A 67 year old man presented with increased sleepiness.  3 days prior to the admission, he collapsed in the garden, witnessed by daughter. He attended A&E and he was discharged on the same day with head injury advice. Since then, he had been on increased sleepiness even in day times. Wife stated that he fell into sleep while talking.

He stated that he had a 6 month history of headahce, for which he had been seen by neurologist for headache with once a month follow-ups. Imagings had been done. Diagnosis was not conclusive. It was suggested  ?Trigeminal neuralgia.

So I put the presenting complaints as

1.    Headache for 6/12
2.    Increased sleepiness for 3/7

My consultant was not convinced my statement. He wrote down in his post take ward round section “admitted with increased sleepiness”

It is true. In fact patient did not come to hospital for headache, but for sleeping issue. His headache has been already under the management of neurologist even though recent issue could be related with previous issues. This consultant is very particular. His documentation is awesome. (He has got a unique hand writing style as well)

What a coincidence! Next day, A&E middle grade doctor referred me a young lady with toothache. It was found out that she took 10 grams of Paracetamol in 20 hours prior to admission. Toxic base suggested that paracetamol more than 150mg/kg in 24 hour is toxic level in non-high risk group. Her figure is 166 mg/kg. A&E happily started parvolex. Interestingly,  no management plan for toothache until she was moved to medical assessment unit. Of  course, they just forgot the reason of admission. I prescribed regular codeine and co-amoxiclav. We had to organize urgent dental appointment.

The same thing happened fortnight ago. A young chap was found out paracetamol overdose by A&E, following ear ache. Parvolex was started. When I saw the patient in medical assessment unit, he was in an agony of pain. His ear had full of pus. We had to transfer him to ENT hospital straight away.

Yes, reason of admission is very important. We must not forget to act it.

Classification of severity of airflow obstruction (when post-bronchodilator ratio of forced expiratory volume in one second (FEV₁) to forced vital capacity (FVC) is <0.7)

A&E referred me this 57 year old lorry driver presented with so called chest pain during my on-call hour.

I reviewed A&E notes, blood test results, ECG and CXR before seeing the patient. All routine blood tests were normal and admission Troponin was negative. ECG was normal sinus rhythm with no T/ST change. CXR unremarkable.

When I chatted with patient properly, it was not really a chest pain.

He expressed he never experienced such a strange feeling while watching tele. Patient described it as "Bang" "Bang" twice from his heart, followed by pounding heart. The attack last about 30 mintues.

At this point, I got a clue. So I asked the patient to tap the bed with his hand as he felt duing the episode. It was revealed that he tapped with vearying rates and varying intensity.

Interestingly, this patient has a knowledge how to feel his radial pulse. He said he felt his pulse that time,which was sometime fainting and sometime strong.

This 79 yr old man admitted with feeling unwell and knee pains.A&E saw and got orthopedic doctor to have a look, suggesting that less likey septic arthritis. But joint aspiration done and awaiting MC&S.

Referred to medics. ( It was me)

Background history showed

• COPD on LTOT under respiratory physician
• CKD stage 4,
• LVF under cardiologist
• Gout

We got rhuematologist to see him.Hight Uric acid on repeat blood test. Colchisine started. Paracetamol and Codeine were regular analgesics.

Pain settling in next a couple of days. Joint aspiration came back as negative culture. we start Phyiso and Occupational input for discharge.

But during the last weekend, he got a sudden onset abdo pain and vomiting. I was asked to see.

Family was around. He looked miserable. Holding sick bowl in which foul smelling fluid.

Not particularly drug interaction, Quinolones reduce the seizure threaddshold. we came acoss pateints presenting with fit after Ciprofloxacin was started.

It is also reported that quinolones associated with tendon rupture. especially Archille's