On the 1st December we marked world AIDS Day. This day was one of the first ever global health days and was introduced to increase awareness of the issue of HIV and AIDS in the 1980’s. The stigma and health concerns over HIV and AIDS have barely abated over this time and the day is as important as ever. Although testing is one aspect of HIV in the ED. I think HIV is more than just a blood test that we perform so I thought I might talk about my approach to HIV.

Not all patients with upper GI bleeds (UGIB) require aggressive resuscitation. But how do you decide which patients require transfusion and aggressive resuscitation? When do you urgently call your friendly neighbourhood GI specialist? Dr. Walter Himmel takes us through the resuscitation of a sick patient with an UGIB and the management priorities including blood products, antibiotics, TXA, octreotide, pantoprazole and endoscopy.

A 35-year-old male presents for intermittent fevers, abdominal pain, and headaches for 3 weeks. On further questioning, he also states he has arthralgias. He denies other medical problems.  Review of systems is remarkable for a recent camping trip in the Boundary Waters Canoe Area of Minnesota.

A 50 year old woman presents with a 2 day history of dysuria, for which she was started on ciprofloxacin last night. Since this morning, she has become increasingly weak, and now finds it impossible to get out of bed. She called 911 when she noticed she couldn’t catch her breath. She wonders whether this might be related to her myasthenia gravis…