Core Cases of the Month

Tags: ,

CC

Chest pain

HPI

50yM no PMH, active smoker presents by ambulance with chest pain. Six hours ago he developed substernal chest pressure and nausea, no vomiting. Pain was moderate and constant, but he had a presyncopal episode 1hr prior and severe worsening of chest pain which led him to call 911. He was given ASA en route.

Read More

Leave a Comment

Tags: , , ,

CC

Shortness of breath and abdominal pain

HPI

62yM PMH HTN, HLD, DM2, bioprosthetic MVR p/w shortness of breath and diffuse abdominal pain for three days. He c/o generalized malaise, nausea and multiple episodes of non-bloody, non-bilious emesis. He is concerned about elevated readings on his home glucometer. He is prescribed lisinopril, metoprolol, metformin and lantus. He denies alcohol or drug use. Denies fevers, chills, chest pain, palpitations, dizziness, diarrhea, dysuria, or recent trauma.

Read More

Leave a Comment

Tags: , , , ,

CC

AMS

HPI

52yM unknown PMH BIBEMS found minimally responsive in the field. The patient is undomiciled-appearing male found on a wet sidewalk in the rain. EMS administered 2 amps D50 IV, 2 mg Narcan IV, and 1L NS without improvement in mental status. He was seen in the ED two times in the previous month for IV heroin intoxication and was discharged after his mental status improved without intervention. On arrival he is lethargic and wet, mumbling incoherently and localizing to sternal rub and his breathing is spontaneous. EKG, CXR, POCUS of the heart are included. NCHCT was unremarkable.

Read More

Leave a Comment

Tags: , , ,

CC

Fever and cough

HPI

59yF HIV on ART last CD4 716, undetectable VL, HTN, CKD p/w non-productive cough and fever x10d. 5d PTA she presented to the ED for dry cough, had CXR WNL, lab values WNL except Cr 3.2 and was discharged with f/u. Symptoms have continued since and she returns now because she has dyspnea at rest x 1d. Also c/o fatigue, chills and loose stools. She denies chest pain, headache, change in vision, rash, sick contacts or recent travel.

Read More

Leave a Comment

Tags:

CC

Abdominal pain

HPI

27yF with h/o anxiety p/w abdominal pain x1d. Pain started yesterday evening, intermittent, a/w nausea and diaphoresis. Began as generalized pain but when supine, radiates to chest a/w mild SOB, otherwise localizes to the right abdomen with radiation to the pelvis.

Denies fever, chills, diarrhea, anorexia, blood in stool, recent travel, sick contacts. Sexually active with one male partner, denies STIs, uses OCPs, LMP 3 weeks ago. Denies vaginal bleeding or discharge.

The remainder of the patient’s labs other than those given are pending. On assisting the patient to the OBGYN room, she becomes markedly diaphoretic, lightheaded, tachycardic to 125, and hypotensive to SBP in the 60s. Repeat EKG shows sinus tach, portable CXR is unremarkable, and a RUSH bedside ultrasound exam notable for free fluid in the pelvis.

Read More

3 Comments

Tags: , , ,

CC

Cyanosis

HPI

83yF PMH HTN, HLD p/w fatigue and cyanosis. Reports that all day she has been feeling fatigued and was noted to have a blue color so her son called 911. On arrival she is cyanotic and hypoxic to 80-85% on NRB. Denies fevers, chills, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, diarrhea, dysuria, hematuria. Patient denies any toxic ingestions or recent medication changes.

Read More

Leave a Comment

Tags: , ,

CC

Altered mental status

HPI

58yF PMH thoracoabdominal aortic aneurysm s/p stent and HTN p/w AMS. Per husband, the patient was in her USOH, walked home from work and suddenly complained of chest pain and bilateral arm tingling. She sat down and suddenly seemed to fall back into the chair. Per EMS, the patient was unresponsive on arrival and never was able to give any history. They report that the patient had a HR in the 60s, and RR of 15, but could not obtain a BP. FS 120.

Read More

Leave a Comment

Tags: , ,

CC

Abnormal movements x1 week

HPI

7yF w/ no PMH brought in by her parents with progressively worsening involuntary movements x 1 week, slurred speech x 3 days. The movements improve but persist during sleep. No trouble eating/swallowing or handling her secretions. She has remained alert, coherent, interactive over this time course.

Read More

3 Comments