Hypotension poses a diagnostic challenge to emergency physicians who often have to exclude life-threatening conditions, make correct diagnosis and institute timely treatment. We presented a case of hydronephrosis causing the supine hypotensive syndrome. Management of the supine hypotensive syndrome and the use of emergency bedside ultrasound in evaluating hypotensive patients were discussed. (Hong Kong j.emerg.med. 2004;11:226-229)

Noisy belching in front of other people, often considered to be an impolite manner, may not be as harmless as it seems. We report on a patient who had spontaneous pneumomediastinum after intentional induction of noisy belching by rapid excessive intake of carbonated drinks (imitating the game played in a popular local television program “The Super Trio Continues…”). The clinical features, investigations and management of spontaneous pneumomediastinum are discussed.