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 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?
A 42-year-old male presents to the Emergency department after tripping on a rocky trail during a hike. He has scrapes on both shins and a heavily soiled deep wound on his right palm. An x-ray of his hand reveals the existence of a foreign object. The patient reports being up-to-date on his tetanus immunization (last vaccination 5 years ago). What measures should be taken in this situation?
A 55-year-old accountant presents with weight loss and excessive sweating. Upon examination, she is found to be clinically thyrotoxic with a diffuse goitre. The following investigations were conducted: Free T4 levels were found to be 40 pmol/L (normal range: 9-23), Free T3 levels were 9.8 nmol/L (normal range: 3.5-6), and TSH levels were 6.1 mU/L (normal range: 0.5-5). What would be the most appropriate next step in the diagnostic process?
A 12-year-old girl presents to the Emergency department with a scalp laceration she sustained while playing basketball.
Upon examination, it is found that she has a clean incised wound on her scalp that is approximately 2 cm in length.
What is the most appropriate method of managing this wound?
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?