This scenario involves a 42-year-old male presenting to a large academic emergency department following an explosion at an oil refinery. The patient arrives with multiple blast-related injuries, including bilateral perforated tympanic membranes, basilar skull fracture, right-sided pneumothorax, bowel perforation, liver laceration, extremity fractures, and superficial burns. Due to the nature of the incident, the patient requires immediate decontamination before further medical management. Critical interventions include emergent reduction of a right ankle fracture causing neurovascular compromise and chest tube placement for a tension pneumothorax. Additional imaging reveals further traumatic injuries necessitating consultations with trauma, neurosurgery, and orthopedic surgery. The scenario emphasizes the importance of blast injury management, including handling primary, secondary, and tertiary injuries. Team coordination with HazMat and emergency services is essential to ensure patient safety and hospital readiness. The case highlights the need for rapid, organized, and multidisciplinary approaches to handle complex trauma in blast-related incidents.

Which of the following statements about non-suicidal self-injurious behaviors are true?

Miscarriage is the most common complication of early pregnancy. For most cases, ultrasound is essential for it’s diagnosis and management. An ultrasound diagnosis of miscarriage is made using objective measurements and often a follow-up interval scan is needed. There are several ultrasound ‘soft markers’ which are associated with an increased risk a failing pregnancy, which may help with counselling a patient and planning when a repeat scan is needed.

This case presents a disaster medical scenario where healthcare professionals respond to injuries following a volcanic eruption and a subsequent lightning strike in Indonesia. The scenario begins with a medical team deployed to a field hospital one week after the volcanic eruptions, only to face a mass casualty incident caused by a lightning strike. The narrative focuses on key elements of mass casualty triage, particularly the unique considerations for lightning injuries, such as reverse triage, where typically nonsurvivable patients may be prioritized for immediate resuscitation. Critical medical management decisions are outlined, including the resuscitation of a pulseless, apneic patient who ultimately regains spontaneous circulation after Advanced Cardiovascular Life Support (ACLS) is applied. The case emphasizes scene safety, reverse triage during lightning events, and teamwork in evacuation procedures. The scenario also highlights the complications of head and neck trauma, rhabdomyolysis, and the need for a higher level of care.

Gestational trophoblastic disease (GTD) is the collective term for a number of conditions characterised by abnormal proliferation of the trophoblast layer of the placenta, including hydatidiform mole (complete and partial), invasive mole, atypical placental site nodule, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. In the UK, all GTDs are managed in one of 3 specialist centres, which has contributed to a near 100% cure rate. Ultrasound is useful in the early diagnosis of hydatidiform moles with improved rates of pre-evacuation identification seen over recent years (88% for complete moles and 56% for partial moles).

Fahr’s disease is characterized as which of the following?

Which of the following factors are NOT associated with an “unlikely to be restored to legal adjudicative competence” finding?

This case presents a detailed scenario involving a mass casualty incident resulting from a bus crash during a snowstorm. The scenario unfolds at an academic hospital and trauma center where the emergency department is alerted to receive 15 to 20 victims of the crash. The chapter emphasizes the importance of mass casualty preparedness, activation of disaster response protocols, and the critical role of triage in managing incoming patients. The teaching objectives focus on utilizing the START triage system, assigning roles, and coordinating between emergency and ancillary teams such as trauma surgery and radiology. Learners are tasked with prioritizing lifesaving interventions, managing resources, and handling the emotional impact on family members. Through a combination of moulage, rapid assessments, and critical actions, this scenario challenges emergency care providers to maintain situational awareness, adapt to evolving conditions, and ensure optimal patient outcomes during high-stress, resource-limited situations.

What is the most common diagnosis that leads to post-partum psychosis?

An ectopic pregnancy is any pregnancy implanted outside of the uterine cavity. They can be classified as either uterine or extra-uterine. The majority are extra-uterine, with the most common site of implantation being within the Fallopian tube. Other types of extra-uterine ectopic pregnancies include ovarian and abdominal pregnancies. Transvaginal ultrasound is now accepted as the diagnostic tool of choice for ectopic pregnancy. The aim of a scan is to positively identify the ectopic pregnancy, rather than to just exclude the presence of a normally sited pregnancy.

A 45-year-old male presents to the emergency department with severe respiratory distress after developing symptoms of fever, chills, myalgias, and a nonproductive cough five days ago. The patient had recently returned from a hiking trip in Yellowstone National Park, where he cleaned a cabin that had rodent nests and droppings. Upon arrival, he is hypoxic and requires supplemental oxygen and intubation. His condition worsens, developing hypotension requiring vasopressor support. Laboratory findings reveal leukocytosis with immunoblasts, thrombocytopenia, and elevated lactate. The patient is diagnosed with Hantavirus cardiopulmonary syndrome (HCPS), a condition linked to rodent exposure, specifically to the inhalation of viral particles from infected rodent droppings. Treatment focuses on advanced airway management, fluid resuscitation, and close monitoring of hemodynamic status. The patient requires intensive care unit admission, and state and local health departments must be notified due to the public health implications of HCPS.

This scenario presents a detailed simulation of a chlorine gas exposure incident following a freight train derailment. The scenario begins with a standardized patient and transitions to a manikin, set in a community hospital in the United States. The patient, a 47-year-old male freight engineer, was exposed to chlorine gas after a train derailment caused by a track defect. The simulation covers the initial emergency response, patient decontamination, and subsequent medical management, including the challenges of airway stabilization and treatment of acute respiratory distress syndrome (ARDS). Key teaching objectives include identifying hazardous materials, diagnosing and managing chlorine exposure, and effective teamwork and communication during a medical crisis. The scenario emphasizes the importance of rapid identification and treatment of chemical exposures and provides a comprehensive guide for healthcare professionals in managing similar emergencies.

Which of the following statements regarding comorbid anxiety disorders are true?

3 dimensional ultrasound and colour doppler techniques can be used to complement standard B mode transvaginal ultrasound imaging in early pregnancy. Colour dopppler can assist in the identification of corpora lutea, localisation of pregnancy implantation sites and confirmation of early embryonic demise. It can also aid the diagnosis of retained products of conception and gestational trophoblastic diseases. 3D ultrasound can facilitate the diagnosis of uterine anomalies and non-tubal ectopic pregnancies.

In this case scenario, a 55-year-old male presents with symptoms of Ebola virus disease (EVD) after returning from a medical mission in West Africa. The patient reports fever, chills, myalgias, nausea, vomiting, diarrhea, and one episode of bloody stool. Upon arrival, he is in septic shock with tachycardia, tachypnea, hypotension, and lethargy. Immediate resuscitation with IV fluids and vasopressors is initiated. As his condition worsens, he develops respiratory failure and pulmonary edema, requiring intubation. Laboratory findings indicate leukopenia, thrombocytopenia, transaminitis, coagulopathy, and metabolic acidosis, which are consistent with EVD. The patient is placed in isolation due to the suspicion of Ebola, and the case is reported to state and local health departments. The scenario emphasizes the importance of fluid resuscitation, hemodynamic support, appropriate PPE for Ebola management, and timely intubation, while discussing the management of exposure risk to clinical staff and follow-up procedures.