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em@3am

EM@3AM: Hyperthermia

A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. Point of care glucose in the field was 102 mg/dL. Vital signs include BP 80/40 mm Hg, HR 154 bpm, T 41C rectal, RR 28 breaths per minute, saturation 94% on room air.  The patient is agitated, not oriented, and becoming combative with ED staff.  A 12-lead EKG shows sinus tachycardia but is otherwise normal.  As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. What is your diagnosis, and what are your next steps in evaluation and management?

em@3am

EM@3AM: Oculomotor Nerve Palsy

A 50-year-old female with no past medical history presents to the ED with a diffuse, constant headache onset a few weeks. The patient describes droopiness of the left eye and double vision associated with specific directional movements of the eye. On exam, you note ptosis of the left eye with findings as indicated in the photograph below (inability to adduct, ability to abduct). The left pupil is dilated at 5mm and minimally reactive to light; the right pupil is 3mm and reactive. The remaining cranial nerve testing and components of the neurological exam are normal.