What treatment does this patient need for her palpitations?
Miss C, a 24-year-old who was recently diagnosed with supraventricular tachycardia, attends the emergency department with a new episode of palpitations accompanied by lightheadedness. Her SVT episodes usually resolve spontaneously or with simple vagal manoeuvres but this time neither the Valsalva manoeuvre nor carotid sinus massage is effective. She is currently on the waiting list for electrophysiology study. She is otherwise healthy and has no family history of heart disease or sudden death. She is taking the combined oral contraceptive pill but is not on any other medication. What is the most appropriate next step in management?
Check your answer in our newly updated Hospital Presentations module on Palpitations. You’ll learn as you work through three scenarios where patients present with palpitations that have different causes. The module is full of tips on initial assessment, interpretation of 12-lead ECGs and rhythm strips, and when and how to initiate treatment.
A patient with dementia is causing disruption on the ward - what should you do?
You are called to a medical ward when working a night shift to see a patient with dementia who is out of bed and wandering round the ward causing disruption and disturbing other patients who are trying to sleep. What factors do you need to bear in mind when deciding on the best approach to managing this patient?
For practical tips on this challenging scenario, see our popular Ask the consultant module on Old-age psychiatry. In this module, consultants Dr Krish Vedavanam and Dr James Warner provide answers to clinical questions submitted by junior doctors. Among the topics covered are management of agitation, recognition of depression in older patients and how to approach care of a patient who feels life is not worth living anymore. The module gets great reviews from other users:
“Really sensible, practical advice. Would highly recommend this module.”
“Really useful module to give you confidence in clinical decision making in these difficult scenarios.”
How confidently can you assess possible causes of blackout?
Do you have a clear strategy for assessing a patient who presents following a transient loss of consciousness? How can you confidently distinguish cardiovascular from neurological and other possible causes? What are the key features to look out for in the history and eyewitness reports? Which investigations are important and which may not be needed?
Check your answers in our highly rated Hospital presentations module on Blackouts and collapse. You’ll learn as you work through typical patient scenarios that you might see in your day-to-day practice. Other junior doctors are giving the module great reviews:
"Well written, excellent presentation of this very common clinical scenario in the emergency department."
“Very good and easy to learn from.”
Get up to speed on sepsis
A 45 year old woman is admitted with right iliac fossa pain following a laparotomy two weeks ago for endometriosis. She has a respiratory rate of 24 breaths per minute, oxygen saturations of 94% on room air, heart rate 117 bpm, blood pressure 108/68 mmHg, and a temperature of 38.5℃. On examination she has tenderness in the right iliac fossa with pus draining from the incision site. You are asked to do a structured risk assessment for possible sepsis. How will you proceed - and how should your findings guide your management plan?
Check your answers in our new Hospital challenges module on
Sepsis in adults. You will work through patient scenarios that are typical of the situations you face in everyday practice as you learn about all the latest practice-changing developments in the evidence, guidance and classification of sepsis. The module is already proving very popular with other users:
"Excellent module with important details about updated sepsis guidelines."
"Very informative and relevant in clinical practice."
Also try the companion module on Sepsis in children to ensure you know how to identify and manage paediatric patients with infections that put them at high risk of serious illness or death from sepsis.
What’s the next step in managing this patient?
A 28-year-old man is admitted as an emergency with haematemesis. An endoscopy the day after admission shows some altered blood in the gastric lumen, but no bleeding point is identified. He is treated with intravenous omeprazole for three days. He then vomits more than 750ml of fresh blood. His blood pressure is 124/68 and his heart rate is 110 bpm. What is the most appropriate next step in managing this patient?
Check your answer in our newly updated module on Acute assessment and treatment of upper gastrointestinal bleeding, which will help ensure you feel more confident next time you have to manage this common emergency. The module covers the main causes of bleeding, initial evaluation, resuscitation of a patient with an upper GI bleed and the diagnostic and therapeutic uses of endoscopy and interventional radiology.
Safe prescribing in renal impairment
Prescribing in patients with acute or chronic kidney impairment can be tricky, with dose adjustments, nephrotoxicity, fluid balance and monitoring requirements among the factors you need to consider. In our new module on Safe prescribing in patients with kidney impairment, you will learn as you work through common prescribing scenarios. Drug classes covered include antibiotics, anticoagulants, antidiabetic agents and antihypertensives.
What do these ABG results indicate?
You see a 20 year old woman with acute severe asthma in the emergency department. She is unable to speak in full sentences. She has been given oxygen (15 l/min) via a reservoir bag mask. Her arterial blood gas results are as follows:
- pH: 7.47
- pO2: 11.2 kPa
- pCO2: 3.7 kPa
- HCO3-: 25 mmol/l
What is her acid-base disturbance?
Check your answer in our updated module on Arterial blood gases: a guide to interpretation. It offers a practical five-step approach that will help ensure you feel confident on everything from how to distinguish respiratory from metabolic disturbances through to trickier challenges like calculating the alveolar-arterial gradient and understanding what it means for diagnosis and management of the patient.
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If you’d like to help BMJ Learning ensure we deliver the content that you need as a medical trainee, join our audience panel to provide feedback and ideas. Email clinical editor Jo Haynes.
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