The patient admits to a dental extraction approximately 6 weeks ago. He has come to see you because he has experienced painless hematuria since this morning. He has an associated cough, dyspnea, anorexia, arthralgias, abdominal pain, diarrhea, a widespread rash throughout his body, and back pain. Electrocardiogram (ECG) shows ST elevation in leads II, III, and AVF this is a new finding when compared to an ECG from 3 months ago.Ī 42-year-old man with a past medical history of hypertension presents with a 6-week history of intermittent fever. Except for tachycardia and tachypnea, heart and lung exams are normal. BP is 148/80, pulse is 100, and respirations are 26. Physical exam shows an obese, middle-aged man in moderate distress. ROS is negative for fever, chills, and malaise. Review of systems (ROS) is positive for diaphoresis, acute dyspnea, and sense of impending doom. He has smoked 1 pack of cigarettes a day for the past 36 years. He has had 3 similar episodes, but they have always resolved after 5 minutes or so of rest. The pain began about 20 minutes ago, and he rates the pain as a 10 on a 0-10 point scale, with 10 being the worst pain he has ever felt. The pain is located in the middle of his chest and radiates to his jaw. He has a past medical history of hypertension and diabetes mellitus. Infectious Diseases is consulted and he is started on an IV antibiotic regimen.Ī 54-year-old man presents with chest pain. Additional diagnostic tests are ordered preliminary results of blood cultures showed 4+ growth of gram-positive cocci. He is admitted to the general medical floor of an acute care hospital. Skin exam shows non healed puncture wound in left antecubital region surrounded by old granulomas and scarring.Ī spiral CT reveals evidence of multiple pulmonary emboli. Physical examination reveals mild crackles of the mid-lung fields bilaterally and a grade II/VI soft systolic murmur, loudest at the left lower sternal border. Vital signs show: Temperature 100.8☏, pulse 108, respirations 24, and blood pressure 98/60. He denies taking prescribed medications on a regular basis. His past medical history is notable only for childhood asthma (no recurrences since age 12) and appendectomy. Over the next 2 days, patient's blood pressures gradually normalized with medical therapy, but potassium levels remained low despite treatment.Ī 39-year-old previously well Caucasian man presents to the emergency department with a 10-day history of fever >101☏ and acute dyspnea with pleuritic chest pain. Patient was treated with IV nitroprusside and IV KCl 40 mEq x 2 doses and was admitted for further treatment. Chest X-ray - clear lung fields normal pulmonary vasculature.CT head - no evidence of intracranial pathology.Renal artery sonogram - Unremarkable. She ran out of all medications 2 weeks ago.Vital signs were normal, except for blood pressure 210/114 in the right arm, 215/115 left arm, 220/100 right leg, and 215/112 left leg.Physical exam:Heart - no visible or palpable PMI normal S1 and S2 without murmur, rub, or gallop.Pulmonary - few faint RLL crackles, which cleared upon coughing.Remainder of the physical exam, including neurologic exam, was unremarkable.ĬBC and BMP were unremarkable except for K+ 2.3 mEq/L.EKG - NSR with one PVC. Past medical history: hypertension, hypothyroidism, prior cholecystectomy.No known drug allergies.Medications: HCTZ 25 mg daily, diltiazem CD 120 mg daily, and levothyroxine 88 mcg daily. Symptoms started 3 days ago and progressively worsened. EKG: complete AV dissociation present.Ī 43-year-old Caucasian woman, previously in good health, presented to the emergency department with headache, blurred vision, and dizziness. Laboratory workup: potassium 5.8 mEq/L, BUN 40 mg/dL, creatinine 4.2 mg/dL, digoxin level 4.8 ng/mL (reference range: 0.5-2.0 ng/mL). Lungs fields clear without rales, rhonchi, or wheezes. Normal S1 and S2 without obvious rub, murmur, or gallop. Vitals: temp 98.8☏, pulse 40 bpm slightly irregular, respirations 16/min, blood pressure 108/60 mm Hg. Yellow/green halos around lights for 3 days. Decreased appetite for 3 days with fatigue and malaise. Medications: furosemide, digoxin, enalapril, carvedilol, tamsulosin. He denies drug allergies but reports blood pressure was low with diltiazem. PMH is significant for congestive heart failure secondary to non-ischemic cardiomyopathy, atrial fibrillation, hypertension, chronic renal insufficiency (with baseline creatinine 2.0), and BPH. 7 days ago, he experienced significant diarrhea for 4 days, with progressively worsening nausea and vomiting since. A 57-year-old man presents to the ED with syncopal spell 1 hour ago.
0 kommentar(er)
