A 30-year-old female attended the Emergency Department (ED), presenting with vomiting, general all over body weakness and an appearance of a ‘dying swan’. She was unable to engage with questions well, responding slowly, appeared breathless and said she felt unable to walk or move.
On presentation she was haemodynamically stable, with a slight tachycardia. Examination in the Emergency Department returned normal findings; chest auscultation was clear with a normal respiration rate. There had been no physical trauma.
The patient has taken her regular medications of prednisolone 10mg OD.
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Question 1 of 3
1. Question
What is the initial management for this patient?
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Question 2 of 3
2. Question
On review an hour later, the patient has continued to vomit and appears drowsy. Clinically, her GCS is now 14, heart rate 122bpm and BP 92/68. Her blood results include Na 131, K 5.0, Ur 7.0, Creat 78, Glucose 2.7
With the patient's presentation and initial investigation results, where would be the most suitable location for her continuing care?
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Question 3 of 3
3. Question
The same patient is involved in a road traffic collision, paramedics stated that she seemed well at the scene, however, on presenting to ED, she appeared slightly shocked by the events and complaining of abdominal pain. At triage, she had a slight tachycardia of 118bpm, everything else was normal.
Working in the ED probably exposes us to a considerable amount of death and dying. From the unexpected cardiac arrest or trauma patient, through to the expected death of a patient with a terminal prognosis
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9 responses
Clinically important case , not to miss
Good review
good review
good review
Interesting case, good for learning
Great brief update/challenge
very good case
Great refresher of Addisonian Crisis
nice case to remind us with Adissonian crisis