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em@3am

EM@3AM: Transfusion Associated Circulatory Overload

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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 was initiated, though within approximately 1 hour of starting the transfusion, the patient became acutely short of breath and stated she was having severe difficulty breathing. What’s the next step in your evaluation and treatment?

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EM@3AM: Hypothermia

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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 intubated. On exam she is unresponsive, pulses show irregular rhythm, and extremities are cool. POC glucose is 65. What is the likely diagnosis, and what is the first step?

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EM@3AM: Polycythemia

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A 63-year-old male without any past medical history presents to the emergency department with several weeks of headaches, some blurry vision while walking at a quick pace, and shortness of breath. His last checkup with his primary doctor was about 3 years ago and everything was ‘normal’. He takes no medications, has no allergies, and has no previous surgeries. He admits to being a long-term smoker, about a half a pack a day for 20 years. Examination in the ED is normal. Basic lab work is drawn which reveals a hematocrit of 63%, elevated RBC mass, and thrombocytosis to 550K/ml. On further evaluation as an inpatient, it was found the patient had a low erythropoietin level. What is the diagnosis? 

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EM@3AM: Methemoglobinemia

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A 42-year-old female with a past medical history of iron deficiency anemia presents to the ED with a peritonsillar abscess. You give 2 benzocaine sprays and successfully aspirate the abscess. As she is waiting for her discharge paperwork, the nurse alerts you that her oxygen saturation is now in the mid-80s. Repeat vitals in the room are as follows: BP 102/78, HR 102, O2 85%, RR 24. She has perioral cyanosis that was not seen on your initial exam. What is the diagnosis and best next step?

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EM@3AM: Pink Baby

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A 3-month-old male is brought in for increased work of breathing for the last 4 days. The patient has had no fevers or sick contacts. He was born full term without complications, is fully vaccinated, and has no familial medical history. Triage vital signs (VS): BP 85/50, HR 152, RR 56, SpO2 92% on room air, oral temp 99.9. The patient is tachypneic with weak cry, but has normal pink color. There is a 4/6 holosystolic murmur, with 2+ femoral and brachial pulses. He has suprasternal and intercostal retractions with wheezes. There is also palpable hepatomegaly. What are your next steps?

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EM@3AM: Blue Baby

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A 6-day-old male presents with increased work of breathing for last 4 hours and an episode of turning blue, which concerned the family. The baby is lethargic, afebrile, and cyanotic, with a weak cry to stimulation. There is a sunken fontanelle, perioral cyanosis with purple intra-oral mucosa, and blue tongue. He is tachypneic and has mild retractions, clear lung sounds, and dullness to percussion 4 cm past right costal margin. There is poor tone and mottled extremities. What should you consider?

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EM@3AM: Marine Animal Bites and Stings

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A 30-year-old male presents with intense left forearm pain after cleaning an aquarium at his job 20 minutes prior to arrival. He is unsure what kind of fish were in the aquarium. Physical exam reveals a patient who appears uncomfortable holding his left arm. There is a 5 cm area of erythema to his anterior forearm that is warm to the touch. What is the diagnosis and the best next step in management?

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EM@3AM: Pacemaker/AICD Complications

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A 69-year-old female presents with shortness of breath, orthopnea, and lower extremity swelling. She has a pacemaker placed 3 years ago for a complete heart block. She hands you her pacemaker identification card indicating that she has a single chamber pacemaker. Triage EKG: ventricular pacing spikes followed by QRS complexes. She has crackles at the lung bases and 2+ lower extremity pitting edema. What is the diagnosis? What is your next step in evaluation? What are some the types of pacemaker complications you should be evaluating for?

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EM@3AM: Heat Stroke

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A 72-year-old female is brought to the ED during a heat wave. Her daughter found her confused in her home. She believes the power has been out for several days. The patient appears lethargic and is intermittently confused. A rectal temperature reads 105.1F. The patient’s skin is warm and dry. She is confused, but the rest of her exam is unremarkable. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?

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winchester primers vs cci primers. emdocs podcast – episode 116 : massive hemoptysis. cooking fit like 20.