Mr Derek Bryant is a 71 year old gentleman, who has lived in a residential home for the past 18 months. He has Type II diabetes, controlled with metformin, and hypertension, treated with bendroflumethiazide and ramipril. He had an MI 10 years ago, and is taking simvastatin and aspirin for secondary prevention of ischaemic heart disease.

His GP sent him into Accident and Emergency (A&E) this morning, after he had been unwell for several days in the home. The excellent Junior Doctor (FY1) in A&E thought bowel obstruction was likely, and treated Mr Bryant by giving IV fluids to correct dehydration and electrolyte abnormalities, and inserting an Nasogastric (NG) tube and urinary catheter. Plain radiography showed large bowel obstruction with no evidence of perforation, and Mr Bryant was admitted to Rosebud A, the surgical ward.