Mannitol is used in cerebral oedema to relieve the pressure. Great you think. That’s just what we need.

You are speaking to neurosurgery whilst the mannitol is infused by the nursing staff. You note the staff looking at the mannitol giving set with the same fascination as if it were an alien embryo.

The neurosurgeon on the phone asks about the management so far and you explain you’ve given mannitol in A&E. There is a stunned silence. The neurosurgeon tells you to stop it now, measure the electrolytes and get some help from ICU.

You later read that 20% mannitol is only used if ICP > 20 mmHg, and is stopped if ICP falls below that. You find out it is only given in ICU environments, with a particular protocol and close monitoring of urine output, kidney function and electrolytes.

The delay with the unnecessary lumbar puncture faff was also not ideal.  Still, the patient lives, and so does your GMC number.

Final score: 5/10