UOTW #17

87 year old male with a history of hypertension called EMS after having leg numbness earlier in the day, then a sudden onset of a headache with radiation to the back of his neck.  The pain resolved right before EMS arrived at his residence. After unloading in the ambulance bay, the patient began to exhibit AMS, then lost pulses.

Answer

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UOTW #16

A 36 y/o male with no previous medical history presents with sudden onset of testicular pain that occurred while at work. The pain that is worse with movement radiates to his suprapubic abdomen. The patient is sexually active with multiple partners, and usually uses condoms. He denies recent trauma to the area, dysuria or hematuria.

On evaluation, his vitals are recorded to be: HR: 106, BP 115/79, O2 100%, Temp 98.8°F. Examination reveals left scrotal swelling and pain with elevation w/o discoloration or bruising. An ultrasound was brought to the bedside, and the following ultrasound is obtained:

Answer

UOTW #15

This is a 65 y/o WM who has a history of paroxysmal atrial fibrillation and CHF presents via EMS with lethargy, weakness and intermittent syncope.  The family found a mostly empty bottle of digoxin in his apartment.  Vitals: 24 75/25 6 99% RA.  You are handed the following 12 lead ECG by EMS:

block

The decision is made to begin transcutaneous pacing the patient.  The pads are placed and the pacing mode is selected.  You are convinced you feel a pulse, and the following ECG strip is obtained:

But the patient remains unconscious.  You obtain the following ultrasound.  What is the cause of the patient’s continued poor clinical status?

Answer