A 32-year-old female presents to the ED with worsening diarrhea for 2 months. The diarrhea is non-bloody but is bulky, foul-smelling, and floats. She has had a 9-pound weight loss. She has ulcers along the buccal mucosa. Her abdomen is soft and nontender, and while she appears tired, the rest of the exam is normal. What is the patient’s diagnosis?
EM@3AM: Celiac Disease Read More »
A 3-month-old female is brought into your ED by her mother for constipation and decreased PO intake for 3 days. She was born full term without complications and is breastfed along with some soft foods. When asking about changes in diet, her mother states they only eat organic and grow most of their own food on their farm. They also can some food to prevent spoiling. Vital signs are unremarkable. It takes longer than expected for her to open her eyes, and she appears to have head lag. She will not feed while in the ED despite multiple attempts. What is the diagnosis?
A 32-year-old male presents to the ED with penile pain. He states he was having sexual intercourse when he heard a loud pop, followed by sharp pain and immediate loss of erection. His vitals are HR 107, BP 128/46, RR 19, and T 37.2C. What is your diagnosis, and what diagnostic study would you order if there was blood at the meatus?
EM@3AM: Penile Fracture Read More »
An 8-year-old male presents after falling onto an outstretched hand. He has an obvious dinner fork deformity to the right forearm. X-ray confirms a fracture of the distal radius and ulna. You prepare for procedural sedation with ketamine while you reduce and splint the fracture. You run through the pre-sedation assessment and exam, then gather all medications and airway supplies. Once the ketamine is pushed you hear a high-pitched stridor and see the patient’s chest rise and fall irregularly as his oxygen saturation drops. What is the diagnosis and management?
EM@3AM: Laryngospasm Read More »
A 25-year-old female with no significant past medical history presents with progressive periorbital and lower extremity edema for one week. She denies recent fever, chest pain, shortness of breath, allergies, or recent travel. Vitals include BP 120/90, HR 90, RR 18, Temp 98.7F. Exam shows a developmentally normal female in no acute distress. She has bilateral pitting edema up to knees without skin changes, but the rest of the exam is normal. Her pregnancy test is negative. What is the likely diagnosis?
EM@3AM: Nephrotic Syndrome Read More »
A 12-year-old boy with no past medical history accidentally ingested a soda can tab 2.5 hours prior to arrival. He is asymptomatic at present, feels well, and is able to tolerate secretions without difficulty. On exam, the patient is alert, acyanotic, and non-stridulous. Breath sounds are clear to auscultation bilaterally, and his abdomen is nontender. What evaluation is necessary, and what is the appropriate management?
EM@3AM: Beverage Tab Ingestion Read More »
A 42 year-old male presents with abdominal pain and fevers for 72 hours, with nausea and vomiting for 24 hours. He has a history of ESRD and has been on peritoneal dialysis for 5 years. Triage vital signs (VS): BP 105/60, HR 121, T 101.4 temporal, RR 24, SpO2 98% on room air. Pertinent physical examination findings include a tender peritoneal dialysis site and diffuse abdominal tenderness, but no erythema overlying the PD site. What’s the next step in your evaluation and treatment?
EM@3AM: Peritoneal Dialysis Emergencies Read More »
A 42-year-old male undergoing recent radiation therapy for colorectal cancer presents with pelvic and anal pain and pain with defecation. He experiences extreme pain prior to and during defecation. He has had mucous and blood in his stool. He denies a history of hemorrhoids. Pertinent physical examination findings include fever, tachycardia, and lower abdominal pain to palpation. Rectal exam reveals reveals tenderness. What’s the next step in your evaluation and treatment?
A 70-year-old male with diabetes, coronary artery disease, and one-vessel CABG presents with palpitations and angina for one day. He is in no acute distress. His vital signs include BP 148/96, HR 150, RR 18, SpO2 96%, and T 37.2C. His EKG reveals atrial flutter.
EM@3AM: Atrial Flutter Read More »
A 66-year-old male presents via EMS in respiratory distress. For the past several days he has had worsening productive cough, chest pain, dyspnea, and fever. He appears fatigued, is sitting up in bed, and has increased work of breathing. On exam there is no JVD, 1+ edema, and crackles bilaterally. Vital signs include T 102.1 F, HR 110, RR 28, BP 94/62. Chest Xray shows bilateral infiltrates. What is the likely diagnosis?
EM@3AM: Acute Respiratory Distress Syndrome Read More »
