em@3am

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?

A 72-year-old female is brought to the ED during a heat wave. Her daughter found her confused in her home. She believes the power has been out for several days. The patient appears lethargic and is intermittently confused. A rectal temperature reads 105.1F. The patient’s skin is warm and dry. She is confused, but the rest of her exam is unremarkable. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?

An 8-year-old male presents 7 days post-tonsillectomy. His mother states he started spitting up blood this morning. The patient appears well, but suddenly starts throwing up coffee ground emesis. When the patient stops throwing up, you look at the back of the throat and see what appears to be a clot. What’s the next step in your evaluation and treatment?

A 28-year-old male presents with abdominal pain, diarrhea, distension, and fever. He has a history of ulcerative colitis. Vital signs include BP 97/58, HR 121, T 100.9 Oral, RR 24, SpO2 98% on RA. Exam reveals a patient who appears systemically ill, and his abdomen is diffusely tender. His bowel sounds are decreased, but he has no peritoneal findings. KUB shows markedly dilated loops of bowel. What’s the next step in your evaluation and treatment?

A 63-year-old female presents with abdominal pain, decreased bowel movements, nausea, three episodes of vomiting, and abdominal distension. She has a history multiple abdominal surgeries. Exam shows abdominal distension and generalized tenderness, but no peritoneal signs. What are your next steps?

A 18-year-old male presents with chest pain and shortness of breath for several days. Approximately one week prior he was suffering from myalgia, congestion, sore throat, and fever and was diagnosed with an upper respiratory infection. Today his vitals are HR 132, RR 28, BP 92/48, T 37.8 C, and Sats 95% on RA. What should you consider, and what are your next steps?

A 58-year-old morbidly obese female patient with uncontrolled diabetes and peripheral arterial disease presents with an open wound to the central plantar aspect of her foot. She reports no pain, does not recall an injury, and is not sure how long she has had the ulcer. On exam, there is a 3.5 cm circular wound with thick yellow material in the center, and the edges of the wound are pink and warm to the touch. What is the diagnosis, and what are your next steps?

A 6-year-old male presents with rash, joint pain, and abdominal pain. VS are normal, and exam reveals palpable purpura in the lower extremities. His abdomen is not tender to palpation, and his testicles are normal. Platelets and coagulation panel are normal. What is the diagnosis?

A 20-year-old male college student arrives by ambulance restrained in a stretcher. Members of his fraternity called the police saying he became violent and agitated after “burning incense”. He is hypertensive and tachycardic with a normal blood glucose. What is the diagnosis, and what are your next steps?

A 50-year-old male with uncontrolled diabetes presents with pain and swelling in his right foot.  He does not recall any injury to the foot or leg.  On exam, crepitus is noted on the foot and ankle. What is the diagnosis, and what are your next steps?