A 55-year-old male presents with shortness of breath, cough, and blood-tinged sputum. He states that he has been fighting off a cold over the past week, but noticed increasing cough over the past several hours, sometimes tinged with blood. He denies any other symptoms, appears well, and has a normal pulmonary, cardiovascular, and extremity exam. What are your next steps?
EM@3AM: Hemoptysis Read More »
A 62-year-old male brought in by EMS for altered mental status and complaints of visual disturbances. Per the EMS report, the patient had homemade moonshine found in his living room. The patient is confused and states his vision is globally diminished as if he were looking through a snowstorm. He also describes a headache and dizziness. What’s the diagnosis, and what’s your next step in your evaluation and treatment?
EM@3AM: Methanol Toxicity Read More »
A 27-year-old female with a history of insulin-dependent diabetes presents to the ED on a Friday evening somnolent and disoriented. Her coworkers report she started slurring her speech and became increasingly altered after they met at a bar after work. Exam reveals a diaphoretic, obtunded female not oriented to person, place, or time. Her GCS is 11. What do you suspect as the diagnosis? What should your first order be?
EM@3AM: Hypoglycemia Read More »
A 31-year-old male presents for headache for the past 72 hours. He has a history of tension headaches, but confirms that this headache feels different. He has a history of HIV/AIDS and is noncompliant with medications. His last known CD4 count one month prior was 200. He appears confused and is febrile. Neurologic exam reveals motor deficit of RUE and RLE. What’s your next step?
EM@3AM: CNS Toxoplasmosis in HIV/AIDS Read More »
A 43-year-old male right hand dominant man presents with pain and swelling of his left index finger. He is a professional painter and was using an industrial pain sprayer when he injected his left index finger. It now is exquisitely painful, with a large degree of swelling. What’s the diagnosis, and what’s your next step in your evaluation and treatment?
EM@3AM: High-Pressure Injection Injury Read More »
A 72-year-old male presents with fatigue for months. He sometimes has prolonged bleeding when he brushes his teeth. He denies weight loss, night sweats, or any other symptoms apart from his fatigue. He has no significant past medical or surgical history, and his VS are normal. Exam is unremarkable except for one hemorrhagic bullae on his oral mucosa. He has no lymphadenopathy or hepatosplenomegaly. What are the next steps in management?
EM@3AM: Idiopathic Thrombocytopenic Purpura Read More »
A 61-year-old male presents in middle of July with altered mental status. The patient’s son states the patient has been increasingly weak for the past three days. The patient has been having multiple episodes of non-bloody diarrhea with associated decreased appetite. Initial triage vital signs include BP 104/66, HR 111, RR 18, SpO2 99%, Temp 36.9 C.
He appears clinically dehydrated with dry mucous membranes and poor skin turgor with tenting. An initial rapid VBG reveals a sodium of 161 mEq/L.
EM@3AM: Hypernatremia Read More »
A 23-year-old female presents with left foot pain after rolling her ankle in volleyball. She has some minor ankle pain, but her lateral foot is painful to touch or with weightbearing. On exam, the base of her 5th metatarsal is tender to palpation, with swelling and ecchymosis. What are your next steps, and what is the likely diagnosis?
EM@3AM: 5th Metatarsal Fractures Read More »
A 61-year-old male presents with lower abdominal pain on the right side. He says “I’ve had this bulge in my groin on the right for two days”. You find a small bulge in the right groin, but with no redness or discoloration of the skin. Palpation reveals mild tenderness over the site. What’s the next step in your evaluation and treatment?
A 57-year-old male presents with hematemesis. He has a history of cirrhosis from alcohol abuse. He appears toxic and is rushed to the resuscitation bay. Initial VS include T 37.2C, HR 122, BP 88/41, RR 24, SpO2 90% RA. What are your next steps, and what is the likely diagnosis?
EM@3AM: Gastroesophageal Varices Read More »