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em@3am

EM@3AM: Serotonin Syndrome

A 40-year-old female with history of depression is brought in by EMS for agitation. On arrival she is confused and diaphoretic. Vitals include temperature of 40°C, BP 150/80, HR 120, and RR 28. Exam is remarkable for muscle rigidity, hyperreflexia, and clonus of the lower extremities. What is the next step in your evaluation and treatment?

em@3am

EM@3AM: Methemoglobinemia

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?