Case 1

Male, Z.B. , 75 yo, presenting in the ED for worsening dispnea for the last couple of days, bilateral feet edema, anuria and chest pain. His past medical history shows atrial fibrilation with medium ventricular response, class II NYHA heart failure and chronic renal failure. On physical examination, the patient appears to be ill, ortophneic, pale. Pulmonary exam – couple crackles at the right base, left base with no murmur. Heart exam – arrhythmic sounds, EKG shows atrial fibrillation with rapid ventricular response. Abdomen is soft, nontender to papation. Lab results show hb 8.6 g/dl, ht of 35 , L = 6700, BUN = 119 mg/dl, ASAT = 78, ALAT = 80. Creatinine was not taken because of the lack of reactive in the lab. Further talking to the patient, he states he hasn't taken his digoxine for the last 2-3 months because his HR dropped too much. What would you do with this patient?

Hello!

Well, here i start with the basic ideea of creating a community of emergency physicians who would like to post their personal thoughts on various cases i'd like to comment here.