Category Name: em@3am

em@3am

EM@3AM: Purpura

A 4-year-old vaccinated male is brought to the ED by his parents for 3 days of hematuria and abdominal pain. They present now because he refuses to ambulate. He has a rash on his legs that family attributes to playing outside in the grass. His vital signs include HR 135, RR 20, and temperature of 37...

em@3am

EM@3AM: Serotonin Syndrome

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?

em@3am

EM@3AM: Tympanic Membrane Rupture

A 31-year-old female presents with right ear pain and decreased hearing. Her symptoms started suddenly after trying to clean her ears with a Q-tip. She denies vertigo, nausea, vomiting, or other facial symptoms. On examination, you see a small perforation in the tympanic membrane (TM) with no discharge or other trauma. What is your next step in evaluation and management?

em@3am

EM@3AM: Pediatric Acute Lymphoblastic Leukemia

A 3-year-old male presents with pallor and nosebleeds. On exam, the patient looks pale and has petechiae across his arms and back. His spleen is palpable. Labs reveal white blood cell count 20,900/μL, absolute neutrophil count 10,400/μL, absolute lymphocyte count 1800/μL, hemoglobin 5.9 g/dL, and platelet count 20 × 10^3/μL. What's the diagnosis?

em@3am

EM@3AM: Elbow Dislocation

A 15-year-old male with no past medical history comes in complaining of left arm pain. The patient was brought to the emergency department by his mother just after he fell while playing football. The patient is noted to have his arm held at 45-degree flexion. There is significant swelling over dista...

em@3am

EM@3AM: Transfusion Related Acute Lung Injury

A 67-year-old female with a history of ALL comes into the ED for weakness, stating her oncologist sent her for her semi-regular transfusion. From review of the EMR, her hemoglobin in 5.9 mg/dL and her platelet count was 1,000 cells/uL. A transfusion of platelets was initiated, though within approxim...

em@3am

EM@3AM: Transfusion Associated Circulatory Overload

A 67-year-old female with a history of CHF and CKD was brought in by ambulance from her nursing home for a gastrointestinal bleed. The patient’s total fluid balance from her nursing home was 2.5L over the past 24 hours. Her point of care hemoglobin is 4 g/dL and a transfusion of 2U pRBC and 1 FFP ...

em@3am

EM@3AM: Hypothermia

A 37-year-old female with history of alcohol and drug abuse is brought in after being found asleep on a bench on a cold winter morning. She is unresponsive. Vital signs are notable for HR 45, BP 85/40, SaO2 90%, rectal temperature 29C. Naloxone is given with no improvement, and the patient is intuba...