Spontaneous hepatic artery pseudoaneurysm rupture as a first presentation of polyarteritis nodosa.

A man in his 70s presented with a sudden onset stabbing back pain radiating to the chest and pre-syncopal symptoms. He underwent urgent investigations, including a CT angiogram aorta which did not reveal any abnormalities within the thorax, abdomen or pelvis and no cause of symptoms was identified. After being discharged, he re-presented 2 days later with syncopal episodes, abdominal pain and a significant drop in haemoglobin levels.

Improving antimicrobial stewardship in an Acute Medical Unit (AMU) during patient discharge following introduction of an antimicrobial information card.

Background: Patients who initially present to the emergency department are often streamlined to an Acute Medical Unit (AMU). A quality improvement project was developed to introduce a new "Antibiotic Information Card" for patients discharged home from the AMU. Aims were to reduce 30-day readmission and reattendance rates due to the same infection after initial discharge by 75%, as well as improving patient education regarding their antibiotic prescription to 75%.

Acrocyanosis in a young adult: a rare presentation of extra-adrenal pheochromocytoma.

Extra-adrenal pheochromocytomas (EAPs) are rare catecholamine-secreting tumours. The patient commonly present with headache, palpitation, anxiety, diaphoresis, raised blood pressure and heart rate which can be sustained or episodic and less commonly Raynaud's phenomenon. We present a case of an adult woman who presented with unilateral upper limb acrocyanosis and hypertension which was secondary to EAP and resolved completely after surgical removal of the tumour.