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Andrea Nillas

EM@3AM: Cotton Fever

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A 30-year-old male with history of IVDU presents with fever. He reports last drug use was one hour prior to arrival and admits to reusing the same cotton filter on multiple occasions. He denies recent cough, chest pain, shortness of breath, abdominal pain, nausea, vomiting, or diarrhea. VS include Temp 101.0°F, HR 110, BP 130/80, RR 18, SpO2 98% on room air. On exam, he is diaphoretic and has track marks on bilateral upper extremities. Lung sounds are clear, and there are no heart murmurs. Complete blood count and metabolic panel are unremarkable. What is the likely diagnosis?

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EM@3AM: Nephrotic Syndrome

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A 25-year-old female with no significant past medical history presents with progressive periorbital and lower extremity edema for one week. She denies recent fever, chest pain, shortness of breath, allergies, or recent travel. Vitals include BP 120/90, HR 90, RR 18, Temp 98.7F. Exam shows a developmentally normal female in no acute distress. She has bilateral pitting edema up to knees without skin changes, but the rest of the exam is normal. Her pregnancy test is negative. What is the likely diagnosis?

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EM@3AM: Serotonin Syndrome

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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?

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