recent articles


EM@3AM: Oculomotor Nerve Palsy

A 50-year-old female with no past medical history presents to the ED with a diffuse, constant headache onset a few weeks. The patient describes droopiness of the left eye and double vision associated with specific directional movements of the eye. On exam, you note ptosis of the left eye with findings as indicated in the photograph below (inability to adduct, ability to abduct). The left pupil is dilated at 5mm and minimally reactive to light; the right pupil is 3mm and reactive. The remaining cranial nerve testing and components of the neurological exam are normal.


EM@3AM: Liver Transplant Complications

A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. For the past two days, she describes worsening pain and intermittent vomiting. She came today because her sister is a nurse who noticed her eyes were yellow. She denies fever or a new rash. She has been taking her medications as prescribed. Vital signs: HR 118, BP 103/68, RR 20, T 99.8. On exam the patient is tachycardic with RUQ pain to palpation and scleral icterus. LFTs are in the thousands.