Case Files

In medicine, patients are the best teachers.This page highlights some of the most important and most interesting lessons.

De-identificaiton is undertaken utilizing the Safe Harbor method described by the US Department of Health and Human Services : Health Information Privacy ( All remaining patient information required for teaching purposes has been altered to maintain this standard.

  • Lethargy and Weakness

    November 27, 2017

    A patient in his 70’s presents with diffuse myalgias, weakness, and confusion. He reports he fell out of bed and was found by his wife shortly after. He denies any head [...]
  • With or Without Contrast ?

    September 21, 2017

    Hx: A middle aged woman presents with flank pain. She has no past medical history and notes sudden onset of severe, sharp, left flank pain. She denies any history of similar [...]
  • Pediatric Syncope

    August 31, 2017

    Hx: A young teenager presents with syncope. Parents note he had 2 episodes today without any preceding problems but the patient notes some mild lightheadedness prior to both [...]
  • Intentional Overdose

    August 15, 2017

    Hx: A 55 yo man presents after an intentional overdose. He is transported by EMS after his family found him poorly responsive with an empty bottle of tramadol. When [...]
  • Inhalation Injury

    August 10, 2017

    Hx: A male in his 20’s is working when he mixes lime away and bleach in a bottle. He then breathes some of the resultant gas and becomes short of breath, develops an [...]
  • Penetrating Head Injury

    August 4, 2017

    Hx: A 60 yo male is transported to a trauma center for a penetrating head injury. EMS reports a hand tool penetrated the forehead and the patient is stable with a GCS of 15. [...]
  • STEMI by CT?

    July 31, 2017

    Hx: A male in his 60’s presents to a small ED with nausea and vomiting for 24 hours. He denies any fever, abdominal pain, or diarrhea. There has been no blood in the [...]
  • Back Stabbing

    July 24, 2017

    Hx: A prison guard is stabbed by an inmate. He is stabbed in the upper back on the left side resulting in a small puncture wound just medial to the scapula. He has immediate [...]
  • Persistent Vomiting

    July 19, 2017

    Hx: A male in his 60’s presents with persistent nausea and vomiting for 4 days. He denies any significant abdominal pain but has had some very mild diarrhea. No fever. [...]
  • Pregnant With Vomiting

    July 6, 2017

    Hx: A 33 yo female presents for possible pregnancy. She gives a hx of only 3 weeks and 5 days since her last menstrual cycle but notes that she had a positive pregnancy test [...]
  • Hx: A young male in his late 20’s presents with shortness of breath. He denies any past medical history and notes that symptoms only began a few days ago. He began with a [...]
  • Chest And Flank Pain

    June 19, 2017

    Hx: A 67 yo male complains of chest pain with shortness of breath. Pain is mid sternal pressure, non-radiating, and started this morning. There was some shortness of breath [...]
  • Headache and Syncope

    June 15, 2017

    Hx: A 34 yo female presents with headache and syncope. She is accompanied by family  who give most of the hx. The patient has a hx of daily migraines for which she takes [...]
  • 23 yo With Chest Pain

    June 7, 2017

    Hx: A 23 yo male complains of chest pain. It has been present for 2 days, and intermittent. This morning he awoke feeling well but then developed 2/10 dull mid chest [...]
  • Hx: A 39 yo female complains of chest pain. It began today, is felt as a pressure in the mid chest with a sensation of heart racing, and is associated with shortness of [...]
  • Facial Injury

    May 1, 2017

    Hx: A prisoner in his mid 20’s presents with a facial injury. History from EMS is that the patient had a syncopal episode and hit his face on the edge of a sink sustaining [...]
  • Tongue Swelling

    April 19, 2017

    Hx: 62 yo female presents with tongue swelling. She notes she went to bed normally without symptoms. When she awoke, her tongue felt thick and throughout the morning it has [...]
  • Hip Pain Post Fall

    April 12, 2017

    Hx: A 25 yo male presents after falling at work. EMS reports that he fell approximately 8 ft from a ladder landing on his right side but without head injury. He complained of [...]
  • Headache and Vision Loss

    April 7, 2017

    Hx: 35 yo female complains of a severe headache. It is frontal, bilateral, and radiates to her whole head. It has been worsening for days and not responding to meds. She has [...]
  • Bad Mexican Food

    April 1, 2017

    Hx: A 50 yo woman arrives in the ED complaining of “eating bad Mexican food”. She was at a nearby restaurant when she experienced abdominal pain, but feels better and [...]
  • Neuro Defecits Post MVC

    March 29, 2017

    Hx: 60 yo male presents by EMS post MVC. According to EMS, the patient drove off the road and into a grove of trees. Another driver witnessed the accident and called EMS [...]
  • Seizure

    March 22, 2017

    Hx: A previously healthy 15 yo female presents by EMS for a generalized seizure. The patient is post-ictal and unable to give any history on arrival. The paramedics state [...]
  • Hx: A 17 month old male presents with a seizure. He is driven to the emergency department by his parents after they witnessed him having the seizure. According to parents, [...]
  • Neonatal Distress

    March 10, 2017

    Hx: 9 day old female presents with mom due to poor feeding. Mom notes that the patient was doing well and breastfeeding with bottle supplementation until yesterday when [...]
  • Respiratory Distress

    March 7, 2017

    Hx: 20 yo male presents in respiratory distress. History from the patient’s family is significant for worsening shortness of breath for a week. He has a history of [...]
  • Chest Pain, Short Of Breath

    February 28, 2017

    Hx: A 55 yo female presents by EMS complaining of chest pain. She states she was about to begin eating lunch at a restaurant when she had sudden onset of mid sternal chest [...]
  • Abdominal Pain Post MVC

    February 19, 2017

    Hx: A 56 yo female presents by EMS after a motor vehicle collision. She was a restrained driver in a head-on collision with another vehicle. Her airbags deployed. She denies [...]
  • An Unusual Case Of Back Pain

    February 4, 2017

    Hx: A 25 yo male complains of back pain. He states the pain began while doing “dead lifts” at the gym 4 days ago. He notes he felt fine during the activity with [...]
  • Headache

    February 1, 2017

    Hx: During a busy shift, you see a 30 yo female complaining of severe headache. She notes that she has a history of recurrent headaches and starting 3 months ago they have [...]
  • Chest Pain

    January 27, 2017

    Hx: It’s the start of your shift and EMS brings a “chest pain” patient to the ED. They report a 62 yo female with onset of chest pain while on a treadmill. [...]
  • Palpitatons and Tremors

    January 26, 2017

    Hx: 25 yo female presents with 12 hours of worsening palpitations, muscle rigidity in the thighs, and tremors of the hands. She denies any fever, strenuous exercise, drug [...]
  • At The End Of Life…

    January 8, 2017

    It was a typical shift. Critical patients streaming in to the ED back to back. Each one was handled by some great team work as we labored to resuscitate the septic, [...]
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