Archives: BETs

You are examining a 4 year old child with abdominal pain - with appendicitis at the top of your differential diagnosis. If the child is tender at McBurney's point is that enough to confirm your suspicion of appendicitis and prompt surgical referral?

A 5 year old child comes into the Emergency Department with abdominal pain. On 'auto-pilot' you order a plain abdominal film. You wonder - will this actually help me make a diagnosis?

A 3 year old child comes into the Emergency Department complaining of tummy ache. As part of the abdominal examination you listen for bowel sounds. You wonder whether this will aid the diagnosis.

A 4 year old boy comes to the Emergency Department complaining that his tummy hurts. He tells you it's really painful. You wonder, does this child's severity of pain mean he is more likely to have more serious underlying pathology?

A 23 year old man presents to the Emergency Department with abdominal pain that started 2 days ago and yesterday became more intense and moved to the right lower quadrant. He has decreased appetite, two episodes of emesis today, and low-grade fever.

A 56 year-old man suffers a witnessed out of hospital cardiac arrest. He is given immediate bystander cardiopulmonary resuscitation (CPR). A paramedic ambulance crew arrives after 8 minutes. The first recorded cardiac rhythm shows ventricular fibrillation. The ambulance crew continue CPR in accordance with current Advanced Life Support guidelines. Initial resuscitation attempts including three defibrillation attempts fail. The paramedic team is equipped with and fully trained in the use of a mechanical CPR device and this is applied and the patient transferred to the nearest emergency department. You wonder whether mechanical CPR or manual CPR is more effective at achieving a restoration of spontaneous circulation and improving the patient's chances of leaving hospital alive.

A 5 year old boy was admitted to a rural New Zealand hospital with 10 day history of abdominal pain. The pain was localised to the RIF with guarding and examination revealed a palpable mass in the RIF. He had previously presented with a 1 day history of severe abdominal pain and fever and had been discharged the following day with a diagnosis of gastroenteritis. He was transferred to the tertiary hospital and a diagnosis was made on ultrasound scan of appendiceal mass with abscess. His condition was stable. He was commenced on conservative management and supportive care with intravenous (iv) antibiotics followed by a 2 week course of oral antibiotics. He responded well to conservative management and was scheduled for appendectomy after an interval of 6-8 weeks. You wonder whether it is necessary, now he is well, for him to have an appendectomy.

An 18 month old child presents to the Emergency Departmentwith diarrhoea following what sounds like an acute episode of gastroenteritis. She is not significantly dehydrated and can tolerate fluids orally. Mum is concerned as the child has an increasingly sore nappy area and because "things just go straight through her". You have heard that live yogourt and probiotics can be helpful and recommend this to the mother. When you mention this to your junior colleagues later they look at you sadly and shake their heads. Self-doubt sets in and you decide to look for the evidence to show them who knows best

A 40 year old male sustains a 2 cm laceration to his left forearm. There is no tendon/neurovascular damage. Would warmed local anaethetic or room-temperature local anaesthetic be less painful on infiltrating the wound prior to suturing?

A 24 year old male pateint presents to the emergency department after a high speed motor vehicle accident. Patient was intubated in the field has a GCS of 7T, multiple lacerations and obvious deformity of his RLE. While ordering diagnostic xrays, you wonder about the radiation exposure to the patient.

A five year boy is presented to the Emergency department by his mother. His mother complains that he has constipation. After examining the boy's abdomen you wonder whether in order to confirm the diagnosis you should perform a digital rectal exam (DRE).

An eight year old boy present to the Emergency Department with acute abdominal pain. His parent tells you that the boy hasn't passed any stools for a few days. You wonder whether an abdominal x-ray would be useful in diagnosing constipation.

24 year old gravida 1, para 0 female at 7 weeks gestation presents to the emergency department with a one day history of vaginal spotting, suprapubic abdominal cramping and nausea. You perform a digital exam and wonder if a speculum exam is really necessary.

You are preparing to perform a lumbar puncture to exclude subarachnoid haemorrhage. The patient is concerned that he might develop a worse headache after the lumbar puncture as his father has experienced in the past. He asks you if there is anything you could do to ensure this does not happen. You are using the smallest available LP needle, and you wonder whether prophylactic caffeine could prevent post lumbar puncture headache.

A 50 year old non-insulin dependent diabetic presents to the Emergency Department with a three day history of fever, acute confusion and lethargy. On assessment you find him in septic shock and commence peripheral fluid resuscitation. As part of the early goal directed management of this man you need to place a central venous catheter but wonder which route will be more successful and produce less complications.

A 77 year old diabetic male attends the emergency department with sudden onset "tearing" interscapular pain and a widened medistinum on CXR. You suspect aortic dissection and request a contrast enhanced CT Angiogram. The radiologist reluctantly agrees, but notes his diabetic history and metformin use as high risk factors for contrast induced nephropathy (CIN). You have no available U&E results, but previous values record an eGFR of 45ml/min. A cardiology colleague mentions off hand that N-acetylcysteine is used regularly to prevent CIN post elective angiography in patients with renal impairment. You wonder whether there is any evidence for its use immediately pre contrast in the acute setting.

An eight year old child presents to the A and E department complaining of abdominal pains and not having passed a stools for two weeks. You wonder whether the use of an osmotic laxative would have a lower risk of recurrence of constipation and if it would mean fewer side effects for the child over the course of the treatment.

A ten year old child presents to the A and E department complaining of abdominal pains and not having passed a stools for two weeks. After examination you decide that he has faecal impaction. You wonder whether there would be any added benefit if a rectal enema was used instead of oral laxatives.

In treating pediatric patients with diabetic ketoacidosis (DKA), minimizing the risk of cerebral edema is a mainstay of therapy. However, the pathophysiologic mechanism of cerebral edema in pediatric DKA is controversial. A literature search is performed to assess the evidence favoring the use of mannitol vs. hypertonic saline in the treatment of pediatric DKA.

A patient presents to the Emergency Department with a 6 mm calculi in the left distal ureter. You wonder if the use of tamsulosin would improve the chances of spontaneous stone passage.