Category Name: em@3am

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 ...

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 u...

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 pati...

em@3am

EM@3AM: Pediatric Epistaxis

A previously healthy 2-year-old boy presents with 3 days of recurrent nosebleeds. He had no adverse birth history and is up to date on his vaccinations. The patient’s mother denies any known trauma and the patient denies picking his nose. In addition, he has no fever, headaches, nausea, hematuria,...

em@3am

EM@3AM: Purpura

A 4-year-old vaccinated male is brought to the ED by his parents for 3 days of hematuria and abdominal pain. They present now because he refuses to ambulate. He has a rash on his legs that family attributes to playing outside in the grass. His vital signs include HR 135, RR 20, and temperature of 37...

em@3am

EM@3AM: Serotonin Syndrome

A 40-year-old female with history of depression is brought in by EMS for agitation. On arrival she is confused and diaphoretic. Vitals include temperature of 40°C, BP 150/80, HR 120, and RR 28. Exam is remarkable for muscle rigidity, hyperreflexia, and clonus of the lower extremities. What is the next step in your evaluation and treatment?

em@3am

EM@3AM: Tympanic Membrane Rupture

A 31-year-old female presents with right ear pain and decreased hearing. Her symptoms started suddenly after trying to clean her ears with a Q-tip. She denies vertigo, nausea, vomiting, or other facial symptoms. On examination, you see a small perforation in the tympanic membrane (TM) with no discharge or other trauma. What is your next step in evaluation and management?

em@3am

EM@3AM: Pediatric Acute Lymphoblastic Leukemia

A 3-year-old male presents with pallor and nosebleeds. On exam, the patient looks pale and has petechiae across his arms and back. His spleen is palpable. Labs reveal white blood cell count 20,900/μL, absolute neutrophil count 10,400/μL, absolute lymphocyte count 1800/μL, hemoglobin 5.9 g/dL, and platelet count 20 × 10^3/μL. What's the diagnosis?