ER Intern: Rashes....

So here are a few crazy cases that should get mentioned. The first may not sound all that cool, but it was my first diagnosis without the help of anyone. And of all things it was hematology. Who would have guessed??

So 16yo kid comes in and presents with "rash" now you know to be suspicious of easy cases in this ER so I'm going in pretty suspicious already.  As you can see from the pictures this is not just a rash, its petechiae, largish all over his body. Petechiae are small bruises under the skin from burst capillaries. And they are all over his
body.  For some freak flash of awesome, the first question I asked after looking at this is are they in your mouth? And yes, yes they are. Along with his bleeding gums.  And I knew, this is ITP (idiopathic thrombocytopenic purpura).  And yes, low and behold his platelets came back at 3. Yep a big ol' 3. So workup for this is to start high dose steriods and call the hematology doctors at 4am because this is legit. And when I said, platelets of 3 - they came right in. :)

Kinda neat.  Lets see another cool case I got was someone in legit SVT with a HR of 290s, sweaty and diaphoretic not responding to adenosine x 3 doses -- so I got to push the shock button. Popped him right out of it... although the guy levitated off the table and screamed "SHIIT" that rang through the whole ER. hahaha. Good thing I gave him drugs so he won't remember how much that hurt. This is the picture of the monitor! Its real.... all the board questions we've been studying are REAL.....

Hm... Another case that was also kind of a mystery case. A transfer from an outside hospital. A guy who had a syncopal or seizure event and came in with a myriad of questionable physical findings. He also had a petechial rash only on his chest and armpits with a purple tongue that was large and

swollen. He was on lisinopril for about 1 year and many were worried he had angioedema. He also had some swelling of the sublingual tissue under the tongue which was different. He was transferred because they were worried about his airway.  You can see that the purple bruising is only on the lateral aspect of his tongue, which gave me a clue as to the fact he'd probably had a seizure earlier that night. I also brainstormed that the petechial rash was most likely from apnea during his seizure that popped the capillaries in his chest. This is often a first sign of cause of death on cadavers in the morgue. My pathology teacher would be so proud of me! So we admitted him, but I didn't give him any angioedema medications because he bit his tongue so hard its probably swollen with all the blood. BAM! I was proud to have sorted this out.