37-year-old diabetic female feeling weak after switching diuretics

37-year-old diabetic female feeling weak after switching diuretics

The patient is a 37-year-old female who presented with a history of longstanding hypertension and diabetes mellitus. She had recently started on a new diuretic, and felt very weak and lightheaded. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. After reviewing the ECG, consider the following questions: 1. Based on this ECG, what type of diuretic is she likely to be taking? 2. How should she be managed?

Read More
16-year-old male experiencing chest and throat pain

16-year-old male experiencing chest and throat pain

The patient is a 16-year-old male who presents with difficulty breathing, pain in his throat, difficulty swallowing, and pleuritic chest pain. He reports that the symptoms began “a couple of hours” earlier. There is no history of trauma, choking, or recent dental procedure. The patient looks well, and is quiet and not toxic. Pulse is 75, O2sat 94; there is no fever. Chest is normal, with bilateral air entry. Assessment is hindered by the patient’s …

Read More
32-year-old male with burning sensation in chest

32-year-old male with burning sensation in chest

The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3 °F View the EKG taken and consider what your diagnosis and next …

Read More
2-year-old boy with Williams syndrome suffers fever and cough

2-year-old boy with Williams syndrome suffers fever and cough

The patient is 2-year-old boy with Williams syndrome who presents two days after a trip to the emergency room for a three-day history of fever, cough, and wheezing. In the ED, the parents report, he received three doses of nebulized albuterol and was diagnosed with reactive airway disease and bilateral otitis media. He was discharged on oral amoxicillin and albuterol MDI. Today, you find he has similar symptoms, plus vomiting. His parents say he vomited …

Read More