A 32-year-old man presents with oral and genital ulcers and a red rash, parts of which have started to blister. On examination, he is noted to have red eyes. He had been treated with antibiotics ten days ago for a chest infection.
What is the most probable reason behind these symptoms?
A 70-year-old known cardiopath is brought to hospital by ambulance, complaining of chest pain and shortness of breath. He looks pale and is very sweaty. Examination reveals a blood pressure of 80/55 mmHg, pulse of 135 bpm, SpO2 of 93% and bibasal wet crackles in the chest, as well as peripheral oedema. Peripheral pulses are palpable. A previous median sternotomy is noted. An electrocardiogram (ECG) reveals regular tachycardia, with QRS complexes of uniform amplitude, a QRS width of 164 ms and a rate of 135 bpm.
What is the most important step in management?
A middle-aged woman is brought to the Emergency Department (ED), after being found unconscious in the town centre by members of the police. She is poorly kept, and a police handover reports that she has no fixed abode. She is well known to various members of ED. On arrival in ED, she is still unconscious. Her airway is patent; she is saturating at 94% on room air, with a respiratory rate of 10 breaths/min. She is haemodynamically stable, with a temperature of 35.6 °C and small, constricted pupils. There appears to be an area of minor external bleeding and a scalp haematoma on the back of her head.
What is the most appropriate initial course of action?
You are on call overnight for orthogeriatrics when you receive a bleep to see a patient who is two days post-op from a left total hip replacement. You are not familiar with this patient. Upon arrival, you notice that the patient is drowsy and confused, and has a very fast heart rate. An electrocardiogram (ECG) reveals peaked T-waves, a PR interval of 230 ms, and a wide QRS. The patient’s potassium level on ABG is 6.4 mmol. What is the most appropriate initial management?
You are on call overnight on orthopaedics when you receive a bleep to see a patient you are not familiar with. The patient had a left total hip replacement procedure 2 days ago and is now exhibiting signs of drowsiness and confusion. Upon examination, you observe that the patient is tachycardic, and an electrocardiogram (ECG) shows peaked T-waves and a wide QRS complex. You decide to take an arterial blood gas (ABG) which reveals a potassium level of 6.4 mmol (normal 5–5.0 mmol/l). What would be the most appropriate initial management action for this patient?
A 42-year-old man is pulled from the water onto the shore by lifeguards after being seen struggling in strong currents. He was underwater for six minutes before being rescued. As a bystander on the beach, you assist in the resuscitation efforts while waiting for the ambulance. The man is unconscious and not breathing. You open his airway.
What is the next best course of action in attempting to revive this individual?
A 25-year-old woman arrives at the Emergency Department in a very unwell state. She reports having had the flu for the past few days and is having difficulty keeping anything down. She feels weak, drowsy, and disoriented, and experiences dizziness upon standing. Upon observation, you note that she is tachycardic and hypotensive and has a fever. She informs you that she only takes hydrocortisone 20 mg orally (PO) once daily for Addison’s disease. What is the most crucial management step in this case?
A 19-year-old man is brought to the Emergency Department with a swollen face and lips, accompanied by wheeze after being stung by a bee. He is experiencing breathing difficulties and has a blood pressure reading of 83/45 mmHg from a manual reading. What is the next course of action?
You are called to attend a 35-year-old man who is in cardiac arrest on one of the wards. On arrival, the patient has defibrillator pads attached and someone is performing cardiopulmonary resuscitation (CPR). A rhythm strip displays ventricular fibrillation during a CPR pause.
What is the most appropriate management?
A 42-year-old man is brought to the Intensive Care Unit after accidental drowning in a lake. He was a swimmer who got into trouble and was underwater for approximately 10 minutes before being rescued. He was found unresponsive and not breathing, and bystanders immediately started performing CPR while waiting for emergency services. Upon arrival at the ICU, he is intubated and ventilated, and his vital signs are as follows: blood pressure 90/60 mmHg, pulse 130 bpm, oxygen saturations 85%, and temperature 33.2 °C.
Under what circumstances is extracorporeal membrane oxygenation (ECMO) considered as a treatment option for drowning patients?