A young patient is brought to the Emergency Department following a car accident and presents with the following symptoms:
respiratory rate 15 bpm
pulse 70 bpm
blood pressure 120/80
Glasgow Coma Score 3/15
nasal bleeding mixed with clear fluid
orbital haematoma (‘raccoon eyes’)
no other facial bruising.
What is the probable cause of the patient’s injuries?
A 32-year-old man is brought into the Emergency Department after a low-speed road traffic collision. He removed himself from the vehicle and was standing in the layby upon arrival of the ambulance. Since he was complaining of neck pain, he was immobilised at the scene as a precaution. All observation en route and on arrival to the Emergency Department are within the normal range, but he is complaining of ongoing pain in the ‘middle’ of his neck. There are no neurological symptoms of note. When you examine him, there are no other injuries apparent, but he is complaining of pain when you press over his upper cervical spine.
What is the next step in the investigation and management of this patient?
A 30-year-old previously healthy man is involved in an accident at work. He is brought to the Emergency Department where he is found to have superficial abrasions to the left side of chest and upper abdomen together with an obvious deformity of the left humerus. Radiograph of the left arm shows a displaced, midshaft humerus fracture. Neurovascular examination reveals radial nerve palsy together with absent peripheral pulses and a cool, clammy distal arm. He was given oral paracetamol at work while waiting for the ambulance to arrive. Pain score remains 9/10. Parameters are as follows:
Patient Normal
Temperature 36.8°C 36.1–37.2°C
Pulse 115 beats/min 60–100 beats/min
Blood pressure 145/93 mmHg <120/80 mmHg
Oxygen saturations 99% on room air 94–98%
Respiratory rate 24 breaths/min 12–18 breaths/min
Which of the following is the most appropriate form of pain relief?
A 20-year-old man has suffered a stab wound to his left upper abdomen, directly below the costal margin in the mid-axillary line. Which organ is the most probable to have been harmed?
A 23-year-old man was stabbed with a knife and brought to the Emergency Department, with the knife still in the left posterolateral side of his body. The knife entered the intercostal space between the left ninth and tenth ribs, 10 cm posterior to the mid-axillary line.
What is the most likely structure to have been damaged first by the knife?
A 25-year-old victim of a high-speed car collision had a right sided pneumothorax, along with fracture of the pelvis and right humerus. A chest drain was inserted, which kept on bubbling over the next few days. The air leak got worse when the drain was connected to low-grade suction and the lung failed to expand fully.
What is the most likely cause of this complication?
A 72-year-old man with a history of smoking and high blood pressure arrives at the Emergency Department complaining of sudden-onset abdominal pain. He reports that the pain is severe and radiates to his back. Upon examination, a pulsatile mass is detected in his abdomen. The patient is currently stable and able to communicate without difficulty. The medical team suspects an abdominal aortic aneurysm (AAA).
Which layers of the abdominal aortic wall are expected to be dilated in this patient?
A 19-year-old man playing rugby injures his right arm, resulting in swelling and tenderness in the cubital fossa. Upon examination, it is found that the patient’s ability to flex his elbow is reduced and his ability to supinate his right forearm is significantly impaired. However, sensation in the skin of his right forearm remains intact. What structure is most likely to have been damaged?
A 28-year-old man is involved in a bicycle accident and is thrown from his bike. He suffers an injury to his left shoulder that results in bruising. The left side of his neck and left shoulder are tender and painful. Upon examination of his left upper limb, there is a loss of external rotation and abduction at the shoulder, as well as a loss of flexion of the elbow and supination of the forearm. Cutaneous sensation testing reveals numbness on the lateral aspect of the arm, forearm, and hand. What is the most likely neurological structure that has been damaged?
A 94-year-old man is admitted to hospital after a fall at home. He reports pain in his right groin when moving and is unable to put weight on his leg, despite taking regular full-dose paracetamol and codeine. Although his pain is well managed when he is at rest, he feels drowsy from the pain relief. An X-ray of his hip and pelvis has revealed no apparent cause for his discomfort. What is the most suitable course of action for managing this patient?