A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
EMS brings you a 38-year-old male patient from the street. He is obtunded, GCS 6, smells strongly of vodka, and was reportedly surrounded by liquor bottles at the scene. He is breathing comfortably with both stable and normal vital signs on assessment. What should be done?
Jorge Aceves, MD
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Figure 1. Index point-of-care echocardiogram.
A 40-year-old man with no known past medical history presented with one week of fatigue and dyspnea on exertion. In the last week, the patient developed significant shortness of breath with only a few steps. The patient reported an unintended weight loss of 25 lbs in the last two months, as well as one month of intermittent epigastric abdominal pain and associated nausea. In the last week, the patient was seen by an outside clinic and diagnosed with H. pylori and started on treatment for H. pylori. He denies any other acute complaints or symptoms including orthopnea or paroxysmal nocturnal dyspnea.
Alejandro Ruiz, MD
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Source: https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome#/media/File:ARDSSevere.png
A 78-year-old female presents with dyspnea, and her chest x-ray demonstrates signs concerning for community-acquired pneumonia (CAP). Despite your best interventions, her oxygenation and work of breathing are worsening, so you call Respiratory Therapy to initiate high-flow nasal cannula. Meanwhile, you’re left thinking, “Would steroids help turn her around? But what are the guidelines - are steroids best used for CAP or sepsis or both? What kind of CAP? When and how much?”
Taylor Wahrenbrock, MD; Kathryn McGregor, MD; and Eric Leser, MD
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