SBA Revise 7

The Police have brought a patient to your Emergency Department (ED) that has had a controlled energy device discharged into their upper back.

You assess the patient after they were subject to the CED (controlled energy device) discharge. They are clinically well and asymptomatic. They have no known medical conditions.

Which of the following is the most appropriate to perform?

A 44-year-old female is brought in by ambulance with a reduced level of consciousness. She has known alcohol dependence.

Observations on arrival:

Oxygen saturations 95% on room air
Respiratory rate 18 breaths per minute
Heart rate 110 beats per minute
Blood pressure 116/65mmHg
Temperature of 38.1oC
She is groaning and shouting out incoherently. There is evidence that she has been vomiting. She has generalised abdominal tenderness and is obviously jaundiced. On arrival, intravenous access is secured and blood samples including blood cultures are collected.

What is the next best step in her initial management?

A 27-year-old female has a 5 day history of myalgia & pyrexia, and has been self-medicating with paracetamol and Lemsip. Over the last 48 hours she has developed nausea, vomiting and right upper quadrant pain. Today she is drowsy and disoriented.

On examination she is slightly drowsy and oriented to person and place but not time. She has scleral icterus and is tender in her right upper quadrant.

Observations:

Temperature 37.8ºC
HR 122
BP 101/58
RR 26
SpO2 100% on room air
Arterial Blood Gas (ABG):

pH 7.303, pCO2 3.3, pO2 14.3, HCO3- 14, Na+ 135, K+ 5.1, Cl- 96, lactate 4.3
Bloods:

Total bilirubin 60µmol/L (<21) ALP 432U/L (30-130) GGT 1171U/L (<60) ALT 2657U/L (<41) AST 2893U/L (1-45) Urea 11.4mmol/L (2.5-7.8) Creatinine 177µmol/L (45-84) INR 1.9 PT 72 seconds (10-14) Which of the following may cause a similar picture on ABG?

The police have brought a patient to your Emergency Department (ED), who was they have “tasered”. The conducted energy device (CED) ‘taser’ was discharged into the patient’s shoulder. The patient is alert and conscious.

Which of the following symptoms would be the most likely during or after the conducted energy device (CED) discharge?

A 27-year-old Indian female presents to the Emergency Department (ED) with left lower abdominal pain and vaginal bleeding on-going for the last 4 hours. She had one fainting episode before presenting to the ED. She uses the Cerazette® (progesterone only contraceptive pill). She had pelvic inflammatory disease which was treated with oral antibiotics three years ago. She is a non-smoker.

Examination: Alert and oriented, appears pale and clammy.

Vital signs:

Oxygen saturations in room air: 96%
Respiratory rate: 22 breaths/minute
Pulse: 115 beats per minute and regular
Blood pressure: 96/60 mmHg
She has a positive pregnancy test. You suspect this is an ectopic pregnancy.

Which of the following could be this patient’s risk factor for developing an ectopic pregnancy?

A 54-year-old man with a history of MI (PCI x 2), Hypertension, Diabetes and Dyslipidaemia presents with acute central chest pain that started 2 hours ago while he was on his usual evening walk.

He describes the pain as “heaviness” in the chest and exactly similar to the time he had his last MI. He also says that the pain was worst at the start but has now comparatively eased off. He denies breathlessness or any nausea and vomiting.

His initial observations are all within normal range except for a BP of 178/110. His initial 12 lead ECG shows T wave inversions in leads V4-V6 and is otherwise unremarkable.

Apart from NSTEMI, which of the following is the most likely alternate diagnosis to consider?

A 19-year-old male is brought to the emergency department (ED) by his roommate, who has become concerned about his behaviour over the past few weeks.

On assessment he appears dishevelled. He tells the triage nurse that his roommate is a hired assassin, which he is aware of because he has heard voices telling him this. He reports not being able to sleep well for a number of weeks, and feeling as if he is being persistently watched. He is worried his roommate will find out that he knows his secret, as his thoughts are regularly broadcast on the radio. He has a family history of schizophrenia.

He is slightly restless, but cooperative.

What level of supervision does this patient require while awaiting medical assessment?

A 29-year-old primiparous woman attends the Emergency Department (ED) at 35/40 weeks gestation. She presents with two days of worsening headaches, vomiting, and right upper quadrant abdominal pain. Over the last 6 hours she has noticed reduced foetal movements.

Her observations are:

Oxygen Saturations: 95% breathing room air
Respiratory Rate: 16 per minute
Heart rate: 110 beats per minute
Blood pressure: 153/95 mmHg
Temperature: 37.3 degrees Celsius

Which would be the most useful initial bedside test?

A 32-year-old female presents to your emergency department (ED) with a two day history of fever, rigors, and left breast pain.

She tells you that she is exclusively breastfeeding her 5-week-old baby.

On examination of note, there is left breast tenderness and a wedge-shaped area of erythema in the upper outer quadrant of the left breast.

Which of the following is the most likely diagnosis?

A 21-year-old medical student, known to have anxiety disorder, is brought to the Emergency Department (ED) by her parents. She has a history of possible propranolol overdose of unspecified amount and unclear timing. She is confused.

Her observations are: HR-80/min, BP-110/70mmHg, Spo2-100% in RA, RR-18/min and CBG-9.1 mmol/L. Her examination is unremarkable.

What is your initial management step for this patient?