An 18-month old previously well child presents to the emergency department of a community hospital with a head injury following an unwitnessed fall from significant height on a play structure with initial loss of consciousness. He is awake but irritable in the trauma bay, with obvious head injury.
A 20-something year old unknown male is brought to your community ED in a wheelchair by friends. They were at a party and a fight broke out. It was loud and dark and then they saw the patient collapse. His low back is covered in blood. He is awake but moaning.
Alice, a 20-year old female with no significant past medical history is brought in by ambulance with worsening upper abdominal pain onset 1 week ago when she woke up. She has felt nauseous and has vomited one time this morning. Two days ago, she began to feel short of breath. She states that it has been getting worse and she is now having trouble lying flat. She was hypertensive with EMS.
Mr. Johnson, a 60-year old man was found at the bottom of 3 steps at home by his wife. He is obtunded with obvious bruising to head. EMS has placed him in a C-spine collar and provided supplemental oxygen. He was swabbed for COVID yesterday due to a new cough and fever and the results are still pending.
This 49-year old male had abdominal and chest pain that start while smoking cocaine. This is on top of a history of untreated hypertension. On exam, he has signs of aortic dissection and requires stabilization before going to the CT scanner. Upon arrival back from the CT scan (which confirms the diagnosis of Type A aortic dissection) the patient is altered and in shock. Assessment reveals the patient to be in cardiac tamponade requiring emergent pericardiocentesis.
Acute asthma exacerbations in children are extremely common. Most asthmatic exacerbations respond quickly to basic treatment with beta-agonists, anticholinergics, and steroids. This case highlights the management of those patients who need treatment that goes beyond the basics.
Elliot, a seven-year old boy, is brought to the emergency department after six days of fever and lethargy. He has a rash, diarrhea and decreased urine output. Both his parents are healthcare workers with possible COVID-19 exposures.
A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.
Denise is a 59-year-old female who presents with a 7-day history of urinary symptoms, fever, and left flank pain. She has a history of STEMI 5 years ago with chronic left-sided heart failure. She becomes unstable in the ER, requiring judicious fluid resuscitation, vasopressors, and empiric antibiotic treatment. The team leader needs to consider the history and arrange renal imaging to discover the severe sepsis is secondary to an infected ureteric calculus. From there, emergent urologic consultation and admission to hospital is warranted.
This case was written by Dr. Skye Crawford and Dr. Nathan Ashmead, academic emergency physicians at the University of British Columbia. Why it Matters Oncology patients often present a challenge to healthcare providers in the emergency department. They have complex medical needs, both from their underlying illness and from the surgical, medical and radiologic treatments … Continue reading Hypercalcemia of Malignancy