A 29-year-old with a history of migraine headaches, thalassemia of unknown phenotype, and no history of hypertension or epilepsy arrived to the emergency department via ambulance after possible seizure. The patient had nausea and vomiting the morning after a night of heavy drinking. After several rounds of vomiting, she felt shaky, lightheaded and experienced paresthesia in both of her hands and feet. There was no loss of consciousness, confusion or incontinence. EMS reported hypertension and tremors with upper extremity spasms. The patient developed a left upper extremity rash distal to the blood pressure cuff after paramedics did the first blood pressure measurement.
Picture this: you’re in the Emergency Department, nearing the end of your shift, when you’re called to see an eye complaint. It sounds like a typical low-acuity eye complaint: this 57-year-old patient presents with a vague chief complaint of having difficulty focusing on distant objects. She notices it has been present for a number of days and notes no other pertinent complaints. She has a history of hypertension and diabetes and has otherwise had no health issues. She sees her doctor regularly. You do your due diligence and perform a thorough review of systems – asking about headache, weakness, and hearing loss. You ask about diplopia, and to your surprise, the patient mentions that she has noticed that she does intermittently see double – especially when she is looking in certain directions.
A 46 year-old male presents with wrist pain after sustaining a mechanical fall and catching himself on his outstretched hand. An anteroposterior (left) and lateral (right) plain films of the wrist are obtained. What is the diagnosis (hint – there are 2 findings), injury classification system, associated findings, and the recommended management plan?
33 year old, vomiting blood, blood pressure 70 systolic. 6 minutes. Crap.
That patient is on the way to your emergency department. They are bleeding out, haemodynamically unstable, cold, shocked, in trouble.
The concept behind my talk was that if they’d been hit by a car – if they were a “major trauma”, then they would be taken to a specialist centre, greeted on arrival by a team leader and at least a dozen people focused solely on keeping them alive.
However, we don’t have a major upper GI bleed team in my hospital, and I suspect you don’t in yours either. These bleeding GI patients may benefit from all the experience and skill that a bleeding trauma patient gets, however we often try to manage them in house, to start with at least.
A 37-year-old G4P3003 female at 27 weeks GA presents via EMS for vaginal bleeding. She began having brisk vaginal bleeding after coitus about 30 minutes ago and has saturated 1 pad since onset. She denies associated abdominal pain, cramping, or prior episodes of vaginal bleeding during this pregnancy. She has not had regular prenatal care; however, she did have a transabdominal ultrasound in her first trimester showing an IUP. She has a history of 3 C-sections and denies complications during her other pregnancies.
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