You are asked to review a 65 year-old man who is comatose (GCS 3) with small pupils (2 mm bilaterally). He has a history of diabetes mellitus and bipolar disorder. He was discharged from hospital yesterday, following a surgical procedure.
Refractory shock in trauma is still most likely due to occult ongoing haemorrhage; shock may be due to the underlying cause of trauma e.g. MI leading to car crash
Apply ATLS/APLS protocol: primary survey to exclude life-threatening injuries, secondary survey, re-evaluation and definitive care.
Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state. His CT head is shown below.
Cyanide is a potentially lethal toxic agent that can be found in liquid and gaseous form. First discovered in 1786 by Scheele, who extracted it from the dye Prussian blue - and promptly died from exposure to the vapours
Salicylate poisoning: mechanisms of toxicity: acid-base disturbance, uncoupling of oxidative phosphorylation, disordered glucose metabolism
Standardised Mortality Ratio SMR is the ratio of the observed or actual hospital mortality and the predicted hospital mortality for a specified time period.
Diaphragmatic Palsy: unilateral can be asymptomatic depending on patients underlying respiratory reserve; bilateral -> most mechanical ventilation dependent
Palmar erythema is a non-specific finding characterised by a redness of the palmar skin.
Obstruction of the superior vena cava results from mediastinal mass lesions. Features include a plethoric and cyanosed face with periorbital oedema, exophthalmos, conjunctival injection, and venous dilatation in the fundi, distended non-pulsatile neck veins and a positive Pemberton sign.
Clubbing is an abnormality of the fingertips with following features: beaked nails; loss of angle between nail bed and finger; increased AP width of finger tip; sponginess of proximal nail bed
Shoulder pain radiating down the arm can be a diagnostic dilemma, with causes arising from multiple visceral and musculoskeletal structures.