4 collapsed patients

Case 1

• A teenager aged 18 is found at home• Febrile and appears confused and is irritable

Examination

• Temperature 39.7• P 120• BP 90/50• Noted to have a faint

rash on skin

Questions

• Which illnesses you consider?• What actions need to be undertaken• How quickly should any intervention be

made?• What are the potential risks ?• Should any action be undertaken relating to

friends or family?

Case 2

• A 62 year old man is found at home• He is collapsed • He is confused but rousable• He is pale and noted to be sweating

Examination

• BP 60 • Unable to palpate wrist pulse• P 40 • HS audible

Questions

• What are the possible causes of this picture?• What actions would you take when this man

arrives in A/E?• What tests are available?• Which organs might be particularly at risk?• Actions?

Case 3

• A 22 year old student is our with friends for a curry

• He suddenly collapses• He is noted to be pale and cold

Examination

• BP 70/50• P 100• Raised rash on trunk and legs• Swelling of lips• Audible wheeze

Questions

• What is the likely cause of this collapse?• What are the possible precipitants of the

condition?• Why has this mans BP dropped?• What actions need to be taken?

Case 4

• A jockey is thrown from his horse on the racecourse at Newmarket

• When the doctor arrives he is responding to pain

• His radial pulse cannot be felt

Examination

• Noisy respiration• Responding to pain• P 120 carotid but not palpable at wrist• Sweating

Questions

• What will kill this man first?• What does the doctor need to do first ?• What is the AVPU score?• What is the most likely reason for the

tachycardia and the low BP?• Where in the body might he be loosing blood

and how much?• What actions are required?