Archives: BETs

A 42 year old man attends the Emergency Department with an episode of renal colic. PR voltarol has not provided any relief. You wonder if a calcium channel blocker would facilitate passage of the stone and allow for earlier discharge from the Emergency Department.

A 28 year old male with known depression attends the Emergency Department (ED) six hours after a small overdose of benzodiazepines. He is threatening to leave the ED prior to mental health assessment. You wonder whether the SADPERSONS scale is useful in predicting his risk of further self harm or completed suicide.

A 52 year old patient 36-hours after mitral valve repair and grafts arrests with an asystolic ECG. He had been on increasing doses of adrenaline and a TOE had shown a poor LV but no tamponade. After 2-minutes of external cardiac massage and 1mg of adrenaline you elect to perform an emergency re-sternotomy with the intention of putting the patient back on bypass. Once commencing internal massage you are surprised at the significantly better arterial pressure that you are able to achieve performing internal massage.

A 720 g neonate in the intensive care unit develops severe hyperkalaemia with cardiac arrhythmia. The specialist registrar decides to give a calcium gluconate bolus and start an insulin and dextrose infusion. The new registrar queries why salbutamol and ion exchange resins were not considered as these therapies are frequently used in the management of hyperkalaemia in older children and adults.

You see an 8 year old girl who developed a widespread rash which appears to be target lesions after a viral URTI. You make a diagnosis of erythema multiforme. You wonder whether steroids may be of some benefit, but your consultant questions whether there is any evidence.

A 35 year old woman presents to A&E with 3 hours of severe unilateral headache and photophobia. She has a history of migraines and has been given opiates and NSAIDS in the past with little success. You wonder whether you should try some IV metoclopramide for her headache.

In a tertiary care neonatal unit a 30 weeks preterm was admitted from delivery suite. There was no any maternal risk factor for sepsis. The neonate remained stable in the first week of life. A percutaneous long line was sited on day 4 and parenteral nutrition was started. On day 8 he started having frequent desaturations & bradycardias, which later needed ventilation. In the view of deterioration he had partial septic screen, the FBC, CRP and Blood culture. The initial & repeated CRP remained negative. He had bedside Procalcitonin checked 24 hours after his illness started which came back strongly positive. The Blood culture grew gram positive cocci. The PCT responded to antibiotic therapy. We wonder if PCT is a better marker of neonatal sepsis than C-reactive protein.

A 8 year old boy present to your Emergency Department having sustained blunt abdominal trauma in a road traffic collision. You are familiar with the use of FAST in adult patients in similar situations, and wonder whether the investigation is useful in the paediatric patient.

You are working in the Paediatric Emergency Department when a 7 year old child comes in who has fallen off a swing and has an obvious deformity to his forearm. Your department has recently introduced a protocol to give intranasal diamorphine for pain relief. However you have also read a paper from Australia advocating the use of intranasal fentanyl in this situation. You wonder if there is any evidence that one drug is more effective than the other.

A 22 year old female presents to physiotherapy with patello femoral symptoms present for the last six months.At this time, she had moved into a flat on the third floor, & noticed gradual onset of symptoms.You are aware that quadriceps strengthening is known to improve the outcome of conservative treatment.Debate ensues as to whether open or closed kinetic chain exercises will be most beneficial in improving pain & function.

A 7-year-old boy is admitted to the general paediatric ward with bacterial community acquired pneumonia affecting the right lower lobe. It is suggested on the ward round that we arrange chest physiotherapy to try to reduce the length of his hospital stay. We wonder if there is evidence to support the use of physiotherapy in this case.

A 7-year-old child with a history of cough and fever for 1 week, has bronchial breathing over her left lower zone on auscultation. A diagnosis of lobar pneumonia is made, confirmed on plain chest x ray, and she is treated with appropriate intravenous antibiotics. However, she continues to have a spiking fever and develops signs of a left sided pleural effusion. Repeat chest x ray shows a "white out" of the left chest with no mediastinal shift. She is referred to the regional thoracic centre for consideration of thoracotomy and drainage of a left sided parapneumonic effusion. Should she be referred to the surgeons and if so, what should they do?

A 19-year-old girl attends the emergency department six hours after ingesting 80 paracetamol tablets. Her serum paracetamol level is above the treatment line and acetylcysteine is administered intravenously. She experiences nausea and vomiting. You have heard that ondansetron is more effective than other anti-emetics in this patient group and wonder whether this should be your first-line option.

A 27 year old female with a 2 day history of headache attends the A&E department. Clinical assessment of this patient comforms with a diagnosis of tension headaches. She was given Kapake for pain relief and discharged.

A 40 year-old man presents to the emergency department with multiple injuries after being involved in a road traffic crash. You wonder whether an initial serum lactate taken in the ED is a useful predictor of mortality.

A 55-year-old woman attends the Emergency Department following a fall, during which she sustained an injury to her left shoulder. She complains of pain and is unable to abduct her arm to more than 90 degrees. An x-ray shows no fracture or dislocation and you suspect a rotator cuff injury. You know that MR imaging is a reliable method of confirming this type of injuries but also that it is expensive and time-consuming.<br><br>You wonder if ultrasound is as an accurate imaging modality at confirming a rotator cuff injury.

A previously well 40 year old female is admitted with fever, headache, neck stiffness & photophobia. No neurological deficit is found on examination, you wonder whether LP can be safely performed without the need for a CT scan?