bestBETs

A 9 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache and two episodes of vomiting since the onset. She is a known migraine sufferer, who has had several similar episodes with associated nausea and vomiting in the past. After history and clinical examination, a diagnosis of migraine is made. You wonder if referral to neurology is necessary to rule out underlying aetiology.

A 11 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache. She is a known migraine sufferer, but her headaches have become more frequent in the last 2 months. After history and clinical examination, a diagnosis of migraine is made with possible secondary aetiology. You feel that neuroimaging is appropriate and wonder whether MRI would be better than CT at detecting any abnormalities.

Clinical Scenario A thirty-three year old male is goes into cardiac arrest after an accidental overdoes of tetracaine. Which drug would be most effective in the resuscitation of this patient?

A fifty-five year old male is administered a dose of local anaesthetic for an interscalene block in preparation for shoulder manipulation. Shorty after the drug is given he suffers a tonic-clonic seizure, after reading a local anaesthetic guideline recently published you question which action you should now take?

A twenty-five year old female receives an axillary block allowing a procedure may be carried out pain free. Ten minutes after receiving a dose of bupivacaine she becomes unresponsive and goes into cardiac arrest. What is the best treatment option in this situation?

A thirty-three year old female has been accidentally administered a large dose of bupivacaine, she is in cardiac arrest and after a prolonged period of standard resuscitation the question is raised if there is any alternatives that may be affective?

A twenty-three year old patient has a number of blood tests carried out within the emergency department, you notice a raised serum amylase, two weeks ago he received lipid emulsion therapy for an accidental local anaesthetic overdose, are these events related?

A patient enters the Accident and Emergency department. They are clearly distressed and do not respond to verbal pleas to calm down. They begin to act in a violent and threatening manner toward the staff, themselves or the other patients. You wonder how you should objectively assess this patient's level of agitation and aggression in order to best treat them.

A patient has received a benzocaine spray for pain relief during insertion of a nasogastric tube, soon after he becomes remarkably cyanosed. methaemoglobinaemia is diagnosed. What would be the best treatment option for him?

A 15-year-old boy is admitted with sudden onset chest pain and breathlessness. Chest x-ray shows a small pneumothorax. He has no background health problems. He is treated conservatively with high-flow oxygen, as the registrar has been taught this can improve the resolution rate of pneumothoraces. The consultant questions the biological plausibility of this treatment.

An elderly female patient of 82 presents to the emergency department with acute confusion of unknown cause. She is too delirious to take a history from and has no family present to give a collateral history. There are no focal neurological signs but you still wonder whether to perform a CT or MRI scan to rule out intracranial pathology as a cause of her confusion.

A 45 year old male presents at the emergency department with apparent acute confusion. He has no obvious signs of respiratory distress and the routine bloods have not come back yet. You wonder whether to order a chest x-ray next as you know some chest pathologies can cause delirium.

A 30 year old male patient with known allergic angioedema presents with acute angioedema with severe abdominal pain and stridor.

A 20 year old female patient presents to the ED of a busy acute hospital with swelling of face and lips and difficulty breathing. She has no previous history and has become suddenly unwell over the last hour.

While working for the neonatal transport team you are involved in the transfer of an extremely low birthweight preterm baby, 28 weeks' gestation, birth weight 800 g, on day 1 of life. The baby is ventilated with stable gases, minimal ventilator requirements and is not receiving any cardiovascular support. On clinical assessment you are concerned as the central capillary refill time (CRT) is prolonged at 4 seconds, despite normal cuff blood pressure. You wonder about the validity of prolonged CRT as a marker of poor organ blood flow in preterm newborns.

A 19 year old Afro-Caribbean male has received IM adrenaline and IV hydrocortisone for acute swelling of his tongue and face. He has shown no improvement after one hour and has begun to develop a hoarse voice.

A 50 year old female teacher with known hereditary angioedema presents to the Emergency Department 2 hours after a routine dental extraction with a rash and periorbital oedema.

A 45 year old female with known hereditary angioedema has a moderately serve acute attack which began 8 hours ago. Her sister died during an acute episode 1 year ago and she is very frightened herself. She has has C1 inhibitor in the past but has read about Icatibant on the internet.

A 21 year old ,ale with no family history of angioedema and no clear allergen exposure has an acute episode of urticaria, genital oedema and stridor which requires IV hydrocortisone and antihistamines in the Emergency Department. Would mast cell tryptase levels help to make a diagnosis?

A young caucasian male who presented with a first episode of severe angioedema requiring steroids and adrenaline has had a complete resolution of his symptoms after 4 hours and is keen to go home.