As an emergency care provider, it is vital that practitioners know how to manage patients presenting with iron poisoning. Iron poisoning is a concerning cause of pediatric poisoning. The 2019 Annual Report of the American Association of Poison Control Centers’ National Poisoning Data Systemreported 4858 single exposures to iron or iron salts, of which there were 12 major outcomes and no deaths. The report documented 8898 single exposures to multivitamins that contained iron, with one major outcome and one death. Overall, 82% of these cases involved children less than six years of age. To best understand how to manage iron poisoning, reviewing the clinical presentation, and determining appropriate methods of obtaining a history, performing a physical examination and ordering the correct diagnostic tests is essential. The treatment plan for those presenting with iron poisoning can be somewhat confusing; therefore, it is vital to understand how to use the antidote, deferoxamine, in these often complex cases. Ultimately, the oral board review case on iron poisoning will prepare practitioners to diagnose and treat patients presenting with this toxic overdose.

This chapter details using flow cytometry immunophenotyping (FCI) in diagnosing chronic myeloid neoplasms and bone marrow disorders. Myelodysplastic syndrome (MDS) is characterized by cytopenias and dysplasia. Immunophenotypic alterations are observed in monocytes, granulocytes, and erythroid precursors, but analysis of CD34+ myeloid precursors provides the best result. The latter include increased CD34+ cells, altered antigen expression, and asynchronous maturation. Myeloproliferative neoplasms (MPN) show less pronounced changes in CD34+ cells, with primary myelofibrosis exhibiting more abnormalities. MDS/MPN, particularly chronic myelomonocytic leukemia, display monocytosis with aberrant monocyte immunophenotypes, including an expansion of the CD14+/CD16− subset and aberrant CD34+ blasts. Flow cytometry can also help detect relapse following stem cell transplant. Bone marrow disorders also benefit from FCI. Paroxysmal nocturnal hemoglobinuria is characterized by a deficiency in GPI-linked antigens. Aplastic anemia often presents with rare CD34+ cells with a normal immunophenotype. We discuss FCI’s role and limitations in distinguishing these disorders from non-clonal cytopenias.

The case examines the evaluation, diagnosis, and treatment of a woman with abdominal pain and vomiting who is found to have a small bowel obstruction.

Pneumonia and septic shock are common illnesses treated in the emergency department. This case reflects a patient with septic shock presenting to the emergency department from the community. The case progresses quickly from simple cough to septic shock with multiorgan failure. As the case progresses, the physician must quickly recognize the signs of severe sepsis and septic shock, which require immediate treatment with appropriate fluids, vasopressors, and antibiotics.

This chapter covers a rare but important cause of chest pain, Boerhaave’s syndrome. The case will cover a possible presentation, clinical findings, diagnosis, and treatment options for Boerhaave’s syndrome.

This chapter describes a case of a 25-year-old female with abdominal pain, who is diagnosed with ovarian torsion. The patient’s symptoms are severe and abrupt in onset, with occasional respites from a nonspecific but intense pain. The chapter outlines the vital signs, primary and secondary surveys, and the patient’s history. The diagnosis is confirmed by pelvic examination and pelvic ultrasound. The treatment of ovarian torsion is time-sensitive, and the risk of losing the ovary increases with total ischemic time. The chapter provides important information for clinicians to identify and treat this surgical emergency.

This chapter presents a case of a 6-year-old boy with abdominal pain, who ultimately had testicular torsion. It’s important to remember that any male pediatric patient who presents with abdominal pain should have a genital exam, as it may be the only presenting symptom. The diagnosis is confirmed by ultrasound, and the definitive management is surgical.

This chapter presents a case of a 82-year-old female with acute pulmonary edema due to hypertensive acute decompensated heart failure. The case highlights the proper use of noninvasive positive pressure ventilation as well as appropriate medical intervention with nitroglycerin and diuretics to prevent progression of respiratory failure.

This chapter focuses on the flow cytometry immunophenotypic evaluation of Burkitt lymphoma, diffuse large B-cell lymphoma or high-grade B-cell lymphoma with MYC and BCL2 rearrangements (with or without BCL6 rearrangement), high-grade B-cell lymphoma not otherwise specified, and diffuse large B-cell lymphoma. The differential diagnosis among these three entities and with other entities is also discussed, with a focus on flow cytometry analysis. The differential diagnosis between surface light chain negatve blastoid high-grade B-cell lymphoma and CD34-negative B-ALL sometimes can be very challenge. Features that may be helpful for such a differential diagnosis, mostly flow cytometric immunophenotypic features, are discussed in detail.

The chapter presents a case of a 34-year-old man with persistent diarrhea and abdominal pain. The patient had no significant past medical history and had traveled outside the country six weeks ago. The diagnosis was traveler’s diarrhea, likely caused by Giardia lambliainfection. The patient was prescribed antibiotics and rehydrated with oral or IV fluids. The chapter emphasizes the importance of eliciting a travel history and sending stool samples for laboratory analysis to identify the cause of diarrhea. It also provides information on the most common causes of traveler’s diarrhea, including protozoan infections like Giardiaand Entamoeba histolytica amebiasis, and bacterial infections like E. coli, Salmonella, and Vibrio cholera. The chapter discourages the use of loperamide in moderate to severe acute infectious diarrhea.

We describe a case of acute pancreatitis caused by the presence and obstruction of gallstones, also known as gallstone pancreatitis. Our case highlights a patient with frequent episodes of “heartburn” after eating. It describes how these episodes were likely episodes of biliary colic ignored and misdiagnosed by the patient. Pancreatitis is an acute inflammation of the pancreas that can typically be caused by heavy alcohol consumption, gallstones, or hypertriglyceridemia in the United States. As in our patient, the pain is typically sharp and constant in nature, with radiation to the back. These episodes are frequently associated with nausea and vomiting. Additional highlights include the adequate management of acute pancreatitis with aggressive hydration, antibiotics, pain control, surgical and gastroenterological consultations, and hospital admission.

This is a case of pediatric respiratory distress in which airway foreign body should be very high on the differential. The physician can wait for ENT assistance as the child is not immediately crashing, but needs to prepare for emergent airway management.

This chapter presents a case of a 22-year-old college student with fever, headache, and altered mental status. The case highlights the initial assessment and early treatment of suspected bacterial meningitis. Discussions in the case include early use of antibiotics preceded by blood cultures, indications for computed tomography (CT) head prior to lumbar puncture (LP), intravenous dexamethasone given with or shortly before antibiotics, isolation of the patient, contacting public health officials, and the chemoprophylaxis of all close contacts, including health care workers, in patients diagnosed with Neisseria meningitidisor Haemophilus influenzae.

A 28-year-old male with arm pain presents to the emergency department. He is diaphoretic and anxious, but in no apparent distress. His vital signs include a BP of 90/65, HR of 125, RR of 16, and temperature of 38.8°C. The patient has a history of occasional back pain and has been taking ibuprofen 800 mg PRN for the last three days. He has used cocaine occasionally and smokes tobacco. The patient’s primary and secondary surveys reveal rhabdomyolysis, heat exhaustion, and acute kidney injury. The candidate should aggressively hydrate the patient, treat hyperthermia, obtain renal consultation, and consider intravenous bicarbonate therapy. The patient should be admitted to the hospital. The use of NSAIDs should be avoided as they can cause renal artery vasoconstriction and reduce GFR. The patient’s EKG shows sinus tachycardia. The complications of rhabdomyolysis include electrolyte abnormalities and acute kidney injury.

This chapter is about managing severe asthma exacerbations up to the rare critical need for intubation. Intubation of asthmatics in respiratory distress is usually not needed and generally avoided; however, it is critical for the emergency physician to recognize when this intervention is appropriate and necessary. Additionally, the emergency physician must know and implement the less invasive standard therapies and adjunct treatments before resorting to intubation. The emergency physician must be able to articulate which clinical and objective findings lead him or her to this final decision of intubation and disposition to the ICU.

Acute undifferentiated leukemia (AUL) is part of the group of acute leukemias of ambiguous lineage (ALAL). It is characterized by the expression of immature hematopoietic cell markers but lacks the expression of markers that allow assignment to myeloid or lymphoid lineage. This chapter discusses the immunophenotype and molecular features of AUL and highlights the immunophenotypic features that can help in the differential diagnosis from other entities, including AML with minimal differentiation, AML with megakaryocytic or erythroid differentiation, T-lymphoblastic leukemia, blastic plasmacytoid dendritic cell neoplasm, and rarely, non-hematopoietic neoplasms.

In this chapter, a 56-year-old male with a history of diabetes, hypertension, hyperlipidemia, and alcoholism presents with altered mental status, tachycardia, tachypnea, and fever. Physical exam demonstrates induration of the skin of his perineum with palpable crepitus. Learners are expected to elicit important exam findings and verbalize an appropriate management plan for a patient with Fournier’s gangrene, a necrotizing soft tissue infection of the groin.

A 48-year-old male with a known history of alcohol abuse is brought in by EMS for altered mental status. Upon arrival to the ED, he is atraumatic, hypertensive, tachycardic, confused, agitated, uncooperative, and diaphoretic. Fingerstick is within normal limits. He is sedated to expedite work-up and for patient and staff safety. A “coma cocktail” is administered without adequate response. The patient subsequently develops a grand mal seizure responsive to benzodiazepines. Alcohol level is 56 and the rest of the bloodwork is unremarkable. CT head without contrast is negative for acute intracranial hemorrhage. The patient is admitted to the ICU for alcohol withdrawal seizures.