35 year old man attends the emergency department having taking a staggered paracetamol overdose. He reports taking 72x500mg tablets over the past two days. He is suffering from persistent vomiting with increasing abdominal pain. His examination reveals right upper quadrant tenderness. He is acidotic on his blood gas. You start him on IV acetylcysteine as per the SNAP protocol immediately. Blood investigations are taken which reveal a raised ALT and INR. You are concerned that he is at risk of developing serious liver injury and wonder if there is any other treatment that could be initiated in addition to NAC to minimise this risk.

A 25-year-old women attends the emergency department having taken a large paracetamol overdose. She reports taking 64x500mg tablets 7 hours ago. On questioning she describes nausea and vomiting with mild abdominal pain. Her examination reveals right upper quadrant tenderness. Blood investigations reveal a high paracetamol level. You start her on IV acetylcysteine as per the SNAP protocol. You are concerned that she is at risk of developing serious liver injury and wonder if there is any other treatment that could be initiated in addition to the NAC minimise this risk.

An 82 year old lady is brought in by ambulance after falling down a flight of stairs. He vital signs are unremarkable and she undergoes a whole body CT after the primary survey. This reveals a moderate right sided haemothorax. The trauma team are in agreement that drainage is indicted. Should a 28-38Fr open thoracostomy tube or a smaller (16Fr or less) seldinger drain be inserted?

A 60 year old male presents to the Emergency Department with a minor head injury after tripping. He has no associated symptoms with the head injury but is on an anticoagulant. Should his management include a CT head?

You are expecting an 80 year old major trauma patient into the resuscitation room of the emergency department. You wonder what early interventions might improve her outcomes.

A 30-year-old, normally fit and well man presents with a headache, 36hrs after hitting his head when falling off his ladder. He did not lose consciousness at the time of injury, but now has a bad headache. He has a normal neurological exam. This fits the criteria for a mild head injury according the WHO head injury score. You know that current NICE guidance on imaging in head injuries has only been validated in populations of patients presenting within 24 hours. You wonder if you should request a CT head scan for this patient to look for possible traumatic intracranial pathology.

55 y/o women presents after taking 100 x 500mg paracetamol tablets. She has been found at home with the empty packets of tablets. On questioning she admits to taking the medication 10 hours ago. You immediately gain IV access and start NAC as per the SNAP protocol. Her paracetamol level comes back as >300mcg/ml. Given the high dose of paracetamol she has ingested you wonder if the standard dose of NAC will be enough and if there is any evidence to support increasing it?

An ambulance crew calls the local trauma unit with an 85 year old female they suspect of being major trauma. They want to know if she should be brought to the trauma unit or taken to the major trauma centre?

A 32 year old gentleman presents to the Emergency Department after falling during his 5-a-side football match. He reports hearing a ‘pop’ and pain in his posterior ankle. His Simmonds-Thomson test is positive and you suspect an acute rupture of his achilles tendon. You wonder if this patient should be put in an equinus cast or heel-raised functional bracing prior to orthopaedic clinic review.

A 36 year old female presents to the emergency department (ED) with symptoms of acute migraine. She has a history of migraine. She is systemically well. You wonder whether this patient could get symptomatic relief from a sphenopalatine ganglion (SPG) block via administration of intranasal lidocaine.

A 46 year old female presents to the Emergency Department out of hours with left leg swelling. Wells score for DVT is +2. You suspect a lower limb DVT and wonder if you can use point-of-care ultrasound to make your diagnosis.

A 37 year-old man attends the emergency department with cyanosis unresponsive to high flow oxygen. When blood is drawn it is a dark ‘chocolate’ colour and does not lighten when exposed to air. The patient reports he has recurrent methaemoglobinaemia of unknown origin and is currently under haematology who are attempting to illicit a cause. When is this man safe to be discharged?

51 year-old man present to ICU with respiratory symptoms, increased oxygen requirement, SOB and increased WOB. He has a background of TIIDM. ABG revealed type one respiratory failure. Patient not weaning. Clinical examination reveals bilateral dull percussion, reduced basal expansion. Portable CXR bibasal consolidation/atelectasis ?infection. COVID -ve. Consultant perform lung ultrasound and revealed bilateral pleural effusion worse on right which was tapped. You wonder if doing ultrasound on everyone would change clinical management and impact on patients quality of care if done routinely.