Emergency and Toxicology

A 74-year-old woman presents with sudden passage of a large volume of dark red blood per rectum. After two litres of intravenous crystalloid her blood pressure…

A 41-year-old man undergoes urgent debridement for a necrotising infection of the calf. Initial broad-spectrum treatment has been given, and deep tissue culture…

A 63-year-old man is admitted with fever, hypotension and rapidly progressive cellulitis of the forearm. He had been licked on an excoriated hand by his daughte…

A 68-year-old man taking gliclazide modified release for type 2 diabetes is found drowsy with a blood glucose concentration of 2.1 mmol/L. He improves after int…

A 29-year-old man is brought in shortly after his partner administered naloxone for suspected heroin overdose. He is yawning repeatedly, has abdominal cramps, d…

A 46-year-old man is found vomiting beside an open container of an automotive fluid. He has tachypnoea, flank pain and oliguria; arterial blood gas analysis sho…

A 29-year-old woman at 25 weeks of pregnancy presents with right flank pain, rigors and vomiting. Her temperature is 39.2°C, pulse 132/min and blood pressure 92…

A 42-year-old man is brought to hospital 45 minutes after taking an unknown number of amitriptyline tablets. He is drowsy, has a blood pressure of 78/46 mmHg an…

A 46-year-old man wakes with markedly reduced hearing in his right ear and a continuous high-pitched noise. He has no pain, discharge or recent infection, and t…

A 62-year-old man has a regular broad-complex tachycardia at 190 beats per minute three hours after treatment for an acute myocardial infarction. He is consciou…

A 39-year-old man with bipolar disorder is brought to the emergency department one hour after becoming agitated and incoherent. His medicines are sertraline, tr…

A 46-year-old man with schizophrenia becomes restless and confused two days after his haloperidol dose was increased. He is febrile at 39.8°C, has widespread mu…

A 41-year-old woman is rescued from a vehicle fire with burns encircling the chest and upper abdomen. She is intubated and ventilated, but her peak airway press…

A 28-year-old electrician receives an electrical injury while working on industrial equipment. There is a small contact mark on the palm and a larger mark at th…

A 32-year-old man is rescued from a burning warehouse. He is confused, hypotensive and tachypnoeic, with soot on his face but no wheeze. His pulse oximeter read…

A 46-year-old man is brought from a house fire with burns to his face and upper chest. He is awake, has soot around his mouth and is coughing; initially his voi…

A 76-year-old man with persistent atrial fibrillation develops sudden severe abdominal pain and vomiting. He is pale and distressed, but his abdomen is initiall…

A 63-year-old woman with type 2 diabetes accidentally injects 60 units of insulin glargine instead of her usual 20 units. She becomes confused with a capillary…

A 74-year-old man with type 2 diabetes presents with several days of lethargy and increasing confusion. His blood glucose concentration is 42 mmol/L, calculated…

A 67-year-old woman with type 1 diabetes is admitted with community-acquired pneumonia and is not eating. She normally injects insulin glargine 24 units at nigh…