A 55-year-old woman is scheduled for a routine blood pressure check. As she waits in the reception area, she suddenly experiences severe breathlessness with stridor. She had mentioned to someone else in the room that she was stung by an insect on her way to the clinic. Based on your assessment, you determine that she is having an anaphylactic reaction to the sting. What would be the appropriate dose and route of administration for adrenaline in this scenario?
A 20-year-old college student is rushed to a university hospital after being found semi-conscious at home. Upon examination, the patient has a Glasgow coma scale of 12, a fever of 39.5°C, a pulse of 120/min, a blood pressure of 105/60 mmHg, photophobia, and meningism. The medical team has already inserted a cannula and sent blood cultures. What should be the next course of action?
You are asked to assess a 75-year-old man who has a medical history of hypertension, diabetes, and congestive heart failure. He has come to the hospital with worsening paroxysmal nocturnal dyspnea and three pillow orthopnea, and is currently experiencing acute shortness of breath.
The patient’s vital signs are as follows: heart rate of 120 beats per minute, regular rhythm, blood pressure of 150/80 mmHg, and oxygen saturation of 88% on room air. The nurse has ordered a chest x-ray for the patient.
Which of the following findings would be inconsistent with a diagnosis of congestive heart failure?
A 50-year-old plumber presents to the Emergency department with a saw injury to his right thumb. On examination, there is a 1.5 cm laceration on the ulnar aspect of the thumb. The neurovascular supply is intact, and there is no evidence of injury to other structures. What is the suitable local anaesthetic to use for exploring the wound and suturing the laceration?
A 40-year-old male presents to the clinic with sudden onset of headache while engaging in sexual activity. He reports no focal neurological symptoms but complains of neck stiffness. What is the best course of action for management?
A 25-year-old male presents with wheezing and a respiratory rate of 35/min, a pulse of 120 beats per min, blood pressure 110/70 mmHg, and a peak expiratory flow rate of less than 50% predicted. He has received back-to-back nebulisers of salbutamol 5 mg and ipratropium 0.5 mg for the past 45 minutes and is currently on face mask oxygen. Additionally, he has been given hydrocortisone 100 mg IV, and the intensive care team has been notified.
An arterial blood gas test was performed on high-flow oxygen, revealing a pH of 7.42 (7.36-7.44), PaCO2 of 5.0 kPa (4.7-6.0), PaO2 of 22 kPa (11.3-12.6), base excess of -2 mmol/L (+/-2), and SpO2 of 98.
What is the recommended next step in therapy for this patient?
A 25-year-old asthmatic has been feeling unwell for the past day, experiencing a productive cough, fever, and occasional wheezing. Despite using his regular salbutamol inhaler, his shortness of breath has been worsening, prompting him to seek medical attention at the hospital.
After being assessed by a colleague, the patient has received four rounds of back-to-back salbutamol nebulisers, one round of ipratropium nebulisers, and intravenous hydrocortisone. However, the patient’s condition is deteriorating, with increasing respiratory rate and speaking in words only. His chest is now silent, and his oxygen saturation is at 90% despite receiving 10 litres of oxygen.
What is the next recommended therapeutic intervention for this patient?
A 49-year-old man has been brought into Accident and Emergency, after being rescued from a fire in his home by firefighters. He has extensive burns across most of his torso and lower limbs; however, on assessment, his airway is patent and he currently has a Glasgow Coma Scale (GCS) score of 11. Paramedics have already been able to gain bilateral wide-bore access in both antecubital fossae. He weighs approximately 90 kg, and estimates from the paramedics are that 55% of his body is covered by burns, mostly second-degree, but with some areas of third-degree burns. His observations are:
Temperature 36.2 °C
Blood pressure 102/73 mmHg
Heart rate 112 bpm
Saturations 96% on room air
Respiratory rate 22 breaths/min
What would be the most appropriate initial method of fluid resuscitation?
A 50-year-old male presents with sudden onset of severe headache accompanied by vomiting and photophobia. Upon examination, the patient appears distressed with a temperature of 37.5°C and a Glasgow coma scale of 15/15. His blood pressure is 146/88 mmHg. The patient exhibits marked neck stiffness and photophobia, but neurological examination is otherwise normal. What is the suspected diagnosis?
A 22-year-old woman is discovered by her roommates in a confused, drowsy, and sweaty state in her bedroom. She is unable to provide a clear medical history. Upon examination, she has a fever of 38.3°C, a heart rate of 110 bpm, a blood pressure of 110/60 mmHg, and appears to be short of breath with a respiratory rate of 30. There is no stiffness in her neck, and her chest sounds clear upon auscultation. An arterial blood gas test taken with 15 l/min oxygen shows a pH of 7.29 (7.35-7.45), Pa O2 of 37 kPa (11-14), PaCO2 of 2.1 kPa (4.5-6), and lactate of 2.4 mmol/L (0.1-2.5). What is the most probable diagnosis?