Table Of Content

100 Cases in Emergency Medicine and Critical Care http://taylorandfrancis.com Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business Eamon Shamil MBBS MRes MRCS DOHNS, AFHEA Specialist Registrar in ENT – Head & Neck Surgery Guy’s and St Thomas’ NHS Foundation Trust, London, UK Praful Ravi MA MB BChir MRCP Resident in Internal Medicine, Mayo Clinic, Rochester, MN, USA Dipak Mistry MBBS BSc DTM&H FRCEM Consultant in Emergency Medicine, University College London Hospital NHS Foundation Trust, London, UK 100 Cases Series Editor: Janice Rymer Professor of Obstetrics & Gynaecology and Dean of Student Affairs, King’s College London School of Medicine, London, UK in Emergency Medicine and Critical Care 100 Cases CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2018 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-139-03547-8 (Paperback) International Standard Book Number-13: 978-1-138-57253-9 (Hardback) This book contains information obtained from authentic and highly regarded sources. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com To Mum, Dad, Dania, and Adam for their unconditional love. To Mohsan, Shah, and Praful for their endless support. And to my patients and teachers, who have drawn me closer to humanity. Eamon Shamil To my parents, patients and teachers. Praful Ravi To my wife, Snehal, for her endless support. Dipak Mistry http://taylorandfrancis.com vii CONTENTS Contributors xi Introduction xiii Critical Care Case 1: Respiratory distress in a tracheostomy patient 1 Case 2: Nutrition 5 Case 3: Shortness of breath and painful swallowing 9 Case 4: Collapse while hiking 13 Case 5: Fever, headache and a rash 17 Case 6: Nausea and vomiting in a diabetic 19 Case 7: Stung by a bee 23 Case 8: A bad chest infection 27 Case 9: Head-on motor vehicle collision 31 Case 10: Intravenous fluid resuscitation 35 Case 11: Found unconscious in a house fire 37 Case 12: Painful, spreading rash 41 Case 13: Submersion 45 Case 14: Crushing central chest pain 49 Internal Medicine Case 15: Short of breath and tight in the chest 53 Case 16: A productive cough 57 Case 17: A collapse at work 61 Case 18: Dysuria and weakness 63 Case 19: Leg swelling, shortness of breath and weight gain 67 Case 20: Chest pain in a patient with sickle cell anaemia 71 Case 21: Fever, rash and weakness 75 Case 22: Rectal bleeding with a high INR 77 Case 23: Back pain, weakness and unsteadiness 81 Case 24: Feeling unwell while on chemotherapy 83 Case 25: Productive cough and shortness of breath 87 Case 26: Vomiting, abdominal pain and feeling faint 89 Case 27: Seizure and urinary incontinence 91 Case 28: Chest pain in a young woman 95 Case 29: Faint in an elderly woman 99 Case 30: An abnormal ECG 103 Case 31: Fever in a returning traveller 107 Case 32: Loose stool in the returned traveller 111 viii Contents Mental Health and Overdose Case 33: Unconscious John Doe 115 Case 34: An unresponsive teenager 119 Case 35: Deteriorating overdose 125 Case 36: Attempted suicide 129 Neurology and Neurosurgery Case 37: Back pain at the gym 133 Case 38: Passed out during boxing 137 Case 39: Headache, vomiting and confusion 141 Case 40: Motor vehicle accident 143 Case 41: Slurred speech and weakness 147 Case 42: A sudden fall while cooking 151 Case 43: Neck pain after a road traffic accident 153 Trauma and Orthopaedics Case 44: My back hurts 155 Case 45: My shoulder popped out 159 Case 46: Fall on the bus 163 Case 47: Motorbike RTC 165 Case 48: Fall onto outstretched hand (FOOSH) 167 Case 49: Painful hand after a night out 171 Case 50: Cat bite 173 Case 51: Pelvic injury in a motorcycle accident 177 Case 52: Unable to stand after a fall 181 Case 53: Twisted my knee skiing 185 Case 54: Fall in a shop 187 Case 55: I hurt my ankle on the dance floor 191 Case 56: Fall whilst walking the dog 195 General Surgery and Urology Case 57: Upper abdominal pain 199 Case 58: Gripping abdominal pain and vomiting 203 Case 59: My ribs hurt 207 Case 60: Severe epigastric pain 211 Case 61: Left iliac fossa pain with fever 213 Case 62: Acute severe leg pain 217 Case 63: Abdominal pain and nausea 219 Case 64: Epigastric pain and nausea 223 ix Contents Case 65: A 68-year-old man with loin to groin pain 227 Case 66: Right flank pain moving to the groin 231 Case 67: Testicular pain after playing football 235 ENT, Ophthalmology and Maxillofacial Surgery Case 68: Recurrent nosebleeds in a child 237 Case 69: Worsening ear pain 241 Case 70: Chicken bone impaction 243 Case 71: Ear pain with discharge and facial weakness 245 Case 72: Post-tonsillectomy bleed 247 Case 73: A swollen eyelid 249 Case 74: Red eye and photosensitivity 253 Case 75: Painful red eye 257 Case 76: Visual loss with orbital trauma 261 Case 77: Difficulty opening the mouth 265 Paediatrics Case 78: Cough and difficulty breathing in an infant 269 Case 79: A child with stridor and a barking cough 271 Case 80: A child with fever of unknown origin 273 Case 81: My son has the ‘runs’ 277 Case 82: A child with lower abdominal pain 281 Case 83: A child acutely short of breath 283 Case 84: A child with difficulty feeding 287 Case 85: A child with head injury 291 Case 86: The child with prolonged cough and vomiting 293 Case 87: A child with a prolonged fit 297 Obstetrics and Gynaecology Case 88: Vomiting in pregnancy 301 Case 89: Abdominal pain in early pregnancy 305 Case 90: Bleeding in early pregnancy 309 Case 91: Pelvic pain 313 Case 92: Abdominal pain and vaginal discharge 317 Case 93: Vulval swelling 321 Case 94: Fertility associated problems 325 Case 95: Headache in pregnancy 329 Case 96: Breathlessness in pregnancy 333 Case 97: Postpartum palpitations 337 x Contents Medicolegal Case 98: Consenting a patient in the ED 341 Case 99: A missed fracture 345 Case 100: A serious prescription error 349 Appendix: Laboratory test normal values 353 Index 355 xi CONTRIBUTORS Mental Health and Overdose, Ophthalmology, Maxillofacial Dr Mohsan M. Malik BSc, MBBS Specialist Trainee in Ophthalmology The Royal London Hospital Barts Health NHS Trust London, UK Obstetrics and Gynaecology Dr Hannan Al-Lamee MPhil, MBChB Specialist Trainee in Obstetric and Gynaecology Imperial College Healthcare NHS Trust London, UK Paediatrics Dr Noor Kafil-Hussain BSc, MBBS, MRCPCH Specialist Trainee in Paediatric Medicine London Deanery London, UK Neurology and Neurosurgery Dr Vin Shen Ban MB BChir, MRCS, MSc, AFHEA Resident in Neurological Surgery University of Texas Southwestern Medical School Dallas, Texas http://taylorandfrancis.com xiii INTRODUCTION Emergency Medicine and Critical Care are difficult specialties and they can be quite daunt- ing for new physicians. The modern Emergency Medicine physician has to take a focused history, which can often be incomplete due to the patient’s care being spread over several hos- pitals, examining the patient, arranging rational investigations and then treating the patient. This is often combined with seeing multiple patients simultaneously as well as time pressure. Similarly, in Critical Care, there is the challenge of having to very rapidly assess unwell or deteriorating patients and initiating a suitable management strategy. This book has been written for medical students, doctors and nurse practitioners. One of the best methods of learning is case-based learning. This book presents a hundred such ‘cases’ or ‘patients’ which have been arranged by system. Each case has been written to stand alone so that you may dip in and out or read sections at a time. Detail on treatment has been deliberately rationalised as the focus of each case is to recognise the initial presentation, the underlying pathophysiology, and to understand broad treatment principles. We would encourage you to look at your local guidelines and to use each case as a springboard for further reading. We hope that this book will make your experience of Emergency Medicine and Critical Care more enjoyable and provide you with a solid foundation in the safe management of patients in this setting, an essential component of any career choice in medicine. Eamon Shamil Praful Ravi Dipak Mistry http://taylorandfrancis.com