Hyperglycemic Hyperosmolar Syndrome (HHS) is a life-threatening metabolic condition that requires prompt recognition and treatment in the emergency setting. Unlike diabetic ketoacidosis (DKA), HHS typically affects older adults with type 2 diabetes and is characterized by severe hyperglycemia, hyperosmolarity, and dehydration—without significant ketoacidosis. This condition often presents subtly, with symptoms such as confusion, lethargy, and weakness, which can easily be mistaken for other medical issues, leading to delayed diagnosis. Understanding the unique pathophysiology and treatment strategies for HHS is crucial for emergency clinicians to reduce morbidity and mortality in these patients.

The diagnosis of subarachnoid haemorrhage in the emergency department is a constant source of anxiety. How do we make sure we pick up everyone with a bleed, but not overinvestigate others?…

Caustic substances are commonly used in the household and the workplace. Some are heavily alkaline, like bleach and ammonia. Others are acidic, like toilet cleaners and battery fluid. All have the potential to cause significant damage when ingested by humans, whether as an accident or as part of a suicide attempt. Injury usually occurs through corrosion of the oral mucosa, oesophagus, and stomach, although the airway may be affected if the substance is also aspirated or if there is “overspill” from the digestive tract.

A 17-year-old right hand dominant male with no past medical history comes in complaining that he broke his right finger after being tackled at football practice. You note a right hand with all fingers held in flexion except for his right index finger, which is in extension. There is some tenderness to palpation at the proximal interphalangeal joint, but otherwise normal elsewhere. He has limited flexion and extension at the second finger but otherwise normal movement in all other digits. Skin is intact with no obvious lacerations or open wounds to the hand. Sensation is intact to the median, ulnar and radial nerve distribution. 2-point discrimination is intact to the radial/ulnar aspect of fingers 1-5. Capillary refill is <2 seconds. He has full ROM at the wrist, elbow, and shoulder.