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The EM Educator Series: Sepsis in the ED

Welcome back to The EM Educator Series! These posts provide brief mini-cases followed by key questions to consider while working and educating. Today we look at several components of sepsis evaluation and management in the ED, followed by key references.

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EM@3AM: Hepatic Encephalopathy

A 52-year-old male with a history of severe liver disease, cirrhosis, and hepatitis C presents with altered mental status. His vital signs are normal, and he displays asterixis on exam, with otherwise normal neurologic exam. His ECG, head CT, and labs are normal. What should you consider, and what are your next steps?

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EM@3AM: Giant Cell/Temporal Arteritis

A 57-year-old female presents with right sided headache and mild fever (100.8 F). You note an enlarged, tender temporal artery with beading on exam. She denies vision changes. What is the diagnosis, and what are your next steps?

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EM@3AM: Endocarditis

A 26-year-old female presents with fevers and chills. She is febrile and tachycardic, with normal BP. You think you hear a murmur on exam, and on further questioning, she says she regularly uses IV drugs. What should you consider, and what are your next steps?

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EM@3AM: Hypertensive Emergency

A 63-year-old female presents with nausea, vomiting, and altered mental status. Initial VS demonstrate BP 225/121, HR 88, 98% RA, T 98F, RR 18. What are your next steps?