47 yo female who suffered from these rashes for over one ye | Figure 1

47 yo female case

47 yo female who suffered from these rashes for over one year. It is puritic with crusting erythematous papules present. She has tried multiple topical steroid creams without any major relief. Any recommendations?

Case 1: Family presence during resuscitation

Why is this question important?

Patients and their relatives increasingly expect to be actively involved in the decisions of treatment. However, there are concerns that family presence during resuscitation (FPDR) can lead to post‐traumatic stress disorder (PTSD)‐related symptoms in relatives, or have a negative impact on the performance of healthcare professionals, thereby hampering the quality of critical care. There are also concerns that patient confidentiality can be violated, as the patient's thoughts and preferences in the situation are unspoken. The needs of all participating individuals must be balanced, as the actions involving patients, relatives, and healthcare professionals is seen as a triangular relationship that may impact one another.

What did we want to find out?

We wanted to examine the existing evidence for the effect of FPDR, including cardiac arrest, trauma, and acute medical care.

What did we do?

We searched medical databases on 22 March 2022 without any language limits. We checked references and contacted study authors to identify additional studies. We included randomized controlled trials (a type of study where participants are randomly assigned to one of two or more treatment groups) of adults who were present during resuscitation of their relative.

What we found

We included 2 trials (3 papers) involving a total of 595 participants who were between the ages of 19 and 78. One trial involved 15 pre‐hospital emergency medical services units in France, investigating FPDR in patients with cardiac arrest. This trial had a one‐year evaluation that we included in the review. The other included trial was a small pilot study of FPDR in patients with cardiac arrest or trauma in an emergency department in the UK.

Key results

There was not enough evidence to draw any firm conclusions on the effects of FPDR on any of the outcomes studied. Overall, it appeared that FPDR decreased PTSD, anxiety and depression, and grief; however, as the studies are very few and were at high risk of bias, this effect is very uncertain. One of the included studies also measured duration of patient resuscitation and personal stress in healthcare professionals during FPDR and found no difference between study groups.

How reliable are the results?

Our confidence (certainty) in the evidence is very low.

Case 2: Sleep issues experienced by a client

Hi, I am a provisional psychologist and in my first 6 months of my internship. I had a client last week and she was talking to me about her sleep issues. I was wondering if anyone can put an input and help me understand her case. Will appreciate it. KH reported that when she sleeps, at times she feels that she can’t breathe in her sleep. It feels like her heart will stop (she will die) if she doesn’t wake up. Along with that, KH reports that while she has trouble breathing, she is also experiencing mild shakiness in her legs, intense head (rotating right to left, hands movement), and the longer she has trouble breathing, the faster the shaking. While this is happening, she is unable to wake up; she has fear of dying. She says that she is half awake and half asleep. She describes this experience like half of her brain wanting to wake up and the other half wanting to sleep. She also says that when she finally wakes up, her brain feels heavy and she still feels almost 70% asleep. She will go back to sleep or stand up, drink water, and wait to feel better, but when she goes back to sleep, the same experience happens over and over again. She says that she doesn’t feel that she is asleep, but her eyes are closed and she cannot move or wake up. However, she knows what is happening around her; for example, when her husband gets up to drink water, she will know he got up and had water. Her husband has witnessed the head shaking and body movement and has tried to wake her up a few times. However, he is a heavy sleeper and can’t watch her all the time. What are your thoughts? I really want to help her. She doesn’t smoke, drink, or take drugs. This happens during the morning usually 4 am - 6 am. She hasn’t had any major incidents and has anxiety, some depression.

Case 3: Positive drug test despite medication

The patient hasn't taken any new OTC meds but takes Celexa for depression and anxiety. A court-ordered monthly salivary drug test came up positive for amphetamines and cocaine. How would you handle this?

Case 4: Chest pain in a 52-year-old man

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case 5: Intense pruritus over the lower back

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.