It is 1600hrs at your tertiary ED. You are asked to review a 22 year-old woman who presents with lower pelvic pain and PV bleeding. Her vital signs are:

It is 1600hrs at your tertiary ED. You are asked to review a 22 year-old woman who presents with lower pelvic pain and PV bleeding

As duty consultant in a tertiary ED, you have just arrived for handover to a late shift on Monday evening. The department is full. There are no monitored or general cubicles available. More than 1/3 of the patients in cubicles are awaiting ward beds. Your medical staff are currently occupied with several high-acuity cases.

A 3 year-old boy is brought to your ED by his concerned mother. He complained of progressive pain in his right groin after playing in the back garden. The boy is a usually healthy, developmentally normal child. On initial assessment he is in obvious discomfort, with noticeable sweating of his right leg.

A 34 year-old man is brought to your tertiary ED after a motorbike crash. Your junior registrar assesses the patient and reports to you a diagnosis of dislocated left patella. He asks you to review x-rays of the patient’s knee.

You are on duty at 1800hrs in your ED. Ambulance brings in a 48 year-old man who suffered 2 episodes of large-volume haematemesis, estimated at 500ml each time. He had one episode of melaena. On presentation, the patient is clammy, with a HR of 120/min and a systolic BP of 85 mmHg

The ambulance has brought in a 65 year-old man with severe dyspnoea. The patient has a history of Chronic Obstructive Airway Disease (COAD), with regular use of bronchodilators. He is still a heavy smoker, but has no other relevant past history. On arrival, he is sweaty, distressed and peripherally cyanosed.

Scenario It is 2100hrs in your urban district ED. An 18 y old man presents with right shoulder pain, sustained in an accidental fall less than 1 hour ago. He has no other injuries, but you suspect a shoulder dislocation. Question 1 Discuss the Role of pre-reduction x-rays in this setting. Outline of answer Question [...]

A 70 year-old lady is referred by her GP with a 2-day history of apparent confusion, with episodes of agitation. She complains of a dry mouth and blurred vision. Her son states she took some over-the-counter medications from the chemist recently