Ranulf is a 14-year-old explorer.

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed.

Whilst you were busy managing head injuries and drownings,  Ranulf had been out with a group of boys from school this evening. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest. Spirits were running high amongst the young teenagers as they ate and drank, regaling their parents with tales from the trip.

Ranulf’s best friend, Tarquin, had particularly enjoyed their lesson in arctic spear-fishing and, in an attempt to demonstrate the native technique, grabbed a knife wedged into a nearby piece of stilton. Tarquin lifted the knife high above the remains of his fish course. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. Lurching awkwardly sideways, Tarquin fell towards his best friend, the knife lunging deep into the left side of his chest.

Ranulf went white with the shock.

Tarquin screamed and pulled the knife straight back out, but blood started to spurt from the decent-sized incision he had accidentally made.

Grabbing a pristine white table napkin to apply pressure to the wound, Ranulf’s class teacher and expedition leader called the ambulance as chaos descended on the restaurant.

A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. The patient has baseline left-sided weakness, but his wife noticed that he developed dense left-sided paralysis and left facial droop a few hours ago. His last known normal was 5 hours prior to ED presentation. On arrival, the patient is taken directly to CT scan due to concerns for CVA. During their report, medics note that the patient had three episodes of emesis during transport and received antiemetics. National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. The patient is in no acute distress. He is dysarthric but nods in agreement when asked if he is dizzy. Glasgow coma scale (GCS) is 12. The CT room is dark and the ED provider notes the patient’s pupils are 5 mm on the right and 3 mm on the left but briskly reactive bilaterally. As the CT is completed, the patient becomes more somnolent and the ED team electively intubates him due to concern for continued clinical deterioration. CT reveals subarachnoid hemorrhage (SAH) with midline shift.

Since its emergence over a decade ago as a potential tool to manage the patient with non-compressible torso hemorrhage, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been the marmite of the trauma world – people either love it or hate it. Needless to say, the social media reaction following the release of the UK-REBOA trial at the Critical Care Reviews meeting in Belfast earlier this month was predictable. The trial’s negative results (the first randomized-controlled trial [RCT] for this procedure) seemed to be an early Christmas present for those in the anti-REBOA camp.

A 3-year-old male with no past medical history presents to the ED with one week of daily fevers >102°F associated with four days of rash on the trunk. His parents have been managing his fevers with acetaminophen and ibuprofen, but became worried today when they noticed redness and swelling of the tongue in addition to swelling in the hands and feet. Vital signs demonstrate a rectal temperature 39.5°C, BP 92/60, HR 130, RR 35, and SpO2 of 98%. Physical exam demonstrates an ill appearing child with bilateral conjunctival injection; erythematous tongue with dry, fissured lips; right sided cervical lymphadenopathy; an erythematous maculopapular rash on the chest, abdomen, and back; and nonpitting edema of the hands and feet. What is the most likely diagnosis?