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A 28-year-old female presents with fatigue, bruising, and vaginal bleeding. She reports a history of heavy menstrual cycles; however, this cycle has been significantly worse. Over the past week, she has experienced dizziness, generalized fatigue, and increased bruising. She felt warm earlier this morning but was not able to take her temperature. She denies any family history of bleeding disorders. Initial vital signs include BP 110/70, HR 120, RR 14, SpO2 100% on RA, and T 100.5F. On exam, she has diffuse petechiae and ecchymoses. Labs reveal hemoglobin 6.5, WBC 1.6, and platelet count of 40. What is the diagnosis?
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Articles
- electrocardiography
- Lloyd Tannenbaum
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ECG Pointers covers flecainide toxicity and the ECG findings.
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A 15-year-old female with PCOS, obesity, asthma, and recurrent otitis media with bilateral tympanostomy tube placement reports three weeks of increasing sanguineous drainage, ear pain, fevers, and worsening left-sided headaches not improving with NSAIDs. She localizes the pain behind the left eye and additionally reports loss of lateral vision in
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- perspectives
- Chuck Pilcher
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Dr. Pilcher covers two difficult cases in this month's medical malpractice insights.
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Acute heart failure exacerbation disposition
Not all patients require admission
Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up
Elevated troponin and serum Cr associated with worse outcomes
Don’t use risk tools alone for DC, but Ottawa Heart Failure Risk Scale may assist in admission (ACEP Level B)
