Toxicity and poisoning

A 22-year-old woman is brought from a music festival by paramedics. She is agitated and confused, her temperature is 39.8 °C, pulse 132/min, blood pressure 158/…

Clinical rotations · middle twist

A 19-year-old woman presents six hours after taking 30 × 500 mg paracetamol tablets in a single impulsive act following an argument. She also took "a few&q…

Clinical rotations · common

A 15-year-old girl is brought to the emergency department by her mother two hours after swallowing a handful of tablets during an argument. She says she took on…

Clinical rotations · common

A 3-year-old girl weighing 15 kg is brought in one hour after swallowing tablets from her mother's iron bottle. Each tablet contains 65 mg of elemental iron and…

Pre-internship · middle twist

A 2-year-old boy weighing 13 kg is brought to the emergency department 40 minutes after his mother found him beside her open bottle of iron tablets, with an ora…

Clinical rotations · middle twist

A father telephones the emergency department. Twenty minutes ago he found his 20-month-old daughter with the back of the television remote prised open and one o…

Pre-internship · middle twist

Several people are brought to a metropolitan emergency department after a chemical was deliberately released in a shopping centre. A six-year-old girl weighing…

Pre-internship · niche

An 18-month-old boy is brought to a rural emergency department after being found in a farm shed beside a spilt container, with his clothing wet. He is drowsy bu…

Clinical rotations · middle twist

A three-year-old girl is brought to a regional emergency department 30 minutes after drinking from an unlabelled bottle her father had decanted drain cleaner in…

Pre-internship · middle twist

A mother telephones her general practice mid-morning. Her two-year-old daughter has been found in the laundry sitting beside an open bottle of a garden product,…

Clinical rotations · common

A two-year-old girl weighing 12 kg is brought to a regional emergency department 90 minutes after being found with her mother's iron tablets. The pack accounts…

Pre-internship · middle twist

A two-year-old boy is brought to a regional emergency department 30 minutes after drinking from a soft drink bottle in the garage that his father had filled wit…

Clinical rotations · middle twist

A 20-month-old girl is brought to a metropolitan emergency department 45 minutes after her brother saw her swallow a 20 mm lithium button battery from a remote…

Pre-internship · niche

A 15-year-old boy weighing 60 kg presents to a metropolitan emergency department six hours after swallowing forty paracetamol 500 mg tablets in one go. He has v…

Pre-internship · middle twist

A three-year-old girl weighing 14 kg is found with her grandmother's dose administration aid, which contains amitriptyline. Two hours later she is drowsy with 5…

Pre-internship · middle twist

A three-year-old boy weighing 15 kg is brought to the emergency department 90 minutes after his parents found him with an open bottle of perfume containing 60%…

Clinical rotations · common

A 14-year-old girl is brought to the emergency department by her mother three hours after being found crying in her bedroom beside an empty packet of ibuprofen…

Clinical rotations · common

A boy born at 38 weeks is 44 hours old on the postnatal ward. His mother attends a treatment program for a daily supervised dose of buprenorphine and reports no…

Pre-internship · middle twist

In late July a 34-year-old man attends with both his housemates. All three have had headache, nausea and poor concentration that build up through each evening a…

Clinical rotations · middle twist

You are a medical student on placement in a rural general practice 90 minutes by road from the nearest hospital. A grandmother brings in her 2-year-old grandson…

Clinical rotations · common

A 46-year-old man with osteoarthritis is brought in three hours after taking twenty-four modified-release paracetamol tablets, each 665 mg, at one sitting. He w…

Clinical rotations · niche

A 26-year-old woman weighing 60 kg presents five hours after swallowing an unknown number of immediate-release paracetamol tablets. She is alert with normal obs…

Pre-internship · niche

A 19-year-old woman walks into a metropolitan emergency department with her sister ninety minutes after swallowing thirty modified-release paracetamol tablets.…

Clinical rotations · middle twist

A 19-year-old woman is brought to the emergency department by her flatmate two hours after swallowing a handful of paracetamol tablets following an argument. Sh…

Clinical rotations · niche

A 34-year-old man is brought to the emergency department six hours after his general practitioner increased his sertraline and added tramadol for back pain. He…

Clinical rotations · middle twist

A 17-year-old girl weighing 55 kg says she swallowed 45 tablets of immediate-release paracetamol 500 mg about ten hours ago after an argument with her partner.…

Pre-internship · middle twist

A 19-year-old man is brought in by friends four hours after a party. He is agitated, mumbles continuously and plucks at the bedclothes, and does not know where…

Clinical rotations · common

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…

Clinical rotations · common

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…

Clinical rotations · common

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…

Clinical rotations · common

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…

Pre-internship · common

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…

Pre-internship · middle twist

A 19-year-old man is brought to hospital 90 minutes after swallowing approximately 60 g of paracetamol. He is drowsy, sweaty and vomiting. Arterial blood gas an…

Clinical rotations · niche

A 32-year-old man is found confused after ingesting an unknown number of amitriptyline tablets. He has a blood pressure of 86/54 mmHg, a pulse of 126/min and a…

Clinical rotations · common

A 58-year-old man is brought to the emergency department after being found drowsy beside an empty bottle of methadone mixture. He has a respiratory rate of 7/mi…

Clinical rotations · common

A 24-year-old woman presents 30 hours after taking repeated doses of paracetamol for a dental infection. She estimates taking 10–12 g daily for four days; her p…

Clinical rotations · common

A 26-year-old man with schizophrenia stopped taking lorazepam prescribed for recurrent episodes of immobility and mutism. Two days later he is mute, alternates…

Clinical rotations · niche

A 34-year-old woman with schizoaffective disorder becomes restless, sweaty and confused six hours after venlafaxine was increased and tramadol was prescribed fo…

Mechanisms of disease · common

A laboratory technician is found unconscious in a poorly ventilated garage. Arterial blood shows pH 7.39, PaO2 13.0 kPa (reference 10.7–13.3 kPa), and PaCO2 5.1…

Mechanisms of disease · common

A 17-year-old girl presents six hours after a deliberate ingestion of tablets taken from the family bathroom cabinet. She complains of nausea, repeated vomiting…

Clinical rotations · common