Description:

In this episode, an 11-year-old boy arrives unconscious, seizing, with a temperature of 40°C and tea-coloured urine. He was treated for malaria for four days. Now his kidneys are failing, his pressure is dropping, and the clock is running out.

In this real-life case review, Dr. Ann Kaguna Imelda (who managed the case) and Dr. Kenneth

Bagonza (EM expert) walk through every critical decision—what worked, what didn’t, and

why the child was unfortunate in the end.

special credit: Dr Daniel Oriba Longoya

Key points of discussion:

· The red flag triad

· Primary survey findings: threatened airway, shock, GCS 6

· Why dextrose has no role in septic shock resuscitation

· CSF Gram-positive diplococci = pneumococcal meningitis – treat immediately

· Managing hyperkalemia + AKI in a crashing child

· The 1-hour sepsis bundle (2026 guidelines)

· qSOFA at the bedside: RR ≥22, altered mental state, SBP ≤100 – no equipment needed

· Why “malaria not improving in 48 hours” demands a rethink

· Final reflection: system failures, early recognition, and what we owe the next child

Listen to learn. Share to save lives. Mastering Emergency Care

Disclaimer: For Educational Purposes only, refer to guidelines for definitive management

Show Notes & Resources:

· Watch the Full Case Video: https://youtu.be/qZZ86tknD8k?si=Pczbbe-vqvcti80V

· Rosen’s Emergency Medicine

· Tintinalli’s Emergency Medicine

· SSC 2026

In this episode, we walk through a high-stakes emergency: a 53-year-old woman with known hypertension who collapses at home, seizes, and arrives at the ED with a GCS of 8 and a blood pressure of 209/120 mmHg.

Join your hosts Dr Daniel Olinga and Dr Emmanuel David Okumu, along with special guests Dr. Brian Twinemastiko and Dr. Ruzige Bashir

Rashid, as we explore the critical, real-world decisions made when the textbook meets

reality.

We Discuss

· How to build and narrow a differential for altered mental status

· Why dropping BP too fast can cause a stroke

· The pathophysiology of PRES (Posterior Reversible Encephalopathy Syndrome)

· Practical management in a resource-limited setting like Uganda

· Key pitfalls: oral antihypertensives, missed pulmonary edema, and nutrition neglect

Tune in to learn how to manage Altered Mental Status secondary to Hypertensive Encephalopathy a pragmatic approach.

Disclaimer: For Educational Purposes only, refer to guidelines for definitive management

Show Notes & Resources:

· Watch the Full Case Video: https://youtu.be/qZZ86tknD8k?si=Pczbbe-vqvcti80V

· Rosen’s Emergency Medicine

· Tintinalli’s Emergency Medicine

· BMJ 2024: Evaluation and Management of Hypertensive Emergency

· PubMed: 40818477, 10972386

· NEJM: 1990;323(17):1178–1184