Delayed Presentation
For many reasons, older people may “put up” with symptoms for longer — stoicism, decreased pain receptor sensitivity, social isolation, cognitive impairment. As a result, they may arrive in the ED “sicker than they look”:
- “feeling a bit weak” –with a new Q-wave from the MI that happened three days ago;
- “just not right” from the systemic sepsis which started as a simple UTI;
- “just dizzy” because of dehydration and postural hypotension from the vomiting of the painless cholecystitis;
- “just not feeling good” from the peritonitis of the ruptured appendicitis.
Discussion: Delayed Presentation
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WEAKNESS – full metastatic CA w peritoneal carcinomatosis
patient who fell 1 week ago and now has balance problems. He had a broken hip.
Most elderly cases present atypically
I keep getting an error trying top post comments
Male in his 80s presented with generalized weakness. No focal complaints of finding on examination.
Turned out to be Sepsis after further investigation.
weakness, third degree heart block
ok
75 y/o M presented with left flank pain similar to his previous right sided kidney stone, ended up with ruptured small bowel diverticulitis
slip and fall with AMI
so many atypical presentations
practically all my sepsis’s are atypical – i would say more of my bacterial pnas in the past yr have no pulm complaints (no cough or sob) than those that do. many of the covid and viral pnas have resp issues but the bacterial ones have not for some reason recently. also most of their vitals are all screwy – often not tachy from their 15 cardiac meds, or inaccurate temp recorded.
yes
mild SOB- Large pleural effusion secondary to malignancy
Dolor abdominal de 3 días de evolución, se documenta infarto evolucionado
Una adulta mayor dependiente parcial de actividades básicas que ingresó como un delirium, se le documenta una itu sin embargo paciente con tórpida evolución clínica, desorientación, dolor mal referido por lo que se amplían estudios y se documenta una pielonefrotis enfisematosa, que si nos hubiéramos casado con sus síntomas iniciales in específicos posiblemente la paciente hubiera evolucionado hacia la meurte en más corto tiempo
an aaa who presented with urine retention only
died later that day
Si, IAM
large dxx
sob – large pleural effusion
Yes, SAH came in with neck strain post golf game
weakness can be a harbinger of much worse disease states
Agreed. Scary how much can be masked by stoicism and decreased pain sensation.
Ambulatory elderly lady with mild abdominal pain with perforated appendix & abscesses.
89 yo with ruptured AAA and reported mild flank pain over a week after shoveling snow.
Patient presented “weak” and dizzy; had Creatinine of 458 due to BPH/obstruction.
patient came to the ED complaining of “feeling dizzy” presenting with pneumonia.
Pt in their 80s, presenting with “not feeling well” x 48 hours- EKG showed an inferior STEMI.
Phlegm 1 day and difficult to breath end up with gi bleeding , and arrest from gut obstruction and bowel ischemia
Rectal cancer in an elderly female with change in bowel habits and weight loss for sometime that she thought was related to her poor appetite and ‘haemorrhoids’ which she had not gone to see anyone for.
ok
sad
Anterior chest wall tenderness to palpation with a PE
I call PE the great masquerador
not feeling well-MI
daily
Happens all the time
ok
Had a massive heart attack present as generally weak x 1 day
Chief complaint of abdo pain, +flatulance and passing gas. Diagnosed w/multi-vessel occlusions
profound weakness and pallor- inferior stemi with large amount of elevation
vague lower limb feeling funny and later diagnosed as sarcoma.
Indigestion x3 days = STEMI with most explicit “tombstone” ST elevation I’ve ever seen
A sobering reminder not to be dismissive to generalized complaints in the aging population.
general malaise and abdo pain for a AAA
Delayed anaphylactic responses
Falls turned out to be related to cardiac
ok
vp shunt + abdo pain = meningitis
Yes
yes
patient stated she had multiple syncopal episodes and was feeling weak x2 days. Patient was convinced it was related to her blood sugar because it was higher than normal. Patient was in a third degree heart block
right side chest pain radiating down right arm was a stemi
fall onto knees ended up having severe injuries
STEMI- generalized weakness, pallor no history of chest discomfort
new brain Ca dx in pt c/o weakness/light headedness
confusion – dx fever/infection/septic
Chest pain x 3 days. Called 911 after syncope.
liver failure patient who had no visible jaundice
stoic rural patient population leads to delayed presentation frequently
sepsis
experienced this
a
odd
MI mimics in elderly
I’ve had a couple situations that ended up being a MI and in one case a patient presented SOB but ended up being a GI bleed. There were some other signs that indicated something else going on which we picked up on early. Unfortunately the outcome was not good.
….
yep
Definitely
yes yes
m
not really
of course
NOT JERRY
investigate everything, assume nothing
Pt felt tired all day the previous day and went to bed early stating they had a good sleep. Woke up still feeling very fatigued like yesterday. Pt was in a third degree block, began to deteriorate and required pacing in the ambulance prior to arrival in the ED and had a pacemaker implanted at hospital later that morning.
HYEAH
low hemoglobin, pericardial effusion
MI- elderly female, c/o UTI symptoms and mild abdo pain ongoing a few days
sepsis
.
.
.
.
ok
metastatic disease, CAD with vague complaints
Multiple falls and weakness had stroke
Seen patients complaining of racing beats,along with shoulder + neck tension which they related to stress
I saw n older patient the other day came in with knee pain. Seen in our sister hospital for same the night before so had resident call for collateral info. Got a bit different story, turns out patient had unrecognized delirium, did a CT and had a large sub-acute SDH.
I saw an older woman with right upper back pain which was actually an MI. She had already been treated for the pain but it was just worse and she “looked kind of sick” to me which prompted a bigger workup
No
Innumerable cancers. Several head bleeds. Large AAA
atypical presentation of an acute appendicitis
Generalized weakness with no other symptoms…
chest pain is often the most common that I have noticed with many of my gerontology patients
–
yessss
yes, patients with delirium specially hypoactive type are not diagnosed properly.
–
okay
Asymptomatic AMI or NSTEMI
Interesting
;
“Anxiety” = NSTEMI with new heart failure
many times, often vague complaints result in lengthy work up
many of our nursing home residents present by EMS in florid sepsis. Ive had a STEMI present as only nausea and vomiting, a saddle pulmonary embolus present as only brief syncope. Acute confusion is a very common presentation for sepsis (mostly UTI).
Hypoxia + syncope (usually) = PE
ok
near syncope in pt with mesenteric ischemia, but without abd pain/elevated wbc, PT WELL APPEARING
very helpful information.
APPENDICITIS
Chronic alcoholic, 3 week hx of ataxia secondary to a fall, had a chronic suburbs
One yeah history of abdominal mass associated with weight loss turned out to be cancer.
NSTEMI SDH electrolyte imbalances
ACS, stroke, diverticulitis, subdural
okay
new diagnosis
yes
….
ok
As our patient population is largely geriatric, many patients have presented atypically. With patients presenting with generalized complaints of fatigue having anything from a UTI, PNA to ACS.
…
..
I recently had a patient with perforated diverticulitis with localized abscess who came in for “intermittent fevers.” No current fever. Otherwise chronic complaints that had not changed.
ok
Mild LUQ pain for a 39 year old turned into Renal Cell Carcinoma.
.
I have seem several pneumonia cases that have waited too long to come in and an occasion al MI that was thought to be heart burn.
new rectal cancer in elderly gentleman who ‘was feeling weak’ with mild abdominal pain
syncope –> ACS
beware the old patient with back pain or Abdo pain
Bilateral subdurals
b
The next worst patients for this… healthcare professionals.
yes, not uncommon.
again why
UTI
UTI’s typically
Watch those UTI’s
weakness
ok
awesome
yes
“don’t feel right” – stemi
urinary issues
Low to no urine output thinking he was dehydrated but actually was in ARF
ascending cholangitis in a patient with no abdominal pain but only decreased appetite and nausea – diagnosis found by abnormal labs followed by imaging and ultimately went to the OR s/p IV BSABx
pts who have the flu but feel its just a cold and were waiting to get over it
wait and put up with pain a while before coming in
neuropathy so foot with massive infection that went unnoticed until daughter visited and noticed odor
All the time–back pain turns into ruptured AAA, weakness turns into code blue.
thorough workup and physical exam
scary
massive STEMI complaining of “I just don’t feel good”; reproducible rib pain; died in the cath lab
ok
jaw pain -> aortic dissection
back pain = MI
a man had been told for approx. a year that he was going through a midlife crisis after his behavior changing 180 degrees. finally at about a year of sx, they did a head CT and found approx. 20 brain tumors. so sad
k
okay
elderly male with back pain and vomiting /MI
patients who have the influenza virus or the common cold, and just feeling weak, sometimes stay days at home thinking it would get better and present with horrible barking coup, greenish sputum and they never realised that a pnuemonia was developing
patients with sepsis or septic shock secondary to infected decubitus ulcers that they may have had for weeks or patients with severe dehydration that has been ongoing for several days
Pt who turned out to have a ruptured appendix who presented to clinic with 3-4 d of severe abdominal pain. He looked sick in clinic and I sent him to ER for urgent workup. He wanted to go home rather than the ER because the abdominal pain “wasn’t that serious” and he did not feel that “sick.” I had another elderly lady present to ED with profound weakness and falls x 2 getting out of bed (an acute functional decline for her) who was having a STEMI.
Recent MI presented with vomiting as only symptom
Female with back pain= MI
weakness and and right shoulder pain + STEMI
chief complaint of nausea in elderly women, triaged to non-acute area, eventually had ECG showed a STEMI
No experience as yet, but important notes to bear in mind when assessing an elderly patient.
Pt with UTI that lead to sepsis and decreased LOC
delayed presentation of ACS
NSTEMI presented as weakness and fatigue x3 days.
A lot of times CAD
symptoms are definitely not specific
c/o weakness for a diagnosis of leukemia
80+ man with dementia brought in by personnel in the house because he was not eating and they thought he was “yellow”. While waiting lab results developed heart stop in the ED, did not survive. Obduction showed AMI.
Most unusual case was a patient brought in by paramedics with weakness and confusion, hypotensive and vomiting, I noticed a rash over his torso paramedics had not yet seen, pt was in anaphylaxis from a bee sting! Was stung an hr prior but family didn’t think it was important to mention because of no prior hx of anaphylaxis and they thought his symptoms started too long after the sting.
.
no
Stroke with hemiparesis, thought it would clear up
noop
sepsis
MI
stroke
renal failure
urinary retention
GI bleed
infection
uncontrolled diabetes or blood pressure
etc
Presented with sepsis, sent home without effective treatment
delirium.
was diagnosed with bladder infection the next day
Paciente con decaimiento y ligero dolor abdominal, y estaba haciendo un STEM
uti
recently have had several malignancy cases with minimal symptoms other than feeling vaguely “off” and maybe slight dyspnea with exertion more than their usual or slight change in BM pattern etc
ok
Severe cellulitis in the diabetic with peripheral neuropathy
Uti
every day something different
Not ED
UTI
NSTEMI presenting as cough and weakness
every day
NSTEMI with weakness and scrotal swelling
Delirious with septic shock, complained of pain in ribs
Upper UTIs presenting as gastroenteritis, ACS, stroke 2 weeks before but didn’t want to bother her daughter.
brain tumor
cancer, acs, etc
ACS for atypical abd pain
nausea and bowel perf
feeling tired from Vtach
confusion for uti
MI presented as backpain for 2 weeks
great
generl weakness electrolyte imbalance
admit for back pain – had ruptured GI tract
Older patient presented with back pain was later found to have a ruptured appendix
Middle aged female had been feeling unwell x 1 week. Had been diagnosed with pneumonia and sent home. Pt was then found by family unable to get out of bed. Pt ended up having souvenir bowel and passed away a few hours later.
***ischemic bowel
older lady previously living independently found to have become incontinent of urine and stool and unable to walk. CT brain and spine normal . Elevated Trops, diagnosed as ACS
older patient presented with thigh pain ended up being ruptured appendix tracking through the obturator foremen
general weakness. sepsis, electrolyte imbalance
This
weakness, N/V, UTI, MI, falls, new bleeds
happens alot with UTIs and pneumonia
client with dementia not putting up with pain of getting BP, so wanting to leave but no BP obtained, high RR, initially minimized as presenting well ; did this x2 I think. 3rd time, finally stayed and accepted full ass’t, SBP in the 80s (not her norm), WBC 20+ … septic with cardiac arrhythmias, electrolytes off as well.
haven’t had the pleasure of experiencing this clinical setting yet unfortunately as I am a student
hip pain which became a ruptured AAA
abdominal assessment
Several cases, cholecystitis, myocardial infarction, hyperthyreoidism
MI
myocardial infarction
people who have behavioural/psychological illnesss
Confused elderly people
happens alot in LTC
helpful
k
unsure
heart burn for MI
UTI
anemic
cancer
when a pt had UTI
dehydration as weakness
IRA avec critère de dialyse qui vient pour nausée
sepsis as weakness
Sepsis… just don’t feel good…
Complex diveriticulitis in pt with mild abdominal pain, no fever, and benign exam
So many!!!!
I work in a geriatric hospital!
Last one: patient fell, had shoulder pain mainly and neck pain. Game in 2weeks later. Unstable cervical fracture
stay broad
MI, Cancers
stomach pain and nausea = STEMI!
definitely
urine retention of 4l, the patient was complaining of some constipation.
Patient transferred for fall from his height. Finally probably fell from advanced sepsis because he had acute renal injury, ACS, elevated lactates, etc.
Yes, elderly with 3 days of weakness and poor appetite. Arrived with signs of MI, renal failure and pneumonia!
Patient with acute appendicitis and ureteric stone but only complained of general malaise
constipation in a patient with a ruptured sigmoid volvulus
Nausea and vomiting from NSTEMI
several
delerium from ACS
elderly female complained of back pain for a week and was discharged three days prior
presented with perf viscus
Elderly lady seen sitting in waiting room, looks not too bad, complaining of being unable to lie down in bed at night – peritonism from perforated viscus
Well looking older gentleman one month post laparotomy feeling a bit weak and short of breath with decreased appetitie but looking quite well had PE, intrabdominal abscess, SBO, and ?pneumonia.
Anaemia presented with fatigue from chronic GI bleed
Yes
many
I cared for a lady who had an MI at home and came to hospital approximately 1/52 post chest pain when she started having some SOB, secondary to new CHF. She stayed home as she was a primary caregiver of her husband who had an advanced dementia. After 2-3 days in hospital, she had a sudden cardiac arrest during shift change while sitting on the side of the bed talking to her daughter. It was determined that she ruptured her ventricle in the postmortem. The husband then had to go into long term care. Very sad end for them both!
Pericardial tamponade from supratherapeutic warfarinisation – presented as lethargy, treated as sepsis to begin with but borderline tachy and hypotensive, went to HDU and had pan CT scan and diagnosed on CT. Very prompt pericardiocentesis post this
Lots of ACS with patients just feeling weak or not right. Encephalitis with just some mild confusion and normal vitals.
cholecystitis in an 80 year old with generalized weakness for 3 days.
many!
Too many
severity of complaint not consistent with severity of illness
a patient with MI who presented with weakness, presenting late
Yes with pneumonia or MI
throat and neck pain – aortic dissection
nausea- NSTEMI
tiredness and lethargy – sepsis
icc
Mi
myocardial infarction, subdural hematoma, acute aortic syndromes
great info
A pregnant female presented to the ER C/O dysuria, they found a 20 cm of a cyst by US. MD performed surgery, when they opened her abdomen, they did not find anything. After that, we found pt had urinary retention, we inserted foley cath and removed more than 1800 ml….It was not a cyst.
Yes
Every patient is completely different and unique. So every patient should be analyzed in a unique approach.
interesting
yep
We find that older pt’s tend to under rate their pain scale. They often have the “I don’t want to bother anyone” attitude. I have found that many younger pt’s over rate their pain “12 out of 10”
Weakness with urinary retention and bladder with 800cc urine with no urinary complaints.
Elderly patients post-fall with traumatic head injury present with normal exams and often have intra-cranial bleeds on CT.
THis happens all the time. Had one patient present as a code stroke who wound up having a large brain tumor
Yes frequently present later
facial laceration > NSTEMI
Great example!!
82 year old man presented with exertional shortness of breathing – bilateral pleural effusion
elderly male presented with acute confusion, had appendicitis
other had a pe
Had lots of pets that gave me a nagging feeling of something more serious than they presented. Reported it to triage but don’t get to know the diagnosis to know if suspicions are correct.
on and off light fevers turns out to be appendisitis
I can’t help but think the recent non-cardiac chest wall pain is something else. Repeat visits for the same. Undiagnosed so far. I am hoping this week’s admission will find the culprit and improve the quality of life for this lady.
atypical presentation of MI in a elderly patient
Many examples. One patient saw three MD’s in walk-in clinics for abdo pain over several weeks, and got treated twice for a nonexistent UTI (no cultures done)and once for “constipation” before she finally presented to ER. She never had any urinary or GI symptoms. I found an easily palpable mass on exam. I organized a CT abdomen and she had a gigantic sarcoma. She told me none of the other doctors had examined her. It’s amazing to me how often patients tell me this, that the last MD they saw gave them a prescription but never examined them. I acknowledge that the yield of the physical exam is not as good as the history, but still.
I am always very suspicious of UTI and constipation as explanations for abdominal pain. They are common causes, of course, but too easily applied incorrectly.
Elderly patient that present with feeling unwell, no chest pain and on ECG had NSTEMI MI
Elderly woman came in with “chest pain” found to have large bilateral breast masses for further investigation and no other source of pain.
Frequently, at any age. That’s why we are there, pick up the atypical cases.
Restless and Agitated with consolidation on CXR
yep
multiple pneumonias with no cough or fever.
ascending cholangitis with no abdominal pain
subdural with no headache
Multiple episodes of septic patients (UTI, pneumonia, acute abdomens), ‘silent’ MI’s, spinal compression #’s,
decreased appetite, increased confusion – UTI
Lower leg pain in a south-east Asian man –> STEMI
presented with frequent belching; ECG revealed STEMI
Delirium -> STEMI, Abdo pain x days & one vomit -> SBO (multiple such patients), R elbow pain -> NSTEMI, Mechanical fall -> Symptomatic Bradycardia, Not feeling right w/ multiple previous ER visits/recent hospitalization -> Metastatic Adrenal CA, Mild subacute cough -> Lung CA/TB, and I’m sure many others that I’ve missed.
Elderly patient presented to triage with compliant of nausea and no chest pain. Turned out to be a massive MI with the highest troponin recorded at our hospital.
Had a 76 year old patient who presented with N/V after eating a 3 day old donair that was in her fridge. Turned out she was a leaking AAA
just nauseas and it was a ACS
Serious bowel obstructions requiring surgery after pt presented with constipation, urosepsis Dx after presenting with new onset confusion, acute MI presenting with weakness.
UTI, Cholecystitis, PE
urosepsis, af, mi….a long list
Atypical presentation MI’s
UTIs
Picked up a lady with a vague Hx of falling the shower 7 days prior to calling. Initially talking with the pt she appeared to be “ok” but upon further investigation it was noted that the L side of her body was swollen at least 1.5 X than the R. Skin was mottled, pt was “a bit cold” & hypotensive etc…Suspected infection and brought to ER ASAP. Pt was in Dx to be in Septic Shock…
lady who got diagnosed with stomach ca after thinking it was mild indigestion
Absolutely I can! Silent MIs, neoplasms, metabolic prolems.
A stomach that is a little upset , turned into a massive inferior MI
Neoro pt that just seemed depressed
dull back pain, reproduceable, no other complaints giant stemi
general weakness for acute MI
“same old UTI” was reported, ended up as bladder ca.
MI
never listen to just what they are saying.
1 word…atypical presentations are red flags!
“loss of eye sparkle” as per nursing = UTI until proven otherwise.
The last couple of sick elderly patients that presented as “feeling unwell” had leaky AAA’s. But CA, MI, etc. the list is endless…
What do you call a Unicorn with 2 Horns?
U-Nique-Corn!
urosepsis
great examples! STEMI in delirious patient admitted with urosepsis (big ST elevations actually missed until the med student saw the Tnt of 12 many hours later); he was too delirious to identify chest pain
79 year old with silent MI – we did an ECG, luckily. Also, a 80 year old with ischaemic colitis – was sent home with ‘constipation’ – came back in with peritonitis and died, unfortunately.
bowel obstruction, perforation, pneumonias and MI
Definitely UTIs
patient feeling short of breath from copd – pulmonary embolism
known elderly gentleman with CVA presented with loss of appetite….patient had sepsis from a pneumonia
80 year old man Diabetic presented with feeling weak and unwell for a week. No other symptoms, had a STEMI. Delayed presentation lack of social support and also didnt think his symptoms were significant.
Many examples. New pancreatic ca in gentleman with vague abdominal pain and generalized fatigue. AMI in elderly woman with fatigue presenting to urgent care.
i remember a lot of examples
Examples are many, most seniors in this way to reach emergency services
la mayoría del tiempo
……
….
Lady with weakness who had a STEMI
I had a female patient who presented with vomiting and nausea after eating a meal with fish (at least that was her association). Vague epigastric tenderness. It was difficult to elicit since her major complaint wasn’t pain per se. Not an alcoholic. She did have DM. ECG was normal but sometimes she was getting periodic chest pain that she felt was moving. Persistent hypotension. CXR possibly had mediastinal widening with a bit of a boot shaped heart but it was an AP and rotated. With the profuse vomiting and epigastric pain one of my colleagues sent her for a CT Abdomen to rule out pancreatitis. Turned out she had a dissecting aortic aneurysm from the root of aorta to beyond the renal arteries.
a man in his 70s developed chest pain while doing a physical work but remained at home until he phoned his son 4 days later with the story, and the son advised him to go to the ER, and he was diagnosed with AMI.
Patient presenting with chest pain ended up having a perforated viscus
75 year old male see 2 weeks prior with swelling of testicles, referred to the surgical opc. CSME back because appointment date was too far. However on examination patient actually had anasarca, no hernia , elevated Troponins And inferior wall ischemic changes on his ECG.
Elderly Pt. presented with abdominal pain after doing sit ups, turned out to be a AAA. The pt. required surgery.
An older gentleman presented with c/o not feeling well, hour hours later died of complications of sepsis.
Mental health issues like depression and anxiety presenting as multiple non specific somatic symptoms
RUL collapse presenting as nausea; MI presenting as delirium;
Large pneumonia causing sepsis and eventually requiring intubation and ICU admission
bowel obstruction in a patient we then drained 500ml fluid from his stomach via NGT after he had been vomiting in the XR.
delayed
xx
new findings of a large uterine tumor in an >70 year old lady, came in because of ‘discharge’
hhh
80yo F presented with a few days of weakness, diarrhea, vomiting as per her hx. She was septic with renal failure and third degree heart block!
post ACS presenting with being unwell;
hyperthyroidism as anxiety
acute stroke on an elderly woman complaining of weakness, nausea, vomiting
90 yo male with hematuria, normal VS, afebrile and ended up with wildly unhealthy BW results
Mildly demented lady presented several days after a subarachnoid hemorrhage. She had had a severe headache and took some of her son-in-laws dilaudid which confounded the diagnosis as her toxin screen was unexpectedly positive and she was too drowsy to say she had a headache.
In our very stoic farming population, often other family members have to drag in nauseated or weak elder who’s only question to me is “when I can go home to finish my work?”
Working in a new program with paramedics. Early development. We will see patients in nursing homes and supportive living settings.
How do I convince them that diagnosis will not be as easy as what their protocols outline as they come upon elders with vague symptoms!
Not sure even their manager gets it!
came to ER because feeling a little “off” and “tired”. Presented with Acute renal failure with a Cr of 650 and K of 8.5
patient in post-CVA rehab with groaning abdo pain – worsened on the day of presentation and ended up being ischemic bowel.
delayed presentation for worsening chest pain x 1 month -> inferior MI
Stomach perforation with very mild abdominal pain x 1 week.
unsure
no experience
Female presented to the ER with sore throat and cough,had a NSTEMI
presented several days after stroke (thinking maybe it would get better), new diabetic came in with severe confusion due to honc, waited in that state for days, sdh often present much later than the fall
cholelithiasis in an elderly man presenting with confusion
man had a fall at a nursing home and his nephew insisted on bringing him to the ED became febrile during his visit and diagnoses and admitted with urosepsis
Asked to see a patient for pseudo-dementia/ depression as a cause of weight loss and decreased appetite without pain admitted from ER. Unfortunately was diagnosed with pancreatic cancer with mets. Cognition was great and would have been happy without cancer.
perforated viscous in an elderly lady with decreased appetite.
right arm tremor – diverticulitis.
I find it harder to think of an elderly patiernt who presented “typically”.
Diverticulitis in a man whose wife described him as depressed
3 DIFFERENT patients in one shift last sunday found on the floor in the AM. All had NSTEMI’s of varying duration. None had current symptoms of chest pain or SOB. Trops ranged up to 6.6.
delayed sub-dural…2 weeks post fall
lightheaded from digoxin toxicity
RLQ adbominal pain with R sided STEMI.
perforated bowel in an elderly woman from a nursing home who was came in “confused”
Weakness and nausea in an elderly woman with pancreatitis secondary to a calculus cholecystitis
a metastatic breast cancer on a 78 year old lady that have found a lump few years ago but didn’t bother her till today.
new rectal cancer in elderly gentleman who ‘was feeling weak’ with mild abdominal pain