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em@3am

EM@3AM: Malaria

A 42-year-old male presents with headache, fever, chills, nausea, and myalgias. He returned from a month-long trip to Africa several weeks ago. On examination, he is tachycardic and febrile. You do not find a rash or meningismus, but you palpate an enlarged spleen and liver.  What is your next step in evaluation and management?

em@3am

EM@3AM: Pancreatitis

A 39-year-old female presents with severe epigastric pain, nausea, and several episodes of non-bloody, non-bilious emesis. The pain is sharp and radiates to her back. On examination, she is tachycardic and tachypneic with diffuse abdominal tenderness, but afebrile. Her lipase returns at 1100 U/L. What is your next step in evaluation and management?

em@3am

EM@3AM: The Sick Neonate

A 10-day-old female presents with her parents with poor feeding and increased work of breathing. Her urine output has been poor, but her parents have not observed fevers. She is afebrile, but her HR is 188, RR is 61, and oxygen saturation is 94% on room air. She demonstrates increased work of breathing and retractions and appears lethargic. Her serum glucose is 48. What is your next step in evaluation and management?

em@3am

EM@3AM: Myasthenia Gravis and Crisis

A 29-year-old female presents with generalized weakness and vision problems. The weakness is worse at the end of the day, and she has noted double vision. The symptoms worsen with heat. She denies any other neurologic deficits, including paresthesias. What is the likely diagnosis, and what is your next step in evaluation?

em@3am

EM@3AM: Multiple Sclerosis

A 33-year-old female presents with blurry vision. She has also experienced intermittent paresthesias in her extremities and weakness. Your motor and sensory exam is normal, but you find internuclear ophthalmoplegia and an afferent pupillary defect. With these intermittent neurologic symptoms and ocular findings, what is the likely diagnosis, and what is your next step in evaluation?

em@3am

EM@3AM: Le Fort Fractures

An 28-year-old male presents after high-speed MVC with facial pain and loss of consciousness. He has severe facial pain and bruising, conjunctival hemorrhage bilaterally, and facial paresthesias. What is the patient’s diagnosis? What’s the next step in your evaluation?