A 50 year-old female who was “on a bender” over the weekend now presents with diffuse abdominal pain and persistent nausea and vomiting. She will have a diffusely tender abdomen, a BP of 80/40, and be tachycardic. The team will need to work through a broad differential diagnosis and should fluid resuscitate aggressively. Once the patient has received 6L of fluid, she will become tachypneic and hypoxic and require intubation. The team will be given a lipase result just prior.
26 year-old female, recently immigrated from Cambodia, presents after a syncopal episode at home. At the case outset, she complains of feeling “a little dizzy” and has a HR of 100 and a BP of 90/60. Once the team initiates care, the patient will say she has to vomit and then become poorly responsive and more hypotensive. The patient does not know that she is pregnant, so the team will have to consider the diagnosis early and use bedside U/S to point them in the right direction. The team will then need to initiate a massive transfusion and arrange for surgery. If the ectopic pregnancy is not recognized, the patient will become persistently more hypotensive until she has a PEA arrest.
A 60-year-old male presents with a four-day history of abdominal pain secondary to cholangitis. The patient presents in septic shock requiring intravenous fluid resuscitation, empiric broad-spectrum antibiotics and vasopressor support and suffers a PEA arrest prior to disposition to advanced imaging or definitive management.