Rachel Bridwell

A 13-year-old male is brought in by EMS for altered mental status after being found in a house fire. The fire department found burned couches in the house with melted plastic covering. His vital signs include BP 78/40, HR 155, T 99.9 Oral, RR 40, SpO2 92% on 15L NRB. He is somnolent but withdraws to pain. He has soot in his nares with carbonaceous sputum, and auscultation reveals rhonchorous and wheezing breath sounds bilaterally. Point of care VBG demonstrates a lactate of 16. What’s the next step in your evaluation and treatment?

This week we continue a series on post myocardial infarction complications.  Today we present a case of a patient who developed left ventricular aneurysm and discuss the diagnosis and treatment.

A 65-year-old with a history of ESRD and renal transplant presents to the ED with lower abdominal pain and fevers. On exam, his vitals include HR 112, BP 101/62, RR 22, T 101.1, SpO2 98% on RA. His is tachycardic with lower extremity edema and lower abdominal tenderness to palpation. What’s the next step in your evaluation and treatment?

A 2-year-old male is brought to the ED by his mom for right ear pain and high fevers. His right ear is notably pushed forward. On exam, he is alert but fussy, with auricular proptosis and mastoid redness. What’s the next step in your evaluation and treatment?

A 21-year-old male is brought to the ED by EMS after an MVC at 60 mph. He is complaining of severe right lower extremity pain, which EMS splinted. You find no other injuries on your exam, but upon removal of the splint, the patient has a clear deformity. You cannot detect a dorsalis pedis or posterior tibialis pulse on the right. What’s the next step in your evaluation and treatment?

An 8-year-old male was brought in by his parents for continuous screaming for 12 hours. He is grabbing his groin area. He is in distress, and exam demonstrates incarceration of the glans by the foreskin with pronounced glans edema. His testicles appear normal. What’s the diagnosis, and what’s your next step in evaluation and treatment?

A 65-year-old male with poorly controlled type 2 diabetes and ESRD on dialysis presents for right sided nose/facial discomfort and swelling and fever. Exam reveals altered mental status. He has right nasal swelling and tenderness, with a necrotic area on nasal septum. He is tachycardic, but the CV, pulmonary, skin, and GI systems are otherwise normal. What’s the likely diagnosis?

A 43-year-old female presents with altered mental status.  Her husband states she has had weight gain, constipation, fatigue, and skin changes. Vital signs include BP 92/60, HR 48, T 93.2 rectal, RR 13, SpO2 96% on room air. She is alert and oriented x 1, and her neck reveals a well-healed midline anterior neck scar. Her abdomen is soft but distended, and her extremities are cool. What’s the likely diagnosis?

A 19-year-old male presents after an MVC. Another passenger reports that the patient hit his head on the seat in front of him. His GCS is 12, and you find hemotympanum, serosanguineous discharge bilaterally from the nares, and CN III palsy on exam. What’s the next step in your evaluation and treatment?

A 30-year-old female presents to the ED with sudden onset right lower quadrant and flank pain. She has also had severe nausea and vomiting. Abdominal exam reveals significant right lower quadrant tenderness, and pelvic exam reveals tender right adnexa. What’s the next step in your evaluation and treatment?