the case.
a 28 year old male presents to your Emergency Department with a 2-3 week history of increasing neck swelling. He is now spitting out frank purulent discharge from his mouth and reports fevers and night sweats.
a knackered neonate…
the case.
You are working in a district hospital and are called to the Special-Care Nursery to assist with an unwell newborn infant.
She was born 2 hours ago at 39 + 4 weeks gestation, to a primip mother who reports a completely unremarkable pregnancy and normal antenatal investigations (including morphology scans). The child has had marked respiratory distress and hypoxia since birth… [Read more…]
a difficult airway…
The Case.
The ‘Batphone’ alerted us of a 68 year old female who is postictal following two seizures in rapid succession. She has a history of ‘a brain tumour’.
P 120. BP 176 systolic !! GCS 8/15. Afebrile. Sats 98% (15L NRB + guedel airway).
She arrives direct to your resus bay 4-5 minutes later and she is actively seizing.
A) Obstructed (Guedel on floor). Trismus ++.
- Bilateral nasopharyngeal airways inserted
- Two-handed jaw thrust
- Ventilating well on 100% BVM.
B) Bilateral air entry. Sats 99% on O2. No added sounds.
C) P 130 (sinus) BP 185 systolic. Diaphoretic. Warm peripheries.
- 2x IVC inserted
- 500mL N.Saline bolus
D) Actively seizing (GTCS with movement in all 4 limbs). Pupils 4mm (L+R).
- 2x 5mg IV Midazolam (seizure resolved)
- 1gram IV Phenytoin (loading commenced at cessation of seizure)
E) Temp 37*C. BSL 13. No rashes, contusions etc.
Impression:
Status Epilepticus (3x seizures with no return to normal mental state)
- ? secondary to ‘brain tumour’ or associated haemorrhage
- No other medical history available
- “Family are bringing in her medications”
Following resolution of her seizure she remains obtunded, GCS (E1V1M4) 6/15 and still obstructing her airway. A decision is made to RSI for airway control and prevention of secondary brain injury, followed by urgent CT. [Read more…]
just a tablespoon…
This is the story of a 59 year old man who presented to our ED with a complaint of haemoptysis. He is otherwise well, takes no regular medications and besides his ’50 per day’ smoking history (over 40-odd years) he has no health concerns or past medical problems.
On the morning of presentation he had his usual morning ‘cough and splutter’ and was surprised to find blood in his tissue. He then proceeding to expectorate a small blood clot. “Its not that big, just a tablespoon”. He may have had some right sided pleuritic chest pain with it.
He looks well, with no increased work of breathing. Room air saturations of 94%. Good air entry with mild end expiratory wheeze. Normal cardiac examination.
This is his CXR…..
