SBA Revise 5

A 62-year-old female with chest pain and shortness of breath was seen in your Emergency Department (ED), admitted to the cardiology ward and treated for acute coronary syndrome.

During her recent hospital admission, she was also treated for heart failure and given doxycycline for a lower respiratory tract infection.

Her past medical history includes diabetes, hypertension and a previous c-section.

Two weeks after her hospital discharge, she returns to your ED with worsening confusion and is drowsy. She has a significantly reduced oral intake and is not passing urine. Her initial blood tests results show a raised serum creatinine and hyperkalaemia.

Which of the following conditions in this patient is most likely to have caused her acute kidney injury (AKI)?

Tracey is a 78-year-old patient who attends the emergency department feeling generally unwell.

Her initial observations are RR 24, SpO2 98% RA, HR 38, BP 120/80, GCS 15.

Tracey has an ECG performed, and is moved to a monitored bed.

With the ALS treatment algorithm in mind, what is your first management step?

A 65-year-old male presents with a productive cough. His chest X-ray is shown. Observations: HR 110, BP 95/55, RR 25, T 38.5

Bloods: CRP 350, WCC 16, Hb 100, Plt 250, Cr 100, Urea 7.4, Na 140, K 4.5.

What is his CURB65 severity score?

A 66-year-old female with diabetes and chronic kidney disease presents with a reduced urine output and features of acute kidney injury. She has no features of infection.

She recently started a new medication but cannot remember the drug name. She is seen in your Emergency Department (ED) and has had a blood test at ED triage.

Which of the following is a biochemical marker of acute kidney injury, occurring within the past 48 hours?

A 43-year-old man with known asthma presents to the Emergency Department (ED) with increasing breathlessness and cough for 2 days. He can complete short sentences in one breath but becomes short of breath on mobilising from the waiting room to the assessment area. He is a non-smoker and between exacerbations is able to run long distance, recently completing a half marathon.

On assessment:

His PEF (peak expiratory flow) is 55% predicted, RR 22, Sats 96%, HR 115, BP 120/80, T 36.5

What is the most likely diagnosis?

You are the registrar on shift in a busy emergency department (ED) and are approached by a junior member of the team, Sara, who wishes to discuss a patient with you.

She tells you that Mr. Adams is a 67-year-old male who presented with an episode of left flank pain. His bloods and observations are normal. She is concerned that he has a kidney stone. After your discussion you feel that it is best to use first use Point of Care Ultrasound (PoCUS) to identify if there is evidence of an Abdominal Aortic Aneurysm (AAA). You ask Sara to bring the ultrasound machine to the bedside where you will join her.

Having explained to the patient your plan you begin to scan and obtain this view. Keen to teach your junior colleague you want to point out the relevant anatomy.

Which label represents the Coeliac axis?

Glenda has noticed that her 5p coin collection is mostly missing. She is concerned her daughter, Lucy, has swallowed or inhaled some of it.

Lucy is four. What best describes the airway differences?

A 2-year-old child, Cecilia, is brought to the Emergency Department (ED). Yesterday her mother found her with an open box of ‘super strong’ ball magnets. She is unsure if any magnets are missing. Cecilia has been off her food. She has mild epigastric discomfort.

Observations:

Respiratory rate: 28
Oxygen saturations: 98% on air
Heart rate: 118
Capillary refill time: under 2 seconds

What is the most appropriate initial investigation?

Your next patient is an 18-month-old girl, labelled ‘constipation’ at triage. You immediately notice that the child is grunting. She has had episodic fevers for the last month. She is rather listless and pale. Her abdomen looks very distended.

Observations:

Heart rate 158 bpm
Capillary refill 3 seconds, cool peripheries
BP 90/50
RR 34 breaths per minute
Oxygen saturations 92% on air
Temperature at triage 37.5 degrees C.

What is the best initial course of action?

A 14-year-old girl presented at the Emergency Department (ED) with a foreign body impaled below her right eye following a fall into a tree.

She was complaining of pain in the right upper teeth and upper lip, and numbness of the right cheek.

On examination, she had a large twig vertically impaled into her right cheek, entering just below the medial aspect of the eye, with around 4cm visible externally. The upper end was pushing against the eyebrow, and the lower was embedded in the cheek, by an unknown distance. There was no active bleeding. The eye appeared to be intact.

She had full range of movement in all ocular muscles, normal visual acuity and peripheral vision. Trigeminal and facial nerve examination was in fact unremarkable.

How should this be managed in the ED?