Archives: BETs

Both authors work in the North-West region of England which has a relatively high proportion of people of Asian origin. We often encounter pregnant women and children from this ethnicity who are clinically and/or biochemically Vitamin D deficient. One solution to this is to supplement Vitamin D to all pregnant women at risk and this would benefit them and their baby. Currently, in our hospitals Vitamin D is given only to those with proven deficiency and not routinely to those at high risk. We decided to look at the evidence for this.

A patient under your care is diagnosed with acute renal failure. You have read the most recent BETs on dopamine, but you wonder if dopexamine may have different results. You investigate.

A 9 year old child comes to the emergency department accompanied by his mother. The child complains of recurrent headaches which started a month ago. The headaches awakens him from sleep and are worse in the morning. He has also had recurrent vomiting associated with his headaches. On questioning the childs mother she reports that her son tends to be confused during the headache episodes, and that there has been a recent change in her sons personality. You are worried that this child could have a brain tumor. You wonder whether a CT scan is better than an MRI scan to rule out the diagnosis of a brain tumor.

An adult patient presents to the Emergency Department after an episode of binge drinking. You wonder whether a brief intervention by the alcohol nurse will reduce their drinking in the future

A patient arrives in your emergency department that has signs of acute renal failure,. You suspect this may be due to their fluid imbalance, causing the kidneys to be inadequately perfused, but you cannot completely rule out parenchymal disease. You have never been completely convinced of the reliability of the fractional excretion of sodium to differentiate between the two, but you wonder if fractional excretion of urate is more effective.

A 9 year old child comes to the emergency department accompanied by his mother. The child complains of recurrent headaches which started a month ago. The headaches awakens him from sleep and are worse in the morning. He has also had recurrent vomiting associated with his headaches. On questioning, the childs mother reports that her son tends to be confused during the headache episodes, and that there has been a recent change in her sons personality. You are worried that this child could have a brain tumor. You wonder whether you should refer the child to radiologists for MRI scan of the head.

A 5 year old child comes to the emergency department accompanied by her mother. The child complains of a bilateral headache of moderate intensity which started 30 minutes ago and is still present. She has also vomited in the last 10 minutes. You wonder whether this patient has a migraine or a tension headache.

A 13 year old child presents with a bilateral severe throbbing headache to the emergency department with her mother. She came to the emergency department 2 months ago complaining of the same type of headache but of moderate intensity. At that time she explained that the headaches started a month before attending the emergency department. She was referred to the head specialist and was given a headache diary to fill in. You look at the headache diary and see that headaches last on average for one and a half hours, are associated with nausea and vomiting and are relieved by sleep. You wonder whether the headache diary is useful in making the diagnosis of migraine.

An 11 year old child comes to the emergency department accompanied by her mother. The child complains of a bilateral severe throbbing headache which started an hour ago but is still present. She has also vomited in the last hour. You wonder whether these two symptoms are adequate to make a diagnosis of migraine.

A man presents to your department with hyperkalaemia, and you are about to begin the standard insulin and glucose therapy, when you recall someone mentioning the use of salbutamol for hyperkalaemia. You quickly treat the gentleman before going to find out.

A patient presents to your A&E department acutely unwell, and you suspect acute renal failure, however creatinine does not appear deranged enough to account for the symptoms seen.

A 70-year-old woman presents to the emergency department (ED) with confusion and collapse. You find her serum creatinine is 180 μmol/l and wonder which classification system you should use to determine her renal function and prognosis.

Your hospital has a policy which states that blood cultures should be taken by dedicated venepuncture, rather than from freshly inserted intravenous cannulae, in order to reduce the risk of contamination. You wonder if this is supported by the literature.

A 45 year old male with diabetes, peripheral neuropathy and obesity presents to the emergncy department with a wound to the planter aspect of his left foot. On inspection you find an ulcer roughly 2cm x 2cm which does not appear to be infected. The man tells you it has been there for some time and is gradually enlarging, although it is not painful. You know that off-loading the pressure on the area should help it to heal and wonder what is the best way to do this.

A 54 year old male with diabetes and peripheral neuropathy presented to the Emergency department with a hot, swollen, red left foot. He was investigated and found to have Charcots arthropathy. You know the best way to prevent further joint destruction is to off-load the foot but wonder what is they best way to achieve this.

A 69 year old female patient with diabetes and peripheral neuropathy presents to the emergency department with a wound to her left foot. On inspection there is an ulcerated area surrounded by callus. There are local signs of infection (swelling and erythema) requiring an antibiotic, but the patient is systemically well and fit for discharge to follow-up. You wonder if the wound can wait to be debrided by the diabetes team the next day or if there would be any benefit to sharp-debridement performed immediatly.

A 60 year old male patient in the Emergency Department has just been diagnosed with Charcot's arthropathy. You know that pamidronate is used to reduce joint destruction and wonder if there is any additional benefit to administering the drug before you discharge the patient compared to him recieving it a day later from the diabetes team.

A 25 year old haemodynamically stable patient presents to the emergency department following a high speed RTA with suspected intraabdominal injury. You wonder whether an FAST scan would be helpful for diagnosis.

A twenty month old girl is seen on the paediatric assessment unit with a 3 day history of diarrhoea, vomiting, and poor fluid intake. On examination she is miserable and lethargic and moderately dehydrated. A random bedside blood sugar measurement is 2.1 mmol/L. A metabolic screen is performed and results are not suggestive of an underlying metabolic disorder. Before discharge a controlled fast is carried out with no abnormality detected. Was all this investigation necessary?

You are working in a very busy Accident and Emergency Department and the Triage Nurse informs you that, a patient with "Amphetamine induced chest pain" has just arrived. you wonder , what his chances are, to develop Acute Myocardial Infarction.