Case of the Month
A 67-Year-Old Woman with Agitation and Confusion
A 67-year-old lady presents to the Emergency Department anxious, confused and agitated. She has also vomited several times. She has recently been started on a course of amoxicillin for a presumed chest infection by her GP. You are unable to take a coherent history...
A 65-Year-Old Woman with Abdominal Pain and Syncope
A 65-year-old woman presents to the Emergency Department acutely unwell with abdominal and lower limb pain. She had a syncopal episode in the department and was moved into the resuscitation area. She had been taking prednisolone for polymalgia rheumatica until...
A Young Asthmatic with Headache and Abdominal Pain
A 28-year-old man with a known history of asthma presents with headache, nausea and abdominal pain. His heart rate is elevated at 117 bpm. He currently takes a salbutamol inhaler and a theophylline for his asthma. He had attended the Emergency Department a few days...
A Blood Transfusion Reaction in a 42-Year-Old Woman
A 42-year-old woman receives a blood transfusion for anaemia secondary to heavy vaginal bleeding. 4 hours after commencement of the transfusion she complains of feeling breathless and has developed a dry cough. Her temperature is measured at 38.1ºC. A chest X-ray is...
Unexplained Debilitating Nausea and Vomiting
A 30-year-old woman presents with debilitating nausea and vomiting. The vomiting occurs in a cyclical pattern, with the patient experiencing episodes every few months. She is also complaining of colicky abdominal pain but her bowel movements are normal. She states...
Managing Paracetamol Overdose
A 25-year-old woman with a long history of depression has taken an overdose of paracetamol. She took the overdose 10 hours ago and cannot recall how many tablets she has taken. She is complaining of abdominal pain and nausea. 1. What is the mechanism of liver damage...
A 2-Year-Old Child with Breathing Difficulties
A 2-year-old boy is brought in to the Emergency Department with stridor and a barking cough. His mum states that he has had a mild cold for a few days and his voice had been hoarse. His observations are as follows: Temperature 38.1°C, HR 135, RR 30, SaO2 97% on air....
Chest Pain and Syncope in a 72-Year-Old Man
A 72-year-old man presents with chest pain and intermittent syncope. He tells you that he has been suffering with episodes of dizziness and fatigue over the past few weeks. On review today his heart rate is 37 bpm and his rhythm strip is shown below: 1. What does the...
A Farm Worker with a Dirty Wound
A 24-year-old man from Russia presents with a wound on his left forearm sustained whilst working on a farm the day before yesterday. The wound has been cleaned under a tap but still contains some debris and dirt. You clean the wound carefully and prescribe...
Severe Chest Pain Following Blunt Thoracic Trauma
A 37-year-old man is involved in a high-speed motor vehicle collision. He was not wearing a seat belt and struck his chest on the steering wheel. He has presented complaining of severe central chest pain and breathlessness. You are the trauma call team leader. His...
