A 75 year-old female with a past medical history of hypertension, hyperlipidemia, SVT, chronic kidney disease, diabetes, lung cancer status post partial right lung resection, and remote history of breast cancer status post resection presented with chest pain. She awoke in the middle of the night after hearing a loud crash and found her husband lying on the ground unresponsive. She thought he was dead and felt an overwhelming sensation of fear, followed immediately by the onset of substernal chest pain radiating to the back associated with some shortness of breath. She denied fever, diaphoresis, nausea, vomiting, or palpitations. She denied any history of angina. Upon arrival to the emergency department she was given nitroglycerin with a subsequent improvement in her chest pain…
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By: Russell Prichard MD and Melanie Lippman MD
CASE
The patient is a 52 year-old female with a past medical history of hypertension, hyperlipidemia, hypothyroidism, and a 2 pack a day smoking history who presented to the emergency department in respiratory distress.
When EMS arrived to the patient’s home, she was hypoxemic with a pulse oximetry reading of 70s on room air and hypotensive with systolic blood pressures in the 80s. She was placed on nasal cannula with improvement in her saturations and she was given aspirin, fentanyl, and nitroglycerin without relief.
Upon arrival her vitals were significant for respiratory rate of 34, pulse oximetry of 98% on 6L NC. She was noted to be in acute distress.
The patient was placed on positive pressure ventilation via BiPAP and broad blood work, chest X-ray and electrocardiogram (ECG) were obtained.
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The patient is a 5-year-old female with a past medical history significant only for torticollis who presented to the emergency department with fever, emesis, diarrhea, fatigue, and rash. The patient began having fevers to 102 degrees Fahrenheit five days prior to arrival. The patient’s mother reported that four days ago, the patient began having diarrhea and non-bloody, non-bilious emesis. Two days ago, she began having decreased PO intake, continued fevers and emesis, anuria, and bilateral neck pain. The morning of arrival, the patient’s mother noted a rash on the patient’s back and bilateral conjunctival injection. She brought the patient to her pediatrician’s office, who sent her to the ED for further evaluation and management…
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A middle-aged male presented in cardiac arrest. He had reportedly complained of preceding chest pain. Upon EMS arrival, his presenting rhythm was ventricular fibrillation (VF), which was refractory to multiple attempts at defibrillation. After receiving treatment for refractory VF, the patient had return of spontaneous circulation (ROSC). He was hypotensive, and ultimately required triple pressor support to maintain adequate mean arterial pressure. An initial electrocardiogram (EKG) was performed, which showed sinus tachycardia. A repeat EKG was performed one hour later, showing…
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