A 59-year-old construction worker presents to the Emergency department after a workplace accident. He fell from a ladder and sustained a deep wound on his forearm from a rusty nail.
Upon examination, the wound appears to be severely contaminated. After obtaining an x-ray to rule out any foreign objects, what is the most effective cleaning agent to use for this wound?
A 25-year-old homosexual male has tested positive for both IgM anti-HBc antibody and hepatitis B surface antigens. What is his current disease state?
A 48-year-old woman is brought to the Emergency department by emergency ambulance following a deliberate overdose of an unknown drug.
She is accompanied by her husband who tells you that she has a long history of anxiety and depression and takes fluoxetine 20 mg od and lorazepam 2 mg bd.
On primary assessment, her airway is clear but she only groans when sternal rub is applied. Her chest is clear to auscultation but her respiratory rate is 6 ventilations per minute and oxygen saturations are 93% on air.
Heart sounds are normal with a rate of 80 bpm and blood pressure is 82/44 mmHg. ECG shows sinus rhythm. Capillary blood glucose is 6.3 mmol/L. Her GCS is 8/15 (E1, V2, M5) but her pupils are slowly reactive bilaterally and size 4. All limbs appear to move equally and there is no apparent injury. She smells of alcohol.
What is the first most appropriate step in the immediate management of this patient?
A 47-year-old female collapses at home and is referred to the medical team. She has had two episodes of haematemesis in the emergency department, but no melaena. Her family denies any history of alcohol excess, and she has been otherwise healthy.
Upon examination, the patient appears pale and sweaty with a pulse of 110 bpm. Her lying blood pressure is 95/60 mmHg, which drops by 30 mmHg systolic upon standing. Palmar erythema, purpura, and spider naevi are noted. There is no hepatomegaly, but a fullness is present in the left hypochondrium.
What is the appropriate course of action for this patient?
A 75-year-old male presents with haematemesis and melaena.
His initial blood pressure is 80/46 mmHg, and his heart rate is 114 bpm. He has a history of idiopathic cirrhosis and mild encephalopathy.
You begin resuscitation with colloid, blood, FFP, and dextrose.
What is the most suitable next medical intervention while waiting for an OGD to be arranged?
As the ward cover foundation year doctor, you receive a fast bleep at 2 am for a patient experiencing a tonic clonic seizure. The nurse informs you that the patient, who is in for neuro observations, sustained a head injury six hours ago in the Emergency Department. The patient currently has an IV cannula, but the nurse has already administered PR diazepam as prescribed on the drug chart. The seizure has been ongoing for about 8 minutes now.
Fifteen minutes ago, the patient’s neuro observations were as follows: HR 70, BP 135/65 mmHg, RR 18, O2 97% on room air, and BM 7.0.
What would be your next course of drug therapy for this patient, who is slightly older than the previous case?
A 17-year-old boy is rushed to the Emergency department following drug use at a party.
What signs indicate that he may have ingested Ecstasy (MDMA)?
What EEG findings are typically observed in patients with hepatic encephalopathy?
A 56-year-old woman presents to the Emergency department complaining of neck pain. She was in a minor car accident three days ago where her car was hit from behind. Upon examination, there is no tenderness in the bones and she has a normal range of motion without neurological symptoms.
What is the best course of action in this situation?
You are summoned to an emergency on the orthopaedic ward where a 75-year-old male has been discovered unconscious by nursing staff. He has recently undergone surgery for a fractured hip.
Upon examination, he is tachycardic with a blood pressure of 100/60 mmHg. His oxygen saturation was 90% on air, and the nursing staff have administered oxygen at 15 litres/minute. His respiratory rate is 5 breaths per minute, and his chest is clear. The abdomen is soft, and his Glasgow coma scale is 10/15. Pupils are equal, small, and unreactive, and he has flaccid limbs bilaterally.
What is the appropriate course of action?