Late Post Partum Pre-eclampsia

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.

Cocaine-induced Aortic Dissection

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.

COPDE with Pneumothorax

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.

Urologic Sepsis

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.

Hypercalcemia of Malignancy

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