em@3am

This week’s EM@3AM brings you a case of a patient with myalgias and dark urine after exercising.

A 2-year-old female presents to the ED with 3 days of fever, cough, congestion, and watery diarrhea. The patient’s mother is concerned as the toddler had two episodes of bloody diarrhea prior to arrival. You obtain a stool sample: fecal occult blood test is positive. Read this week’s review to find out why HUS should be on your differential diagnosis.

A 34-year-old male presents to the emergency department following a “shock” to the hand. Per the patient, while installing a ceiling fan thirty minutes prior to arrival, he experienced the sudden onset of severe pain in his right hand when it made contact with an exposed wire. He is currently asymptomatic. Is an evaluation warranted? Let’s take a look at this week’s review of electrical injuries.

A 32-year-old female, with a history of rheumatoid arthritis (methotrexate therapy), presents to the emergency department for severe itching, mouth ulcers, and a diffuse rash. The patient denies recent travel, sick contacts, and new exposures. Review of systems is positive for abscess/cellulitis treatment (cephalexin and trimethoprim/sulfamethoxazole) three weeks prior to arrival. What diagnosis should be on your differential? Take a minute to read this week’s review of DRESS.

A 62-year-old male presents with left lower quadrant pain, which he states is “exactly like his episode of diverticulitis.” His vital signs are within normal limits and his abdominal exam remarkable only for mild abdominal tenderness to palpation. How do you evaluate and treat this patient? Read this week’s review of acute diverticulitis for management pearls.

A two-year-old male presents to the emergency department following the ingestion of his grandmother’s propranolol. Upon presentation, the young boy is lethargic. EKG demonstrates sinus bradycardia (heart rate: 39 beats per minute) and a first degree AV block. How do you treat this patient’s bradycardia? Read this week’s review of beta-blocker toxicity for a rapid refresher.

A 37-year-old trauma patient, involved in a motor vehicle collision six hours prior to arrival and stabilized at a county hospital, is transferred to your ED. A nurse notes blood oozing from the man’s central and peripheral lines. What laboratory studies do you order? If you’re in need of a refresher, take a look at this week’s review of disseminated intravascular coagulation.

An 8-year-old male presents to the ED for 9 days of watery diarrhea. The patient’s mother reports the onset of his symptoms following a family vacation to Mexico. Do you prescribe antibiotics? Read this week’s review for helpful hints.

A 31 year-old female, undergoing ED evaluation for chronic back pain, is found to have microscopic hematuria on urinalysis. She is asymptomatic. Is follow-up advised? Let’s review hematuria.

A female patient, with a previous history of an ectopic pregnancy, presents to the ED with abdominal pain and vaginal bleeding following a positive home pregnancy test. What is the likelihood that the patient is experiencing a second ectopic pregnancy? Read this week’s review to find out.