Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 9-year-old girl is brought to a Western Australian emergency department by her mother with three weeks of intermittent abdominal pain. While her mother is out…
Acute Care · Pre-internship · middle twist
A 58-year-old man is treated in the emergency department for a Colles fracture sustained tripping over a gutter. He smokes 25 cigarettes a day and lights the fi…
Acute Care · Clinical rotations · middle twist
A 24-year-old woman is brought in by ambulance after being found unrousable at home. She had swallowed six of her flatmate's morphine tablets, which he takes tw…
Acute Care · Pre-internship · middle twist
A 41-year-old bricklayer attends the emergency department after cutting his forearm on a broken glass door at home. The wound is cleaned and sutured. On routine…
Acute Care · Clinical rotations · middle twist
A 23-year-old woman is medically cleared six hours after taking 20 of her flatmate's quetiapine tablets at the end of a relationship. She says she regrets it, i…
Acute Care · Pre-internship · middle twist
A 74-year-old woman is being discharged from the emergency department after a fall at home with an undisplaced pubic ramus fracture on radiography. She can weig…
Acute Care · Pre-internship · middle twist
A 6-year-old boy fell from a trampoline five hours ago onto grass. He cried immediately and did not lose consciousness. He vomited once at the scene and not sin…
Acute Care · Clinical rotations · middle twist
The mother of a 5-year-old girl admitted to a Perth public hospital with gastroenteritis tells the bedside nurse that her daughter is going flat and is not hers…
Acute Care · Pre-internship · middle twist
A 58-year-old man walks into a Perth emergency department at 1900 hours saying he has had heavy central chest pain radiating to his jaw for the past 40 minutes.…
Acute Care · Clinical rotations · middle twist
A 74-year-old man collapses in a shopping centre and is brought to the emergency department in cardiac arrest. Resuscitation is unsuccessful and he is declared…
Acute Care · Pre-internship · middle twist
An intern covering a Perth hospital's wards and its residential aged care liaison service is asked about five deaths in one afternoon. All five are Western Aust…
Acute Care · Clinical rotations · middle twist
A 58-year-old man dies in the resuscitation bay after an out-of-hospital cardiac arrest. His wife and adult daughter have been waiting in the relatives room wit…
Acute Care · Pre-internship · middle twist
A 61-year-old woman with metastatic pancreatic cancer is in the emergency department short-stay unit with vomiting. She already knows her disease is incurable.…
Acute Care · Clinical rotations · middle twist
An 82-year-old woman with advanced dementia is admitted to a Perth hospital with a fractured neck of femur. She cannot repeat back or weigh up any part of the d…
Acute Care · Pre-internship · middle twist
A 34-year-old man is brought to a Perth emergency department with a stab wound to the thigh. He is alert, gives a clear account of the assault, and knows the da…
Acute Care · Pre-internship · middle twist
A 26-year-old man is brought in after coming off a motorcycle at speed. He has an anterior dislocation of the left shoulder and fractures of the left pubic rami…
Acute Care · Clinical rotations · middle twist
A 63-year-old man with renal colic is receiving morphine 2.5 mg intravenously every 5 minutes on your instruction. He has now had 12.5 mg and says the pain has…
Acute Care · Pre-internship · middle twist
A 71-year-old woman attends the emergency department with 10 hours of vomiting that began after a family barbecue. She has Parkinson disease treated with levodo…
Acute Care · Clinical rotations · middle twist
A 5-year-old boy is pulled from a backyard swimming pool in Mandurah after an unknown time under the water. He is limp and blue and is not breathing normally. H…
Acute Care · Pre-internship · middle twist
A 34-year-old bushwalker is winched out of a gully in the Stirling Range after a night in cold rain. He is unresponsive and pulseless. Cardiopulmonary resuscita…
Acute Care · Pre-internship · middle twist