Archives: BETs

Jack is a 2.5 year old boy. He has been referred for developmental assessment by his health visitor. His community paediatrician diagnoses speech and language delay. His mother reports he first sat independently at 9 months and walked at 17 months.

A baby sustained extensive skin burns after the use of a skin preparation (alcoholic chlorhexidine). Following this event the hospital started using an aqueous preparation of chlorhexidine 0.05%. Was this the right choice and what is the evidence for the use of this or any other skin preparation in preterm infants?

A patient arrives in the emergency department is suffering from withdrawal symptoms. You know benzodiazepines can be given but are not sure if its the best treatment choice

A patient in the emergency department shows the beginning of alcohol withdrawal symptoms. You know that you can start them on a standard tapering course of treatment but have been told by a colleague that symptom based treatment using the patients CIWA score would be better

A patient presents to the emergency department whom you believe to be a chronic alcohol abuser. Your worried he may be at risk of wernickes encephalopathy and wonder whether you should give him prophylactic Vitamin B supplementation

A patient arrives in the emergency department because of an alcohol related incident. You want to know whether they are at risk of further problems and believe the Paddington Alcohol test would be appropriate but are not sure if it is as useful as the better known CAGE questions.

A 47 year old female patient is brought to your ED. She admits to regular alcohol consumption, is tachycardic with extremities tremor and ataxia. She asks you for something to help her with her symptoms. She has not drunk any alcohol for two days. You wonder if any biological marker would allow you to predict if she is really at risk of developing an alcohol withdrawal syndrome.

A 45 year old man with diabetes and peripheral neuropathy presents to the emergency department with a hot, red, swollen foot. There is no break in the skin and the patient cannot recall an injury. You suspect Charcot's arthropathy and wonder if plain x-ray or MR Imaging should be your imaging method of choice.

A 58 year old male patient with long standing diabetes mellitus and peripheral neuropathy presented to the emergency department after having noticed a deep wound to the plantar aspect of his left foot. You suspect osteomyelitis and wonder what would be the most appropriate imaging modality- plain radiograph or MRI.

A 9 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 once. She complains that noise makes the headache worse. She has had this headache once before last week but did not attend the emergency department as it was relieved after sleeping. After taking the history and clinical examination your clinical impression is migraine. You wonder whether the ICHD is useful to support your diagnosis.

A 12 year old child comes to the emergency department accompanied by her mother. The child complains of a severe throbbing headache which started an hour ago but is still present. She has also vomited once in the last 30 minutes. She has had this headache once before last week but did not attend the emergency department. After taking the history and doing the clinical examination you diagnose the child as having migraine. You wonder whether Prochlorperazine is useful in treating the childs migraine.

A 43-year-old male is brought into the resuscitation room having been stabbed with a knife in his left chest. The patient is hypotensive (blood pressure 80/40mmHg) but remains conscious, and cardiac tamponade is suspected. A focussed abdominal sonography for trauma scan (FAST) shows an obvious haemopericardium with early right ventricular collapse. There is no on site cardiothoracic support and the general surgeons want to transfer the patient to another hospital for definitive surgery. The on call surgical registrar decides to perform pericardiocentesis for this patient but you wonder if this procedure is useful.

A 3 year old child presents to the emergency department with a twenty four hour history of vomiting, diarrhoea and reduced oral intake. You wonder whether giving oral ondansetron would improve the success of oral rehydration and reduce the requirement for IV rehydration.

A 25 year old male adult falls 4 ft and lands on his back. He comes into the Emergency Department complaining of lower back pain. He denies any pain in the neck region. The pateint has been completely immobilised by paramedics. On neurological examination NAD. Plain X-ray shows a Type A thoracolumbar burst fracture at the T12-L1 junction. You wonder whether further spinal immobilization is necessary in this patient

A 59 year old man has a witnessed out of hospital cardiac arrest and immediate bystander cardiopulmonary resuscitation (CPR). When the paramedic ambulance crew arrive after 8 minutes the first recorded rhythm is asystole. Resuscitation continues according to current ALS guidelines. The patient is intubated, ventilated with high flow oxygen and receives 1mg of adrenaline and 3mg of atropine iv. He remains in asystole after a further cycle (2 minutes) of CPR. You have heard that other agents may be useful at this stage and wonder if there is any evidence that iv aminophylline is effective.

Following a fall from a height a window cleaner aged 40 years arrives by ambulance to the emergency department. He complains that he can't feel his legs. Neurological examination shows both motor and sensory deficit in the lower limbs. You wonder if MRI would be better than CT as the primary radiological investigation

A 45 year old male patient falls 12 ft from a ladder onto his back. He presents to the emergency department complaining of lower back pain. You wonder if CT is better than plain X-ray at diagnosing thoracolumbar fracture

A 45 year old male presents to the emergency department complaining of lower back pain following a 6 ft fall from a ladder. CT confirms your suspicion of a burst fracture at L1. Neurological examination is normal. You wonder if bed rest and TLSO bracing in these patients will produce a satisfactory functional outcome

A 45 year old adult presents to the emergency department following a fall from a height. Neurological examination is normal, however, CT shows a burst fracture at L1. You wonder what the current method of management in these patients is.

It is midsummer''s day in a busy Emergency Department and it is sweltering outside. Your impervious, long-sleeved uniform (that the Trust insist you should wear for health and safety reasons) is moist with sweat. The temperature is 30 degrees centigrade and you are rushing around, like usual, trying to do three things at once. You decide to turn the electric fan on but the nurse in charge tells you that Infection Control have removed all of the fans because they spread infection. The air conditioning has been out of use for a long time because it, too, apparently spreads infection. You wonder whether there is actually any evidence that electric fans spread infection or whether it is more of a risk for the patients to be treated by an overheated, dehydrated, sweaty doctor.