scholarly journals 19-year-old Woman with Intermittent Weakness

2021 ◽  
Vol 5 (3) ◽  
pp. 276-282
Author(s):  
Garrett Cavaliere ◽  
Neeraja Murali ◽  
Laura Bontempo ◽  
Zachary Dezman
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Chief Complaint ◽  
Case Presentation ◽  
Diagnostic Studies ◽  
Definitive Therapy ◽  
Electrolyte Abnormalities

Introduction: Systemic weakness is a common chief complaint of patients presenting to the emergency department (ED). A well thought out approach to the assessment and workup of these patients is key to diagnostic accuracy and definitive therapy. Case Presentation: In this case, a 19-year-old female presented to the ED with generalized weakness and near syncope. She had global weakness in her extremities and multiple electrolyte abnormalities. Discussion: This case takes the reader through the differential diagnosis and evaluation of a patient with weakness and profound electrolyte derangements. It includes a discussion of the diagnostic studies and calculations that ultimately led to the patient’s diagnosis.

scholarly journals 73-year-old Female with Syncope and Motor Vehicle Collision

2021 ◽  
Vol 5 (4) ◽  
pp. 369-376
Author(s):  
Kevin Flanagan ◽  
Zachary Dezman ◽  
Karl Dachroeden ◽  
Laura Bontempo
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Motor Vehicle ◽  
Motor Vehicle Collision ◽  
Initial Assessment ◽  
Case Presentation ◽  
Traumatic Injuries ◽  
Vehicle Collision ◽  
Attending Physician ◽  
Suspected Diagnosis

Introduction: Patients with traumatic injuries can be difficult to assess, and their evaluation often evolves in the emergency department (ED). We describe how an ED attending physician member developed a differential diagnosis for this presentation, arrived at a suspected diagnosis, and what test he proposed to prove his hypothesis. Case Presentation: This clinicopathological case presentation details the initial assessment and management of a 73-year-old female who presented to the ED following a motor vehicle collision precipitated by a syncopal episode. Conclusion: The final surprising diagnosis is then revealed.

scholarly journals 36-year-old Male with Syncope

2020 ◽  
Vol 4 (3) ◽  
pp. 272-276
Author(s):  
Samantha King ◽  
Ryan Spangler ◽  
Zachary Dezman ◽  
Laura Bontempo
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Initial Examination ◽  
Case Presentation ◽  
Work Up

Case Presentation: A 36-year-old incarcerated male presented to the emergency department (ED) after an episode concerning for syncope. The patient had nystagmus and ataxia on initial examination. Discussion: There is a broad differential diagnosis for syncope, and for patients presenting to the ED we tend to focus on cardiogenic and neurologic causes. This case takes the reader through the differential diagnosis and systemic work-up of a patient presenting to the ED with syncope.

scholarly journals 37-year-old Transgender Man with Fevers, Dysuria, and Sudden Decompensation

2020 ◽  
Vol 4 (3) ◽  
pp. 277-282
Author(s):  
Emily Fleming ◽  
J. David Gatz
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Case Presentation ◽  
Stable Case ◽  
Work Up

Introduction: Patients in the emergency department may experience sudden decompensation despite initially appearing stable. Case Presentation: A 37-year-old transgender man presented to the emergency department (ED) with several months of fevers, myalgias, and weight loss. The patient acutely became febrile, tachycardic, and hypotensive after an initially reassuring assessment in the ED. Discussion: This case takes the reader through the differential diagnosis and work-up of the decompensating patient initially presenting with subacute symptoms.

scholarly journals The Tired Pregnant Woman

2021 ◽  
Vol 5 (4) ◽  
pp. 494-498
Author(s):  
Katie VanNatta ◽  
Nicole Yuzuk ◽  
David Trotter ◽  
Brandon Wisinski
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Pregnant Woman ◽  
Hyperemesis Gravidarum ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Pregnant Patient ◽  
Initial Assessment ◽  
Case Presentation ◽  
Intermittent Bleeding

Introduction: Many pregnant women develop hyperemesis gravidarum. There are numerous gastrointestinal, genitourinary, neurologic, and metabolic causes to consider in this patient population. Case Presentation: This clinicopathological case presentation details the initial assessment and management of an 18-year-old pregnant patient who presented to the emergency department with a complaint of nausea, vomiting, fatigue, and intermittent bleeding. Discussion: This case takes the reader through the differential diagnosis and evaluation of the patient and the signs and symptoms, including her agitation and tachycardia, that led us to the correct diagnosis.

Common Pediatric Dermatologic Conditions

2020 ◽  
pp. 240-261
Author(s):  
Julie Furmick ◽  
Dale Woolridge
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chief Complaint ◽  
Discharge Instructions ◽  
Admission Requirements ◽  
Life Threatening ◽  
Atypical Presentations ◽  
Schonlein Purpura ◽  
Clinical Algorithms

Rash and skin complaints comprise a common pediatric chief complaint and among the top 20 reasons patients present to the emergency department. For this reason, it is important for emergency physicians to be able to distinguish life-threatening rashes from those that are benign. This chapter reviews common dermatologic conditions seen in pediatrics, such as eczema, erythema multiforme, Henoch–Schonlein purpura, scabies, tinea infections, urticaria, impetigo, and ecthyma. For each presentation, the incidence, epidemiology, typical and atypical presentations, diagnosis, differential diagnosis, treatment, disposition, complications, and clinical algorithms are reviewed. The chapter focuses on topics that are clinically relevant to patients seen in the emergency department, including admission requirements, discharge instructions, return precautions, and subspecialist follow-up.

scholarly journals 55-year-old Male with Exertional Dyspnea

2020 ◽  
Vol 4 (2) ◽  
pp. 111-115
Author(s):  
Eric Friedman ◽  
J. David Gatz ◽  
Zachary Dezman ◽  
Laura Bontempo
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Chest Radiograph ◽  
Successful Treatment ◽  
Type I Diabetes ◽  
Diagnostic Study ◽  
Type I ◽  
Exertional Dyspnea ◽  
Case Presentation ◽  
Work Up

Introduction: Dyspnea is a common presenting complaint for many patients in the emergency department. Case Presentation: A 55-year-old man with type I diabetes presented to the emergency department with one month of intermittent palpitations and dyspnea. His lungs were clear to auscultation, and his chest radiograph was normal. Discussion: This case takes the reader through the differential diagnosis and systematic work-up of dyspnea with discussion of the diagnostic study, which ultimately led to this patient’s diagnosis and successful treatment.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

scholarly journals Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Min Li ◽  
Gang Zhu ◽  
Hao Guo ◽  
Shun Nan Ge ◽  
Guo Dong Gao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
High Altitude ◽  
Fat Embolism ◽  
Neurological Rehabilitation ◽  
Case Presentation ◽  
Sympathetic Hyperactivity ◽  
Paroxysmal Sympathetic Hyperactivity

AbstractBackgroundCerebral fat embolism (CFE) syndrome at high altitude was rare complicated with paroxysmal sympathetic hyperactivity (PSH) syndrome and septic shock. It is a challenge to differential diagnosis and treatment at high altitude.Case presentationThis case presents a CFE with PSH and septic shock of a 23-year-old man occurred at high altitude of 3800 m above sea level, transferred by airplane successfully and cured in the department of neurosurgery, Xi’an Tangdu Hospital.ConclusionsIt is key that CFE with PSH can be rapid diagnosed and treatment bundles of septic shock should be initiated as soon as possible. Early neurological rehabilitation played an important role for good outcome.

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

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