Round 27 (Back Pain, Dysuria, Knee Pain)

You are working a shift at ABEM General when three patients check in simultaneously at the start of your shift at 6AM.



Initial Vitals#1 (Ms. Taylor, 65F with Back Pain)



* Temp 98.8* HR 120* RR 22* BP 210/110* O2 97%



Critical Actions#1 (Ms. Taylor, 65F withBack Pain)



* Obtain Medication/Social Hx (Ciprofloxacin use, Cocaine use)* Diagnose Aortic Dissection (Type B)* Treat HR Appropriately (Esmolol drip)* Treat BP Appropriately (Cardene drip)* Treat Pain



Initial Vitals#2 (Ms. Thomas, 50F with Dysuria)



* Temp 101.0F* HR 120* RR 22* BP 106/65* O2 98%



Critical Actions #2 (Ms. Thomas, 50F with Dysuria)



* Obtain pregnancy test* Perform chaperoned pelvic exam* Diagnose PID /w Fitz Hugh Curtis & Treat /w abx* Treat pain* Council patient appropriately on +STD (treatment of partner, no intercourse until treated)



Initial Vitals#3 (Ms. Wells, 40F with Knee Pain)



* Temp 99.9F* HR 90* RR 18* BP 120/80* O2 98%



Critical Actions#3 (Ms. Wells, 40F with Knee Pain)



* Obtain appropriate workup (ESR, CRP, XRay, Cultures)* Treat pain* Perform Arthrocentesis* Gonococcal Arthritis* Treat with appropriate Antibiotics



Further Reading



Aortic Dissection – CoreEM



Pelvic Inflammatory Disease – EMDocs



Septic Arthritis – EMDocs