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ARDS

64 years old female patient, with metabolic syndrome (already on therapy with statin and antihypertensive with good compliance and DM), being on triple tx with metformin+pioglitazone and SU for years with excellent HbA1c control (6.5%), we decided to stop SU before two months due to night hypoglycemia/morning hyperglycemia (around 180mg) and the levels of FBG were normalised to 100-110mg only with the dual tx. Then, we changed the combination to metformin+empaglifozin (850mg+12.5mg bid) and after one month the FBG values were around 160-170mg. We tried to correct them by increasing metformin to 1000mg and after one month, the values were around 140-150mg. I think we will wait one more month to check the HbA1c (to see the three month control), but would you suggest to change the combination, to try a DDP4 maybe, or adding a third drug, or just wait? I don't know if I will see a change in FBG after waiting for 8 weeks or 12 weeks! any more info needed, I will be glad to provide.

Bronchopneumonia

Female, 64 year old. Complaing chest pain, retrostrernal without propagation, vomited 2 times. Positive anamnesis for CVD, DM typ II, oral antidiabetics. TA 170/90 On exam, cardipulmonal compensated, eupnoic. Opinions, NonStemi, left main stenosis, or inferior wall involvement?

Dispatched to residence for assaulted person. Upon arrival patient is 37yo/m found unresponsive on living room floor in pool of dried blood with no active bleeds noted. Patient moved to back of truck and becomes slightly more responsive making incomprehensible sounds. Patient has open necrotic wound on forehead and what appears to be multiple contusion and abrasions all over the anterior/posterior thorax. Lower extremities are also covered in open wounds and contusions. Skin on the left and right metatarsals/ phalanges are rubbed raw. Due to patients decreases level of consciousness and respiratory rate decision was made to RSI. Other than forehead wound and bruising no obvious deformities were noted. Only blood work abnormality is Creat of 3.6mg/dl and close to non existent WBC. Head CT showed nothing of interest. Thoughts? Vitals GCS-8 Bp-92/40 HR-130 RR-6 shallow BLG-102 Hx Heavy ETOH abuse Meth use Heroin use

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?