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Case 1

A 30 yo Fijian seasonal worker is in Australia picking sweet potatoes.
He presents with 3 days of epigastric and shoulder pain. He has dyspnoea and fevers.

On examination he looks unwell and is diaphoretic.
Vitals are: Heart rate of 85bpm, BP of 120/90, Respiratory rate of 36, SPO2 98% on room air, Temp 38.5
He has an essentially normal examination except for some slight tenderness the RUQ, but no Murphy sign.

This is a case presented by Dr Adam Michael at EMCORE Fiji last year. Let’s look at the case presentation and I’ll add some commentary in real time. It is a great learning case.

Case 2

A 36 yo woman presents to the emergency department complaining of numb feet. “I can’t feel the pedals in the car when I’m driving…….. It started 2 days ago and seems to be increasing…. I mean, going up my legs”

There are no other symptoms and the patient is well otherwise. She has a medical history of diabetes and has had a recent chest infection.

Examination reveals dual heart sounds and bilateral, equal air entry. There is symmetrical sensory loss of the feet to the level of the ankles, with no other neurology.

She is seen on the night shift and the registrar, diagnoses a sensory loss secondary to diabetes. The patient is sent home with a plan to review with her endocrinologist as early as possible.
The patient represents 2 days later with weakness in her lower limbs. There is no back pain and no bladder or bowel disturbance.

What would you do next? What is the working diagnosis? How should we investigate? What is our role in the Emergency Department?

In a glimpse of what the new EM Mastery Website (soon to be released) will bring you, let’s work through the case together in this Clinical Cases Podcast.

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