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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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- Jeremy Kim
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Traumatic ankle pain is a common presenting problem to emergency departments. While sprains are the most common injuries (most common = anterior talofibular ligament), the patient still needs to be assessed for fracture. Since its derivation and validation in 1992, the Ottawa ankle rules are the most frequently used clinical
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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)
