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em@3am

EM@3AM: Pneumothorax

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A 30-year-old male presents after a motor vehicle accident with chest pain and shortness of breath. He is alert, speaking in 1-2 word responses, and appears in moderate respiratory distress. He has normal left sided breath sounds, but none on the right. No lung sliding is seen with ultrasound examination of the right thorax. His trachea is deviated left, and increased JVD is noted. What is this patient’s presentation consistent with? What is your next step in management?

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EM@3AM: Peritonsillar Abscess

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A 15-year-old male presents to the pediatric ED for worsening sore throat and fevers for 5 days. He complains of right sided throat pain, odynophagia, and a muffled voice. He is tachycardic, febrile, uncomfortable appearing, and sitting upright.  You note trismus, swollen right tonsil, erythematous and elevated soft palate, and uvula deviated towards the left tonsil. What’s the next step in your evaluation and treatment?

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EM@3AM: Malaria

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A 42-year-old male presents with headache, fever, chills, nausea, and myalgias. He returned from a month-long trip to Africa several weeks ago. On examination, he is tachycardic and febrile. You do not find a rash or meningismus, but you palpate an enlarged spleen and liver.  What is your next step in evaluation and management?

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EM@3AM: Pancreatitis

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A 39-year-old female presents with severe epigastric pain, nausea, and several episodes of non-bloody, non-bilious emesis. The pain is sharp and radiates to her back. On examination, she is tachycardic and tachypneic with diffuse abdominal tenderness, but afebrile. Her lipase returns at 1100 U/L. What is your next step in evaluation and management?

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EM@3AM: The Sick Neonate

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A 10-day-old female presents with her parents with poor feeding and increased work of breathing. Her urine output has been poor, but her parents have not observed fevers. She is afebrile, but her HR is 188, RR is 61, and oxygen saturation is 94% on room air. She demonstrates increased work of breathing and retractions and appears lethargic. Her serum glucose is 48. What is your next step in evaluation and management?

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EM@3AM: Back Pain

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A 59-year-old man presents to the ED for acute onset low back pain that started immediately after he moved furniture. He states his lumbar pain has been unrelenting, with mild pain radiating to down both legs.  He appears in pain and has mild midline and bilateral paraspinal tenderness to palpation over his lumbosacral spine.  He has bilateral loss of strength in the distal lower extremities, notably in dorsiflexion.  What diagnoses should you consider?

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EM@3AM: Overdose

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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 mydriasis and diaphoresis. He has track marks on his arms and you find packets of what appears to be mixed prescription drugs, heroin, and methamphetamine in his pocket. What’s this presentation most consistent with? What’s your next step in evaluation and treatment?

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