Case1

Patient, 59Y, Male, consult ED due to chest pain 1hour, during breakfast, and is
described as severe, dull, and pressure-like. It is substernal is location, radiates to
both shoulders, and is associated with shortness of breath. And very sweaty when
the pain began. And have vomiting once. The patient had DM and HTA and takes HCT
and metformin.
Vital sign : 150/100，P 95。T 37.3，SPO2 98%。
On auscultation, faint crackles are heard at both lungs bases. HR is irregular. The
examination of the abdomen reveals no masses or tenderness. ECG showed AF and
II,III,avF ST elevated.
Impression of inferior wall myocardial infarction and AF(Atrial fibrillation)
Examination: CTnT,CTnT, ck-mb.
Case2
Patient 19Y, Male. brought to ED(emergency department) due to diffuse abdominal
pain, vomiting, and altered level of consciousness. symptoms began several days ago.
His symptoms at that time included profound fatigue, nausea, mild abdominal
discomfort and some urinary frequency.
His past medical history is unremarkable, and he is currently taking no medications.
Vital sign: temperature is 36.0°C (96.8°F), pulse rate is 140 beats per minute, blood
pressure is 82/40 mm Hg, respiratory rate is 40 breaths per minute.
Dehydrated appearance, deep and fast breathing.
there is an unusual odor to his breath.
The lungs are clear bilaterally with increased rate and depth of respiration. The
cardiac examination reveals tachycardia, no murmurs, rubs, or gallops. The abdomen
is diffusely tender to palpation, with hypoactive bowel sounds and involuntary
guarding. GCS: 13 分 E4V4M5?
Laboratory studies: white cell 16,000 and the hemoglobin and hematocrit levels are
normal.
Electrolytes reveal a sodium of 124 mEq/L, potassium 3.4 mEq/L, chloride 98 mEq/L,
and bicarbonate 6 mEq/L. BUN and creatinine are mildly elevated. The serum glucose
is 41.1 mmol/ L. A 12-lead ECG shows sinus tachycardia. His CXR is normal.
NS 1000ml/h already infused
Insulin IVF already given.
Monitor BG and recheck CBC+ Electrolytes.
CASE3
Patient 23Y, male, transported to emergency department (ED) from the scene of a
rollover motor vehicle collision (MVC). .He was found approximately 1 hour after the
accident had occurred. At the scene, the patient was awake and complained of pain
in his back and legs.
In the ED, he is awake, Multiple abrasions are noted over the neck, shoulders,
abdomen, and legs.
GCS: 15, temperature is 35.6°C (rectally), pulse rate is 106 beats per minute,
blood pressure is 110/88 mm Hg, respiratory rate is 24 breaths per minute,
his speech is clear and appropriate, normal breath sounds over bilateral lung fields.
He has palpable, equal bilateral femoral pulses
His chest wall is nontender. His abdomen is mildly tender. The pelvis is stable, but he
has extensive swelling and tenderness of the right thigh. He has a deep scalp
laceration over his right temporal area that continues to ooze.
(FAST) is performed revealing free fluid in Morison pouch and no other
abnormalities.
WBC of 14,800 cells/mm3, hemoglobin of 11.2 g/dL
IMP: motor vehicle collision (MVC) , Spleen laceration and bleeding
CASE4
64Y, male, brought into the emergency department (ED) by his family after fainting at
home. He was standing, dusting a bookshelf, He was noted to be pale and clammy
during the incident, and recovered spontaneously in approximately 30 seconds.
He does remember the moments just prior to and after the incident.
He felt lightheaded and had palpitations just prior to falling, no shortness of breath,
chest pain, headache, nausea, diplopia, or loss of bowel or bladder control.
His history includes a myocardial infarction 2 years prior. The patient has been taking
his regular medicines as directed, which include aspirin, a β-blocker, and a
cholesterol-lowering agent.
ED, the patient's vitals are blood pressure 143/93 mm Hg, heart rate of 75 beats per
minute, temperature of 37.1°C. and oxygen saturation of 97 % on room air.
His examination is no special finding. A 12-lead electrocardiogram (ECG)
demonstrates a normal sinus rhythm at 75 beats per minute with no significant
changes from a prior study 6 months earlier; the ECG reveals Q waves in leads II , III,
and aVF.
The patient now states he feels dizziness and didn't want to go back home.
He stayed in ER for 3 days. Repeat blood analysis was noted HB dropped
progressively from 12 to 9. However, Bp 140/09 . P 80, T 36.5.