Case Files

In medicine, patients are the best teachers.This page highlights some of the most important and most interesting lessons. Whenever possible,  real presentations are used with minimal changes to protect patient anonymity.

  • 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 [...]
  • Persistant 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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