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em@3am

EM@3AM: Typhlitis

A 62-year-old male presents with abdominal pain and fever for 2 days. He has recently completed induction chemotherapy a few days prior. Review of systems is remarkable for vomiting and anorexia. Exam reveals BP 96/69 mm Hg, HR 122, T 101.9 oral, RR 28, SpO2 97% on room air. He is ill appearing and has dry mucous membranes but no mucositis. Abdominal exam reveals guarding and tenderness in the right lower quadrant. What is the diagnosis, and what’s the next step in your evaluation and treatment?

em@3am

EM@3AM: IUD Complications

A 24-year-old female presented to the ED for pelvic pain that started 8 hours ago. The patient reports sudden onset pain that is getting progressively worse, along with vaginal bleeding. The patient has not had unprotected sex and no history of sexually transmitted infections. She appears visibly uncomfortable, is tachycardic, has dry mucous membranes, and is tender in the suprapubic area. Pelvic exam reveals scant blood per os, IUD strings seen, and she has pain with bimanual uterine palpation. What’s the next step in your evaluation and treatment?

practice updates

EM@3AM: Testicular Rupture

A 25-year-old male is brought to the ED by EMS with pain in the right scrotum after a motorcycle crash. The patient was wearing a helmet, could ambulate at the scene, and states his main concern is his right scrotal pain. Review of systems is unremarkable. He has ecchymosis of right scrotum with exquisite tenderness and perineal bruising. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Papilledema

A 32-year-old female with a previous medical history of acne on isotretinoin presents to the ED for 2 months of headaches that awake her from sleep, more prominent in the morning. She also endorses nausea and vision changes. She notes that her vision is blurry especially in her periphery.  The patient denies the possibility of being pregnant.  She denies fevers, neck stiffness, facial weakness, dysarthria, and personal history of cancer or venous thromboembolic events. Neurologic exam is normal. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Transfusion Related Acute Lung Injury

A 67-year-old female with a history of ALL comes into the ED for weakness, stating her oncologist sent her for her semi-regular transfusion. From review of the EMR, her hemoglobin in 5.9 mg/dL and her platelet count was 1,000 cells/uL. A transfusion of platelets was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. She is in distress with rhonchi bilaterally. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Transfusion Associated Circulatory Overload

A 67-year-old female with a history of CHF and CKD was brought in by ambulance from her nursing home for a gastrointestinal bleed. The patient’s total fluid balance from her nursing home was 2.5L over the past 24 hours. Her point of care hemoglobin is 4 g/dL and a transfusion of 2U pRBC and 1 FFP was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. What’s the next step in your evaluation and treatment?