Emergency Department Minute Quiz: Vomiting

August 18, 2020

Our latest Emergency Department Minute Quiz from Brady Pregerson, MD. Can you determine the correct diagnosis?

Case: A woman in her 50s with a history of hypertension and fibromyalgia presents to the emergency department for gradually worsening vomiting, generalized weakness and body aches over the past 24 hours. She denies syncope, palpitations, chest pain, dyspnea, fever, abdominal pain, diarrhea or other complaints.

Exam: Vital signs are normal except for a pulse of 115. Exam is otherwise normal with no abdominal tenderness

Initial differential diagnosis: Tachydysrhythmia, Electrolyte abnormality, ischemia, dehydration

COMPUTER EKG READ:

1. SINUS RHYTHM

2. BORDERLINE RIGHT AXIS DEVIATION

3. NONSPECIFIC ST & T-WAVE ABNORMALITY

Do you agree with the computer? What is the most likely diagnosis?

A) Atrial flutter

B) Hypokalemia

C) Painless acute coronary syndrome

D) Pulmonary Embolism