Welcome back to another week of rapid fire case conference review here at THE OSU EM Residency Program.
Leading off is Dr. Nicholson with his patient presenting from dialysis clinic with a chief complaint of “Problem with fistula site.” A quick duplex study with basic labs reveals an occluded outflow vein and a potassium of 7.3. Understanding the arrhythmogenic potential for hyperkalemia, he obtains the following EKG:
Welcome back to another edition of Case Conference Review here at Academic Medicine Pearls at THE Ohio State University! Old Man Adams starts us off with a 38-year-old male with known history of alcohol abuse presenting via EMS for suspected EtOH withdrawal. On walking into the room, Dr. Adams is greeted with choice expletives and the subsequently refuses any vitals or to participate in the examination. The patient then promptly starts to seize, sending Dr. Adams down his alcoholic withdrawal seizure pathway.
Conference moderator and forever resident Dr. Zach Adams leads off this week’s case conference with a 65-year-old female diabetic presenting with the always challenging chief complaint of a “room-spinning” dizziness, otherwise classified as vertigo. She describes it as worse with position, severe, and present intermittently for the past few days. Suspicious for peripheral vertigo, Dr. Adams performs the Dix-Hallpike maneuver (Figure 1). Seconds after placing the patient in the reclined position with head turned laterally, the patient displays strong rotary nystagmus and promptly vomits on Dr. Adams’ shoes. Confirming his suspicion for benign paroxysmal peripheral vertigo, Dr. Adams then successfully performs the Epley maneuver (Figure 2) to reposition the otoliths within the semicircular canal and relieve the patient’s vertigo.