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em@3am

EM@3AM: Bacterial Meningitis

A 21-year-old male is brought to the ED via EMS after a reported seizure. As per girlfriend, the patient began complaining of a headache yesterday, and today he is confused. He is febrile and tachycardic. He is confused and has nuchal rigidity. However, Kernig and Brudzinki signs are negative. CT is negative. What is most likely diagnosis, and what is the next step in diagnosis?

em@3am

EM@3AM: Cushing’s Syndrome

A 60-year-old female with diabetes and hypertension from skilled nursing facility presents with worsening mental status, shortness of breath, and muscle weakness. Vital signs include BP 175/100, HR 105, RR 22, SpO2 95% on room air, T 100.7F, and blood glucose of 275. Physical exam is remarkable for A&Ox2, obesity, striae, bilateral upper/lower extremity muscle weakness, and 2+ bilateral lower extremity edema. CMP/CBC is unremarkable, BNP is 250, and EKG shows low voltage. Outpatient random serum cortisol is 2700 nmol/L. What is the diagnosis, and urgent interventions will reduce the patient’s morbidity/mortality?