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 »
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 62-year-old male presents with abdominal pain and fever for 2 days. He has recently completed induction chemotherapy a few days prior. Review of systems is remarkable for vomiting and anorexia. Exam reveals BP 96/69 mm Hg, HR 122, T 101.9 oral, RR 28, SpO2 97% on room air. He is ill appearing and has dry mucous membranes but no mucositis. Abdominal exam reveals guarding and tenderness in the right lower quadrant. What is the diagnosis, and what’s the next step in your evaluation and treatment?
A 67-year-old female with a history of ALL comes into the ED for weakness, stating her oncologist sent her for her semi-regular transfusion. From review of the EMR, her hemoglobin in 5.9 mg/dL and her platelet count was 1,000 cells/uL. A transfusion of platelets 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. She is in distress with rhonchi bilaterally. What’s the next step in your evaluation and treatment?
EM@3AM: Transfusion Related Acute Lung Injury Read More »
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?
EM@3AM: Transfusion Associated Circulatory Overload Read More »
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?
EM@3AM: Hypothermia Read More »
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?
EM@3AM: Polycythemia Read More »
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?
A 3-day full term male presents with poor feeding and lethargy, looking grey. He is diaphoretic with feeds. He has not gained weight since birth. He is afebrile, tachycardic, tachypneic, grey appearing, with cool extremities and poor capillary refill. What should you consider?
