A 60-year-old man received a two unit blood transfusion 1 hour ago. He reports feeling a strange sensation in his chest, like his heart is skipping a beat. You conduct an ECG which reveals tall tented T waves in multiple leads.
An arterial blood gas (ABG) test shows:
Na+: 136 mmol/l (normal 135–145 mmol/l)
K+: 7.1 mmol/l (normal 3.5–5.0 mmol/l)
Cl–: 96 mmol/l (normal 95–105 mmol/l).
What immediate treatment should be administered based on these findings?
A 72-year-old man presents to the Emergency Department with fever, rigors, breathlessness and a cough. He is producing a frothy pink/green sputum spotted with blood. On examination, you find that he is very confused, with a respiratory rate (RR) of 33 breaths per minute and blood pressure (BP) of 100/70 mmHg. Bloods reveal his urea is 3.2 mmol/l. On auscultation of the chest, you hear a pleural rub. Chest X-ray reveals multilobar consolidation.
Which one of the following statements regarding his management is most appropriate?
A 68 year old homeless man is brought into the Emergency Department with acute confusion. The patient is unable to provide a history and is shivering profusely. Physical examination reveals a body temperature of 34.5oC.
Regarding thermoregulation, which of the following statements is accurate?
A 38-year-old man is brought in by ambulance as a trauma call following a road traffic collision. On admission, he has a GCS score of 10 and a primary survey reveals asymmetric pupils, an open right forearm fracture, absent breath sounds on the right side, extensive RUQ pain, a painful abdomen, and a systolic blood pressure of 90 mmHg. When prioritizing intervention and stabilization of the patient, which injury should be given priority?
An 81-year-old man, who is confused and aggressive, is admitted to the Medical Admission Unit. He is unable to give any history due to confusion. His wife had taken him to the general practice surgery yesterday due to increased confusion, and trimethoprim was prescribed to treat a urinary tract infection. From a previous discharge letter, you ascertain that he has a background of Alzheimer’s dementia, atrial fibrillation (AF), ischaemic heart disease and osteoarthritis. His wife reports that he is normally forgetful but is much more confused than usual.
On examination, his pulse is 124 bpm (irregularly irregular), blood pressure 134/74 mmHg, oxygen saturation (SaO2) 95% (on 28% oxygen), respiratory rate 22 breaths per minute and temperature 38.4 °C. He has crepitations and increased vocal resonance at the right lung base, with an area of bronchial breathing above this. Neurological examination of the upper and lower limbs is normal.
Chest X-ray (CXR): focal consolidation, right base
Electrocardiogram (ECG): AF with rapid ventricular response
Urine dip: protein ++, otherwise NAD
Blood results are pending.
What is the most likely cause of this patient’s acute deterioration?
A 21-year-old man is brought to the Emergency Department after near-drowning. This occurred after he fell from a boat into a lake, while intoxicated with alcohol. He has no medical history. He is drowsy, with a Glasgow Coma Scale (GCS) score of 9; his oxygen saturations are 80% on an inspired fraction of oxygen (FiO2) of 1.0 via a non-rebreather face mask.
Which of the following is part of the treatment algorithm for drowning?
A 68-year-old man with known long-term chronic obstructive pulmonary disease (COPD) visits his General Practitioner (GP) complaining of increasing breathlessness and wheeze. He reports that a week ago, he could walk to the store and back without getting breathless, but now he cannot even leave his house. He has been coughing up thick green sputum for the past 48 hours and is currently hypoxic – 90% on oxygen saturations, in respiratory distress, and deteriorating rapidly. An ambulance is called, and he is taken to the Emergency Department for treatment.
What is the most appropriate next step in managing this patient?
You are alone walking in the countryside when an elderly man collapses in front of you. There is nobody else around. You look, listen and feel, ensuring his airway is open. He is not breathing and is unresponsive. You phone for an ambulance.
What is the next step that you would take while waiting for the ambulance to arrive?
A 57-year-old man is admitted to the Intensive Care Unit (ICU) with acute pancreatitis caused by excessive alcohol consumption. His abdominal sepsis is complicated by multi-organ failure. He is currently receiving mechanical ventilation, inotropic support, and continuous haemodialysis in the ICU. What evidence-based strategies have been shown to decrease mortality in cases of sepsis?
An 85-year-old woman has been brought to Accident and Emergency from her residential home due to increasing concern from staff there. She has been experiencing increasing confusion over the past few days, which staff initially attributed to her Alzheimer’s dementia. She has a known history of chronic obstructive pulmonary disease (COPD), but no other long-term medical conditions. During the ambulance ride to the hospital, she was given intravenous (IV) paracetamol. Unfortunately, you are unable to obtain any useful medical history from her. However, she is responding to voice only, with some minor abdominal tenderness found on examination and little else. She appears to be in shock, and her vital signs are as follows:
Temperature 37.6 °C
Blood pressure 88/52 mmHg
Heart rate 112 bpm
Saturations 92% on room air
An electrocardiogram (ECG) is performed, which shows first-degree heart block and nothing else.
What type of shock is this woman likely experiencing?