23 yo female  p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs.  No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with  mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?

Submitted by Dr. Sheehan- EM2

54 year old male presents to the ED by ambulance. 911 dispatcher sent an ALS crew to a local pharmacy where a the patient was filling a prescription for lansoprazole. He was seen in another ED for epigastric discomfort and occasional shortness of breath 2 days prior. He was discharged with PMD follow up and a prescription for lansoprazole. While filling the script, the patient began to feel the same epigastric pain, with shortness of breath and broke out into a cold sweat. The patient has no medical problems, allergies or surgeries. EMS gave the patient O2, ASA and two sprays of NTG sublingual. Upon presentation, the patient's symptoms worsened, his distal pulses were weak, and was very anxious. His VS were HR:60, BP:80/40, 30, 99% on NRB. Below is his ECG (top image is a right sided ECG and the bottom image is the triage ECG). What is your interpretation?

 An 8 year old female patient presents to the ED brought in by the mother who claims that the patient had been complaining of a sore throat for the past 3 days. Today she developed a fever and refused to eat. The child is tired and sleepy in triage, and is noted to be drooling. The patient refuses to open her mouth for a temperature. Her vitals are: Tr:103, HR:130, R:30, POX 100%. You note her to be sleepy but arousable, consolable by mother, and confirm that she is drooling. On pharyngeal exam, the patient refuses to open her mouth, you palpate fullness of the neck with right sided torticollis, anterior cervical LAD, note rhinorrhea, and mild stridor. Without further upsetting the child you smartly get a lateral soft tissue of the neck. What is your diagnosis? What is your next steps in managing this patient?