Category Archives: Cases

A Rare Cause Of Splenic Rupture

Hx: A male in his 30s presents with abdominal pain and vomiting. He relates that he was recently hospitalized for 4 days for alcoholic pancreatitis, at an outside institution. He was feeling better when he was discharged but the pain recurred 2 days ago and has been increasing steadily. He states it is now more severe than when he was

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Lethargy and Weakness

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 or neck injury and denies any headache. He has had a mild cough for two days and notes increasing generalized weakness for 3 to 4 days. His wife adds

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With or Without Contrast ?

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 symptoms. Pain is constant, and does not radiate. No associated chest pain, shortness of breath, or abdominal pain. No hematuria, dysuria, hx of kidney stones, change in stools, or

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Pediatric Syncope

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 episodes. He denies any other symptoms and has no complaints now. No pain. Medical history is positive only for mild reactive airway disease. Parents note a family history of hypercoagulability involving only

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Intentional Overdose

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 paramedics arrived the patient was groggy but able to answer questions. He had a bottle for 350 tramadol 50mg tablets that was filled 2 weeks ago, now empty. He admitted to

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Inhalation Injury

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 intractable cough, and his co-workers call EMS. He is given a single albuterol nebulizer treatment on the way to the hospital along with supplemental oxygen by non-rebreather

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Penetrating Head Injury

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. He arrives and is able to give a history of using a chisel when it ricocheted and struck him mid forehead. He states he blew his

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STEMI by CT?

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 emesis. However, symptoms have persisted for 24 hours. He also denies any history of similar episodes. PMHx: Hypertension SocHx: occasional alcohol, no tobacco or drugs Exam: Vitals:

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Back Stabbing

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 onset of back pain then has progressive shortness of breath, diaphoresis, and pain with inspiration. No anterior chest pain. On EMS arrival they find him in

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Persistent Vomiting

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. Emesis is dark, almost black. Stool was also dark. He has been unable to tolerate any oral intake because he has vomiting within a few minutes of intake each time.

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