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em@3am

EM@3AM: Myxedema Coma

A 43-year-old female presents with altered mental status.  Her husband states she has had weight gain, constipation, fatigue, and skin changes. Vital signs include BP 92/60, HR 48, T 93.2 rectal, RR 13, SpO2 96% on room air. She is alert and oriented x 1, and her neck reveals a well-healed midline anterior neck scar. Her abdomen is soft but distended, and her extremities are cool. What’s the likely diagnosis?

em@3am

EM@3AM: Basilar Skull Fractures

A 19-year-old male presents after an MVC. Another passenger reports that the patient hit his head on the seat in front of him. His GCS is 12, and you find hemotympanum, serosanguineous discharge bilaterally from the nares, and CN III palsy on exam. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Ovarian Torsion

A 30-year-old female presents to the ED with sudden onset right lower quadrant and flank pain. She has also had severe nausea and vomiting. Abdominal exam reveals significant right lower quadrant tenderness, and pelvic exam reveals tender right adnexa. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Orbital Cellulitis

A 12-year-old male is brought to the ED by his mom for right eye swelling and pain. The patient reports pain with extra ocular motion and decreased vision in the right eye. You see extensive right eyelid swelling. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Mesenteric Ischemia

A 65-year-old male with a history of paroxysmal atrial fibrillation presents with diffuse, severe abdominal pain after eating. He is not on anticoagulation. He has had some bloody stool. What do you need to consider, and what’s your next step in your evaluation and treatment?

em@3am

EM@3AM: Lyme Disease

A 35-year-old male presents for intermittent fevers, abdominal pain, and headaches for 3 weeks. On further questioning, he also states he has arthralgias. Review of systems is remarkable for a recent camping trip in the Boundary Waters Canoe Area of Minnesota. You find a bulls-eye rash on his trunk. What are your next steps?