A 72-year-old male with a past medical history of hypertension, type 2 diabetes, hyperlipidemia, atrial fibrillation, coronary artery disease (CAD) with triple-vessel disease, heart failure with a known ejection fraction (EF) of approximately 30%, chronic mesenteric ischemia, and liver cirrhosis presents to the emergency department (ED) with complaint of bilateral lower extremity swelling.

Michael Hohl, MD

It’s 3:00 AM and the ER theme song wakes you from your Trauma swivel chair nap. “County, this is CFD. We’re bringing you an 11-year-old male who was a restrained passenger involved in a head-on motor vehicle collision going 45 miles per hour. Airbags deployed, and the patient was able to self-extricate. We’ll be there in 2-3 minutes.”

Michael Hohl, MD; Taylor Wahrenbrock, MD; Ari Edelheit, MD

A 50-year-old male with past medical history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and alcohol use disorder presents to the ED with chest pain. He states that his chest pain started around 6:30 PM today (it is currently 9:10 PM) and that he felt dizzy and diaphoretic upon onset of symptoms. He denies fever, chills, SOB, abdominal pain, nausea, vomiting, change in bowel habits, dysuria or any other complaints. An ECG was obtained on arrival (Figure 1).

Authored by Michael Hohl, MD; Taylor Wahrenbrock, MD; and Ari Edelheit, MD.