Case of the Month Archive

30 year old with a background of Emotionally Unstable Personality Disorder day 2 post Critical Care admission for Mixed Overdose.

Author: Dr Alison Cairns

A 23-year-old primi-gravida Vietnamese woman was admitted to the Maternity unit with per vaginal (PV) bleeding, nausea, vomiting and malaise at 35+5 weeks of pregnancy.

Author: Dr Deepak Sharma

A 32-year-old female presents to the emergency department with reduced conscious level and a 1-day history of vomiting, diarrhoea and abdominal pain. Her observations are as follows: SpO2 100% on 15L O2 NRB; RR 24; HR 118...

Authors Dr Eva Peck

A 30-year-old female presents to the Emergency Department after a collapse at work. She had been feeling unwell for a few days, with a low-grade fever and increasing shortness of breath. 

On further questioning she reports some dyspnoea on exertion and excessive tiredness, both of which started during a pregnancy 18 months ago...

Authors: Dr Tom Casson, Dr Kris Bauchmuller and Prof Robin Condliffe

An 82-year-old man is admitted to hospital on a hot summer evening following concern from his carers. He was found in an armchair confused, drowsy and unable to stand unaided. He was last seen in the morning. On initial assessment he was tachypnoeic, tachycardic with hypotension...

Authors: Dr Jamie Gibson, Dr Oliver R. Gibson

Hyperinflammatory State in the Intensive Care Unit .

A 45-year-old woman presented via ambulance to A+E complaining of shortness of breath, cough, malaise and headache that had been ongoing for the last 3 days. Her past medical history consisted of HIV which she was diagnosed with 20 years ago; she stopped highly active anti-retroviral therapy (HAART) 10 years ago...

Author: Dr Iain Fraser

A 52 year old Gentleman was admitted to ITU following an in-hospital PEA cardiac arrest. He is known case of multiple myeloma; post autologous stem cell transplant with subsequent neutropenic sepsis. He has a background of Hypertension and Bipolar Depression on Lithium...

Author: Ahmed Elsayed

A 61-year-old gentleman presents to the Emergency Department with increased urinary frequency, thirst, nausea and is drowsy. The patient has recently been discharged from the hospital following an admission for a bilateral pneumonia...

Author: Dr Rhiannon Kirk

Major Burn Injury: Taming the Flames

You are the ICU registrar on-call overnight. You are called to ED following a pre-alert for a patient with major burns being brought in by an ambulance crew...

Author: Dr Maximilian Ralston

A 39-year-old grand multipara (Gravida 7 Para 5) presented to the Labour Ward actively labouring at term. Apart from a long history of smoking, she was otherwise fit and well with a BMI of 28.

Her obstetric history included one forceps assisted delivery, followed by a miscarriage and then four vaginal deliveries.

Author Dr Michelle Bradshaw

Part 2 - Assessment and Management of Coagulopathy and Specifics of Management of Ongoing MOH

In part 1, you were presented with a 39-year-old multipara who suffered a postpartum haemorrhage (PPH) following a normal vaginal delivery which progressed to Major Obstetric Haemorrhage.

Author Dr Michelle Bradshaw

A 66-year-old male is brought into the Emergency Department by ambulance with reduced consciousness and severe agitation. The patient had complained of chest, abdominal and back pain at home. He has a past medical history of type 2 diabetes mellitus, hypertension, ischaemic heart disease...

Authors Dr Jamie Gibson and Dr Adam Walker

A 22 year old female was admitted to the Acute Assessment Unit with shortness of breath. She has a past history of anxiety and depression. The history revealed that she was refusing to eat anything for over a week and was losing weight over the last few months...

Author Dr Abhay Vaidya

Maternal Collapse

A 31 year old primigravida presents in spontaneous labour at 39+4 weeks gestation. The pregnancy has been uncomplicated thus far. On initial vaginal examination her cervix is 4 cm dilated and she in contracting regularly. She is in significant pain and requests an epidural...

Author Dr Tim Knowles

Posterior Reversible Encephalopathy Syndrome (PRES)

A 51 year old woman is referred from the medical team. She had been admitted with new onset confusion, blurred vision and headache. She has had two tonic-clonic seizures in hospital and the medical registrar is concerned that she is in status epilepticus. She had a background of SLE...

Author Dr Helen Cole

A 40-year-old gentleman with no past medical history of note presents to the Emergency Department with increasing shortness of breath, productive cough, fever and pleuritic right sided chest pain for 7 days.

On assessment he is noted to be tachycardic (heart rate 110 bpm), tachypnoeic (respiratory rate 30 breaths/minutes), febrile (temperature 38.0oC), SpO2 of 85% on 15L/min O2 using a non-rebreathe mask and a PaO2 of 8.0 kPa...

Author Dr Lamya Mohammed

A 23-year-old man presents to A&E having sustained a blunt force trauma to his head outside a nightclub. On arrival, he has just vomited for the second time and is confused. He is aggressive and claims not to remember the events. He shouts at you that he has no other medical problems, and no collateral history is available.

There is an obvious red swelling above his right brow ridge. There is a substantial ecchymosis overlying the right orbit...

Author Dr Andrew Gardner and Dr Meesha Jogia

A pre-alert has been received for a 25-year-old man who has fallen from a high wall while intoxicated. He is being transferred to your hospital with full spinal immobilisation in place.

On arrival in the Emergency Department, he is on a spinal board, has a cervical spine collar in situ with three-point immobilisation of the head, and is conversant but agitated. He is complaining of neck pain with paraesthesia and weakness of all four limbs...

Author Dr Nick Charlesworth

A 27 year old man presents to the Emergency Department with decreased conscious level. He has a past medical history of type 1 diabetes mellitus. On examination, his airway is patent, respiratory rate is 24 breaths per minute...

Author Dr Noel Pradeep

A male infant presents to the emergency department at one week of age. He is pale and floppy. He was born by SVD at term weighing 3.5kg and discharged without complication...

Author Dr Joanna Thirsk

A 27 year old lady presents to the Emergency Department having taken an unknown quantity of her father’s diltiazem following a family argument...

Author Dr David Harding

A 46 year old male was brought in by ambulance to the Emergency Department after being found by friends in an unresponsive state...

Author Dr James Hewitt

A 22-year-old woman presents to the Emergency Department with fever, chills, headache, muscle aches, and a diffuse erythematous rash resembling sunburn over her body.....

Author Dr Elaine Yip

A 61 year old gentleman was admitted to the Emergency Department following a witnessed sudden collapse...

Author Dr Marc Fadden

A 42 year old female, presents to the Emergency Department with worsening shortness of breath. She has been unwell for a few days with increasing breathlessness and cough, which isn’t relieved with inhalers. She also reports increasing swelling of her feet and legs over the past 2 weeks...

Author: Dr Swathi Pinto

Cardiovascular; Cardiothoracic

The emergency department refers a 72-year-old gentleman who woke up this morning with excruciating pain in his chest and between his scapulae, which he describes as ‘tearing’. He is known to have hypertension and has a 50 pack-year history of smoking. On examination he has a heart rate of 103 beats-per-minute (BPM) and a blood pressure (BP) of 190/101mmHg in the right arm and 171/97mmHg in the left...

Author Dr Joslan Scherewode

Cardiovascular

It’s February and a concerned mother brings in her 4-month-old boy, Jacob, to the paediatric emergency department. After two days of fever and runny nose, his mother, Janice, takes him to the General Practitioner. Today, Janice is concerned by his chesty cough and audible wheeze...

Author Dr Jonathan La Crette

Paediatrics; Respiratory

You are called to see a 52-year-old gentleman on the coronary care unit who was admitted with a myocardial infection 3 days ago...

Authors Dr Gursevak Singh and Dr Andrew Martin

Cardiovascular; Cardiothoracic

A 75 year old man presented to the Emergency Department with a 1 week history of progressive proximal leg weakness, a subsequent fall and resultant long lie on his living room floor. On arrival he was noted to be short of breath and had SpO2 of 82% on air...

Author: Dr David Burtle

Biochemistry; Renal

A 40 year old lady presented to hospital with decreasing conscious level. She was found by her partner with empty paracetamol packaging on the floor...

Author: Dr Mohamed Shoaeir

Cardiovascular; Cardiothoracic
Liver; Toxicology & Pharmacology

A 61 year old lady presents to hospital with lethargy, generalised aches and pains, cough and 2 episodes of loose stool...

Author: Dr Rick Bell

Renal

A 53 year old male currently on the Haematology ward is referred because of type 1 respiratory failure...

Author: Dr Grace Hoey

Haematology

A 34 year old primigravida of Asian ethnicity at a gestation of 36+4 and BMI 24 has presented to obstetric triage...

Authors: Dr Stuart Edwardson & Dr Arlene Wise

COVID, Obstetrics

A 60 year old man is admitted to the intensive care unit with spontaneous bacterial peritonitis on a background of alcoholic liver disease...

Author: Dr Christopher Shaw

Gastrointestinal

A 55 year old man presented to hospital with acute onset shortness of breath, cough and a multiple episodes of small volume haemoptysis...

Author: Dr Rose Mudie

Respiratory

A 40 year old female presents to the Emergency Department with acute onset breathlessness, palpitations and haemoptysis...

Author: Dr Ben Peirce

Endocrine

A 60 year old woman was admitted to hospital with a one week history of increasing confusion and malaise...

Author: Dr Rathai Anandanadesan

Haematology

A 35 year old woman presents to the Emergency Department with 1 day history of fever, urinary frequency and left loin pain...

Author: Dr Lucy Powley

Neuro

A 74 year old gentleman is admitted to the critical care unit following a 3 week admission on the medical wards with pyrexia...

Author: Dr Matthew Wright

Haematology

A 22 year old woman presents to hospital with a 3 day history of abdominal pain and vomiting...

Author: Dr Oliver Robinson

Gastrointestinal

A 48 year old woman recently commenced chemotherapy for a new diagnosis of acute myeloid leukaemia...

Author: Dr Claire Adams

Biochemistry, Renal, Toxicology & Pharmacology

A 34 year old woman presented to the Emergency Department with a two day history of progressively worsening double vision, followed by ataxia and slurred speech...

Author: Dr Chris Allen

Neuro

A previously well 48 year old male, presents to ED with a 48 hour history of severe epigastric pain radiating to his back...

Author: Dr Colin McAdam

Gastrointestinal

A 65 year old woman has a cardiac arrest at home. She is in VF and receives 2 DC shocks by the paramedics before return of spontaneous circulation (ROSC) is established...

Authors: Dr Andy Martin & Dr Lucy Priestner

Cardiovascular, Resuscitation

A 40 year old male was admitted to intensive care unit requiring intubation and ventilation for community acquired pneumonia...

Author: Dr Louise Hartley

Respiratory

You are asked to review a 25-year-old female office worker who has presented to ENT with a sore throat and a progressive dysphagia...

Author: Dr Martin Smith

Neuro

You are called urgently to A&E to assist with a patient who is 36 weeks pregnant with a low GCS...

Author: Dr Tarni Duhre

Obstetrics

A 63 year old man with a history of hypertension and ischaemic heart disease has been admitted to the intensive care unit with refractory hypotension due to severe sepsis...

Author: Dr Adam Marshall

Cardiovascular

A 74 year old female with a background of hypertension presented to the emergency department with gradually increasing breathlessness and pleuritic chest pain following a recent long haul flight...

Author: Dr Rathai Anandanadesan

Respiratory

An unresponsive 76-year-old male is admitted to the intensive care unit. He has a past medical history of bipolar affective disorder...

Author: Dr Laura Kocierz

Endocrine, Renal, Toxicology & Pharmacology

A previously well 76-year-old male presents to ED having been found on the floor at home by a relative...

Author: Dr Colin McAdam

Neuro

A 67 year old man has been admitted overnight to the intensive care unit.  He presented with flu-like symptoms and a non-productive cough...

Author: Dr Pete Hersey

Respiratory

A 54 year old woman with a history of hypertension presented to the emergency department with a sudden onset severe headache...

Author: Dr Rosaleen Baruah

Neuro

A 40 year old male was found unresponsive in the garden. Initial GCS was 9 (E3V2M4) which deteriorated to 7 (E2V2M3) on arrival...

Author: Dr Kyle Gibson

Toxicology & Pharmacology

A 25 year old male is admitted to critical care following a motorcycle accident. ..

Author: Dr Sarah Marsh

Trauma