Category Name: em@3am

em@3am

EM@3AM: Lyme Disease

A 35-year-old male presents for intermittent fevers, abdominal pain, and headaches for 3 weeks. On further questioning, he also states he has arthralgias. Review of systems is remarkable for a recent camping trip in the Boundary Waters Canoe Area of Minnesota. You find a bulls-eye rash on his trunk. What are your next steps?

em@3am

EM@3AM: Spontaneous Intracerebral Hemorrhage

A 65-year-old male presents with altered mental status and right sided weakness. Symptoms began approximately two hours earlier when the patient began to complain of a severe headache. He has become more confused and is now unable to walk normally. Vital Signs: BP 202/98, HR 89, RR 12, T 36.7, SpO2...

em@3am

EM@3AM: Hemoptysis

A 55-year-old male presents with shortness of breath, cough, and blood-tinged sputum. He states that he has been fighting off a cold over the past week, but noticed increasing cough over the past several hours, sometimes tinged with blood. He denies any other symptoms, appears well, and has a normal pulmonary, cardiovascular, and extremity exam. What are your next steps?

em@3am

EM@3AM: Methanol Toxicity

A 62-year-old male brought in by EMS for altered mental status and complaints of visual disturbances. Per the EMS report, the patient had homemade moonshine found in his living room. The patient is confused and states his vision is globally diminished as if he were looking through a snowstorm. He al...

em@3am

EM@3AM: Hypoglycemia

A 27-year-old female with a history of insulin-dependent diabetes presents to the ED on a Friday evening somnolent and disoriented. Her coworkers report she started slurring her speech and became increasingly altered after they met at a bar after work.  Exam reveals a diaphoretic, obtunded female n...

em@3am

EM@3AM: CNS Toxoplasmosis in HIV/AIDS

A 31-year-old male presents for headache for the past 72 hours. He has a history of tension headaches, but confirms that this headache feels different. He has a history of HIV/AIDS and is noncompliant with medications. His last known CD4 count one month prior was 200. He appears confused and is febrile. Neurologic exam reveals motor deficit of RUE and RLE. What's your next step?

em@3am

EM@3AM: High-Pressure Injection Injury

A 43-year-old male right hand dominant man presents with pain and swelling of his left index finger. He is a professional painter and was using an industrial pain sprayer when he injected his left index finger. It now is exquisitely painful, with a large degree of swelling. What’s the diagnosis, and what’s your next step in your evaluation and treatment?

em@3am

EM@3AM: Intussusception

A 3-year-old male presents with his mom with chief complaint of vomiting and recurrent abdominal pain. Her son will intermittently cry and refuse to eat, followed by normal activity. His appetite has been decreased. VS are normal. Physical exam reveals a patient who appears stated age, nontoxic, and...