Category Name: em@3am

em@3am

EM@3AM: Overdose

A 38-year-old male presents from triage in a hospital wheelchair with his head slumped to one side. You immediately move him into bed and assess his ABCs. He wakes briefly, but he seems to be hallucinating. Vital signs: BP 154/110, HR 110, T 102.1, RR 20, SpO2 100% on room air. Physical exam reveals...

em@3am

EM@3AM: Urolithiasis

A 34-year-old male presents with intermittent, sharp, left-sided flank pain. He took ibuprofen with minimal relief, but came to the ED when he noticed blood-tinged urine. He has also experienced severe nausea without emesis. He appears uncomfortable, writhing in bed. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Placental Abruption

A 31-year-old G3P2 female at 32 weeks gestation is brought in by EMS after a fall with complaint of lower abdominal pain. Exam reveals gravid abdomen with lower abdominal tenderness and no signs of bruising. External pelvic exam shows no signs of trauma, but there is scant blood at the introitus. Fe...

em@3am

EM@3AM: Mastoiditis

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?

em@3am

EM@3AM: Myasthenia Gravis and Crisis

A 29-year-old female presents with generalized weakness and vision problems. The weakness is worse at the end of the day, and she has noted double vision. The symptoms worsen with heat. She denies any other neurologic deficits, including paresthesias. What is the likely diagnosis, and what is your next step in evaluation?

em@3am

EM@3AM: Pelvic Inflammatory Disease/Tubo-ovarian Abscess

A 23-year-old female presents with acute onset lower abdominal pain with abnormal vaginal discharge. She denies fevers, chills, nausea, vomiting, dysuria, hematuria, diarrhea, and constipation. She is sexually active with one partner of 3 months and inconsistently uses condoms. Speculum exam shows small amount of blood and cervical discharge. What is the likely diagnosis?

em@3am

EM@3AM: Pancytopenia

A 36-year-old male with a history of HIV presents to the ED complaining of dyspnea on exertion and fatigue. He is not compliant with his anti-retroviral medications. His conjunctivae are pale. There is a painful ulcer to the distal aspect of the tongue and scattered petechiae on his legs. Laboratory...

em@3am

EM@3AM: Knee Dislocation

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?