Case report: A 23-year-old female presents to the emergency department due to the development of a perioral rash that has developed over the past few days that is intensely pleuritic, she reports the rash looks like “little bubbles” and when she looked up pictures online “it looks like herpes”. She reports she has not been …
44 year old male presents to ED with a medical history of hypertension and notes several vague complaints including numbness, fatigue, and slurred speech. Patient’s girlfriend notes that over the last several days the patient has been acting strangely, slurring his speech, appears confused, while periodically falling asleep. Physical exam is grossly negative with the …
Continue reading Toxic Alcohols and the 5 minutes before the exam
72yo female with recent diagnosis Bullous pemphigoid, HLD presenting complaining of a week of rapid HR in 90s, palpitations, higher than normal BP, and cold blue fingers, toes and blue tint to lips. In triage patient was found to be 89 on RA and placed on 2 L NC rises to 95% other vitals are …
The post below was reviewed and edited by the guest lecturers Dr. Wiegand and Dr. Nacca from the University of Rochester toxicology department. Flumazenil is a nonspecific competitive antagonist of the benzodiazepine receptor, which can be used to reverse benzodiazepine-induced sedation following general anesthesia, procedural sedation, or overdose. However, the use of flumazenil in the …
A 51 year old male presents for altered mental status. On arrival to the emergency department he was agitated, diaphoretic, and was having hallucinations requiring sedation with benzodiazepines for patient and staff safety. Post sedation he was noted to have worsening diaphoresis and tachycardia and was having intermittent myoclonic jerking movements. Family was with the …
Poisonings with methanol, ethylene glycol, and isopropanol often present the emergency physician with major diagnostic challenges: The identity of the ingested substance is frequently a mystery on presentation. Patients with an intentional ingestion, either for recreation or with suicidal intent, may be less than forthcoming. Young patients may not be able to identify the substance. Patients may be …
A 59 y.o m with a hx of bipolar on wellbutrin and paxil presents with altered mental status. On exam he is found to be tachycardic, hypertensive, diaphoretic, and flushed. He has a fever to 38.1. He has clonus on exam as well as hyperreflexia and rigidity in his bilateral lower extremities. He requires intubation …
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