Supratherapeutic INR
A 70 year-old man has presented to your emergency department to get his INR checked. It is markedly elevated - how should you manage this?
Category Clinical Cases
LITFL Clinical Case Collection. Over 250 Q&A style clinical cases to assist Just in Time Learning and Life Long Learning. Cases are categorised by specialty and can be searched by keyword from the database table
Tricyclic antidepressant toxicity
A 25 year-old male (70 kg) is brought in by ambulance 30 to 60 minutes after ingesting 70 x 50mg amitriptyline. He is tachycardic (HR 120) with an otherwise 'normal' ECG (QRS 95 ms) but is becoming drowsy. You are called to the resuscitation room to assess him.
Irukandji Syndrome Territory-style
You are working as a locum doctor in the Northern Territory. Your patient is a 32 year-old Indonesian man who says he was stung while hauling in a net on an offshore fishing vessel.
Chironex fleckeri envenoming
Case-based question-and-answers on a near fatal box jellyfish sting. Can you save the day?
It was the little octopus!
A 21 year-old sailor placed a small blue and yellow octopus on his shoulder while wading back to shore after spear-fishing with a friend. As he reached the beach he threw the little octopus into the sea
Stingray envenoming
While riding in a boat off the North Queensland coast a 12 year-old boy was struck by a large fish that had catapulted itself out of the water.
Lionfish envenoming
Clinical case of a man being stung on the distal palmar surface of his right index finger by his lionfish (Pterois volitans) while cleaning his aquarium.
Theophylline overdose
Toxicological evaluation and treatment of a patient with theophylline toxicity
Little Johnny and Grandad’s warfarin
Little Johnny is an inquisitive 15kg 3 year-old boy. His grandad was looking after him for the evening. About an hour ago, the phone rang just as grandad was about to take his evening warfarin tablets. Although he only turned his back for a second, there was enough time for little Johnny to start ploughing into the tablets...
Paracetamol…too much, too often?
You are called by a doctor in a remote hospital asking for advice. The doctor is concerned about the risk of hepatotoxicity from repeated supratherapeutic ingestion (RSI) of paracetamol in the following patient:
Poisoning by a mercury thermometer
Your next patient is an 80 year old man suffering from Alzheimer's dementia. He was brought into the ED by his wife and daughter who are his care-givers. He had a recent catheter-associated urinary tract infection and his daughter was checking his temperature orally with a mercury thermometer 30 minutes previously.
Bitten by a Redback Spider
A 27 year-old woman felt a sting on the back of the right leg while pulling on her tracksuit pants. She investigated further and discovered a small black spider, with a red-stripe on its back, crawling around in her tracksuit pants.