Brady Pregerson, MD

: A middle-aged woman with a history of diabetes and hypertension is brought to the emergency department by paramedics as a field-activated ST-elevation MI. They report that about 40 minutes ago she fainted and when she came to she had anxiety, chest pain, and shortness of breath. There was no head injury.

Medics gave aspirin plus 3 doses of nitroglycerin en route without relief.

: On exam, the patient is obese, diaphoretic, and appears very anxious bordering on delirious. She is unable to give much history and is thrashing around.

: Pulse 131, BP 95/58, pulse ox 98% on oxygen. Lungs are clear and heart is tachycardic with normal heart sounds. Abdomen is rotund and non-tender. Legs have no edema, chords, tenderness, or erythema. Pulses are symmetric.


Articles

Our latest case report from Brady Pregerson, MD, features a middle-aged woman brought to the emergency department by paramedics as a field-activated ST-elevation MI. Check out the EKG and see if you can determine the correct diagnosis.

Endocrinology Case Report: Syncope and ST-Elevation

: A man in his 40’s presents to the emergency department with shortness of breath and leg edema for 2 months that has become worse during the last 2 days. He has a history of diarrhea & protein wasting due to prior gastric bypass surgery, but is otherwise healthy. He denies fever, chest pain, or cough.

: Vitals are notable for tachypnea and tachycardia. He is 5’8” and weighs 258 lbs. Pulse ox is 95% on room air. The oropharynx is moist and his lungs are clear without wheezing or rales. His legs have 1-2+ bilateral edema with a negative Homan’s sign and no erythema.

: Atrial fibrillation at a rate of 158 and nonspecific ST abnormalities.

: Sodium 150, chloride 128, carbon dioxide 11, creatinine 1.7, magnesium low at 1.2, albumin low at 1.7.



VQ scan of same patient showing perfusion defect in left lingula.

Our latest case report from Dr. Brady Pregerson features a man in his 40s presenting with shortness of breath and worsening leg edema. Can you determine the correct diagnosis?

Case Report: Shortness of Breath and Worsening Leg Edema

A woman in her late 70’s is brought to the ER by medics for facial droop, slurred speech, and left-sided weakness. She lives at a nursing home and at baseline is bedridden but A+Ox4 and able to feed herself. She was last seen normal about 1.5 hours prior to ER arrival. Her PMH includes CVA, HTN, DM, CAD, CHF, Afib, and GERD. She is hard to understand due to her slurring but does complain of headache and left-sided weakness. She verbalizes no other complaints.

Vital signs are normal except for BP 171/89. Physical exam is notable for weakness in all extremities but she is able to lift her right arm and leg off the bed but not the left side, though she can move it a little. Speech is slurred to the point of being difficult to understand with left facial droop. Heart is regular and lungs are clear. Her skin is dry. A stroke code order set is entered.

Our latest case report from Brady Pregerson, MD, features a woman in her 70s presenting with a facial droop and slurred speech. Can you help determine the correct diagnosis?

Emergency Department Minute Quiz: Stroke Code

: A woman in her 50’s with a history of asthma presents to the emergency department for cough, tactile fever and SOB. She denies syncope, palpitations, chest pain or other complaints. She thinks she’s probably having an asthma attack but hasn’t had one in over a decade so did not have medicine at home.

: Vital signs are notable for a pulse of 134, BP 113/62, temperature is 98.6, and a saturation of 95% on RA. Exam is notable for obesity, tachycardia, and mild wheezing with good air movement and no respiratory distress. There is no leg edema.

COMPUTER EKG READ: Sinus tachycardia, Left axis deviation, Low voltage QRS, Inferior infarct, age undetermined.

Our latest case report from Dr. Brady Pregerson features a woman in her 50s presenting with cough, tactile fever, and shortness of breath. Can you determine the correct diagnosis?

Brady Pregerson, MD

Articles

Endocrinology Case Report: Syncope and ST-Elevation

Case Report: Shortness of Breath and Worsening Leg Edema

Emergency Department Minute Quiz: Stroke Code

Case Report: Cough and Tachycardia