clinical ed cases (8 2-12)
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Dr Bish – Miscellaneous ED case presentations
Clinical CasesMiscellaneous ED presentationsPort Hedland – Rural Clinical School tutorial (8/2/12)
Dr Bishan Rajapakse
Dr Bish – Miscellaneous ED case presentations
Renal failure and back pain49 yo man end stage renal failureOn dialysis times a weekFall 4 weeks ago – back pain and
lower leg pain since – walking with limp, uses a stick
OE// Tender in L upper thigh, lower lumbar spine
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Describe what is seen on the Xray?
What is your differential diagnosis?
What further investigations do you want?
Dr Bish – Miscellaneous ED case presentations
CT scan of the abdomen showed changes consistent with renal osteodystrophy
ESR was not raised
Dr Bish – Miscellaneous ED case presentations
Red eyes and abnormal Cornea11 yo boy with 3 day history of
bilateral red eyes (worse on L)Treated for viral conjunctivitis
with Chloracetmycin drops but not improving
Visual acuity in L eye 6/18 R eye 6/6
Diffuse Fluoroscein uptake
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Nb vertical line is light reflexDescribe what you see?
Dr Bish – Miscellaneous ED case presentations
What can be the cause of this appearance?
What is your plan?
Dr Bish – Miscellaneous ED case presentations
Ophthalmology consulted◦Likely to be viral conjunctivitis◦Chloramphenicol drops further irritant
to cornea resulting in oedma and swelling
◦Treat viral conjunctivitis stop antibiotic drops and continue with sterile lubricant Review in 24 hours Urgent referral if no improvement
Dr Bish – Miscellaneous ED case presentations
Nb Visual acuity was 6/6 at follow up, patient improved
Dr Bish – Miscellaneous ED case presentations
Ankle pain without trauma38 yo with painful swollen Ankle2 day history, no trauma
reportedProgressively worse yesterdayToday unable to walk without
limp
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
What is your differential diagnosis
Describe the ankle x-rays◦Is there anything to see?
Dr Bish – Miscellaneous ED case presentations
Painful red eye…32 year old male with one day
history of painful red eye
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Describe what you see?What is the likely diagnosis?
Dr Bish – Miscellaneous ED case presentations
Chest abnormalities78 yo man presents with SOB to
provincial hospital ED
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Describe what you see?What is your differential
diagnosis?What is your plan?
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
What was done?Describe what you seeWhat is the diagnosis now?What else will need to be done?
Dr Bish – Miscellaneous ED case presentations
Hand is hurting!
Dr Bish – Miscellaneous ED case presentations
What is the diagnosis?
Dr Bish – Miscellaneous ED case presentations
He was treated in a volar resting splintComment on this treatment
Dr Bish – Miscellaneous ED case presentations
Acute Breathlessness 62 yo male truck driver acutely SOB –
BIBA as a category one to resus bay◦Transfer from airport after one hour flight
Lips blue, RR 50, O2 sats 88% on RAGiven oxygenSpeaking in short sentences, some
chest tightness, no painDoesn’t admit to previous lung
pathology
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
What is the differential diagnosis?
What other history will you ask for?
What other investigations will you order?
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
What is the diagnosis?
Dr Bish – Miscellaneous ED case presentations
Presumed malignancy with initial differential as
History of wt loss and haemoptysis
This was first medical presentation
Lung Ca confirmed on bronchial washings – referred from respiratory to oncology team
Dr Bish – Miscellaneous ED case presentations
Abnormal CXR
64 year old presents non-distressed with epigastric discomfort
Dr Bish – Miscellaneous ED case presentations
What is the diagnosis?
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
What does this CT scan show?
Dr Bish – Miscellaneous ED case presentations
The patient has a ruptured diaphragm with bowel herniation seen on CT
Dr Bish – Miscellaneous ED case presentations
Child with distension?8 y.o. boy with history of
development delay Abdominal distension ++Pain requiring morphineLimited history from mother
◦Suddenly became unwell in the last 2 hours
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Describe what you see?What is the treatment?Do you know the diagnosis?
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
He has a history of ingesting objects on further questioning of mother◦Battery ingested
Management◦Resuscitation and supportive cares◦Nasogastric to decompress the
stomach, referred urgently to paed surg
Dr Bish – Miscellaneous ED case presentations
5 hours later after conservative Rx
Dr Bish – Miscellaneous ED case presentations
Acute dysponea32 year old female presents with
acute dyspnoea 12 hours after a long haul flight from Europe to Australia
Saturations are 88% on RA, improve with oxygen
Dr Bish – Miscellaneous ED case presentations
Describe what you see?
Dr Bish – Miscellaneous ED case presentations
Dr Bish – Miscellaneous ED case presentations
Multiple filling defects on CTPA consistent with PE
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