Paramedics present to an urban emergency department with a middle aged
man found unresponsive in a nearby alley. The paramedics were unable to
obtain IV access due to years of drug abuse and overall poor venous
A 31-year-old African American male without any significant medical
history presented to the emergency department with complaints of left
arm pain, vomiting, and dark urine. One week prior to his presentation,
he felt a sudden burning sensation to his arm and then developed
redness, swelling, and pain.
A 48-year-old male presents to the emergency department complaining of
bilateral hand numbness and tingling over the past few months. The
patient has also noticed a mild swelling of bilateral lower extremities,
worse at the end of the day and improved with leg elevation. He has no
significant past medical history and takes no medications.
The patient is a 38-year-old African American male with a past medical
history of schizoaffective and bipolar disorder who presented to the ED
with altered mental status and chest pain. The patient had been issued a
day / evening pass to leave the psychiatric facility where he currently
resides and spent the evening at home with family.
A 68-year-old male presents to the emergency department for evaluation
of weakness. According to the patient’s daughter, he has been
increasingly confused over the past 24 hours and has been vomiting
“constantly” for the past 48 hours. The patient appears lethargic, but
adds that he has been experiencing severe stomach cramping as well as
several episodes of diarrhea.
A 17-year-old male with no significant past medical history is brought
into the ED by his parents with altered mental status after an evening
spent with some friends. The patient is awake but anxious and unable to
provide a detailed history. His heart rate is 132 bpm, blood pressure is
162/85 mmHg, respiratory rate 32 breaths per minute, and temperature is
Paramedics are called to a college fraternity Halloween party where a
large cauldron of “green witches brew” was being served. Several
students are found intoxicated with altered mental status and
hallucinations. Two male freshman students suffer generalized
tonic-clonic seizures en route to the ED.
Annually, more than 3,000 patients seek care in the United States
following envenomation by poisonous snakes. Many of these envenomations
are from Crotalinae such as rattlesnakes, cottonmouths, and copperheads,
which mainly cause local tissue injury as opposed to a minority of
bites from the Elapidae or coral snake which causes neuromuscular
weakness leading to respiratory arrest. In October 2010, the American
Heart Association and the American Red Cross issued their most recent
first aid guidelines.
A 35 year-old male with a past medical history of severe mental
retardation and a seizure disorder was observed eating 16 “snake”
fireworks by nursing home staff. He presented to the ED uncooperative
and was tachycardic.
The patient is a 27-year-old stock exchange worker who presents to the
ED with a complaint of anxiety, chest pain, sweating, palpitations and a
feeling of “paranoia and impending doom” following the recreational
ingestion of “bath salts” two hours prior at a company party.