Medical Diagnoses in ER: A Comprehensive Review of Medical Conditions in Season 11
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Season 11 of ER marks a transition period for County General, blending high-stakes trauma management with intimate, often heartbreaking personal medical narratives. The season is characterized by complex neurological cases, rare pediatric diagnoses, and the stark reality of iatrogenic injuries. From the chaotic aftermath of a mass casualty river crash to the controversial ethics of HIV-positive organ transplantation, the medical scenarios push the boundaries of emergency medicine.
Below is a comprehensive, episode-by-episode review of the medical cases, diagnoses, and treatments presented in Season 11.
Content ⁉️
Episode 1
Ruptured Proximal Aorta and Cervical-Cord Injury
Elgin Gibbs. A victim of a vehicle submersion in the Chicago River presented with flaccid paralysis. Diagnosis: While initial films were negative, the patient developed spinal shock and coded. An emergency thoracotomy revealed a Ruptured Proximal Aorta with massive hemothorax (3 liters). Outcome: Despite aortic clamping and massive transfusion, the injury was fatal.
Epidural Hematoma
Greg Pratt. A resident involved in the same crash showed a classic "lucid interval" before herniating (blown pupil). Diagnosis: Epidural Hematoma secondary to a skull fracture tearing the middle meningeal artery. Treatment: Intubation, Mannitol to reduce ICP, and surgical evacuation.
Infant Botulism
Sara. An infant presented with severe muscle weakness requiring ventilation. Diagnosis: Infant Botulism, confirmed by stool toxin assay. Cause: Ingestion of honey containing botulism spores. Treatment: Supportive care (ventilation, tube feeding) pending muscle recovery.
Other Medical Diagnoses and Conditions Discussed
Terminal Hemorrhage: In a patient with oral malignancy (tonsil cancer).
Epstein-Barr Virus: Chronic fatigue source.
Antler Trauma: Penetrating injury.
Ocular Chemical Exposure: Super Glue in the eye.
Vaginal Foreign Body: Illicit substance retrieval.
Dislocated Hip: Requiring reduction.
Sternal Fracture: Blunt chest trauma.
Episode 2
Intracranial Sinus Infection
Kyle Skinner. A veteran with skin grafts presented with altered mental status and fever. Diagnosis: Head CT confirmed a Sinus Infection with Intracranial Spread. Treatment: Ceftriaxone and surgical drainage.
Traumatic Cardiac Tamponade
Tom. A blunt trauma victim presented with hypotension and muffled heart sounds. Diagnosis: Cardiac Tamponade secondary to pericardial effusion. Treatment: Emergency pericardiocentesis (250cc drained) followed by exploratory laparotomy.
Other Medical Diagnoses and Conditions Discussed
Meningitis: Differential diagnosis.
Anterior Shoulder Dislocation: Reduced with traction.
Pyelonephritis: Kidney infection requiring dopamine.
Acetaminophen Toxicity: Treated with Mucomyst.
Nurse Shark Bite: Marine trauma.
Flail Chest: Blunt force trauma complication.
Episode 3
Salicylate Toxicity (Aspirin Overdose)
Mr. Tunny. A cyclist presented altered after a crash. Diagnosis: Salicylate Toxicity from chronic aspirin overuse for knee pain. Treatment: Urinary alkalinization with bicarbonate.
Delayed Laryngeal Edema
Jane Doe. An attempted strangulation victim presented with stridor. Diagnosis: Delayed Laryngeal Edema. Treatment: Emergency Rapid Sequence Intubation (RSI) when the airway closed.
HIV+ Organ Transplant
Douglas James. An HIV+ patient with end-stage liver failure. Treatment: A controversial HIV-to-HIV Liver Transplant using an organ from a brain-dead HIV+ donor.
Other Medical Diagnoses and Conditions Discussed
Penetrating Abdominal Trauma: Stabbing victim requiring laparoscopy.
Arterial Embolus: Vascular emergency.
Acute Coronary Syndrome: Managed with MONA protocol.
Pyloric Stenosis: Infant feeding difficulty.
Colles' Fracture: "Dinner fork" wrist deformity.
Episode 4
Benzodiazepine Withdrawal Psychosis
Nichelle Richardson. A mother forced her children out a window due to delusions. Diagnosis: Benzodiazepine Withdrawal Psychosis after stopping Valium cold turkey. Treatment: Oral Valium stabilization.
Stage IV Lung Cancer (Cutaneous Metastases)
Mr. Hayslip. A smoker presented with "skin rash." Diagnosis: Stage IV Lung Cancer with cutaneous metastases (firm nodules). Treatment: Oncology referral for chemotherapy.
Other Medical Diagnoses and Conditions Discussed
OCD: Compulsive checking behavior in staff.
Pneumonia: Pathway compliance discussion.
Angulated Tibia Fracture: Severe lower leg break.
Meckel's Diverticulum: Source of GI bleed.
Tension Pneumothorax: Trauma complication.
Episode 5
Lymphoblastic Leukemia
Juan Enriquez. A patient with syncope and extensive bruising. Diagnosis: Lymphoblastic Leukemia, confirmed by blasts on blood smear and thrombocytopenia. Prognosis: Good remission rate with chemotherapy.
Other Medical Diagnoses and Conditions Discussed
Septic Arthritis: Intra-articular infection.
Chronic Lead Exposure: Chelation therapy required.
Coronary Aneurysms: Kawasaki's disease complication.
Spinal Shock: Loss of sympathetic tone.
Intussusception: Pediatric bowel obstruction.
Evans Syndrome: Autoimmune cytopenia with varicella.
Episode 6
End-Stage Liver Failure (Variceal Bleed)
Charlie Metcalf. An alcoholic patient presented with hematemesis. Diagnosis: Hemorrhagic Esophageal Varices and Hepatorenal Syndrome. Treatment: Octreotide, Linton tube placement, and ethanol drip for withdrawal. Outcome: DNR signed; patient died.
Other Medical Diagnoses and Conditions Discussed
Wheezing: Airway obstruction sign.
Myocardial Infarction: Heart attack.
Gastric Ulcer: Source of GI bleed.
Smoke Inhalation: Toxic gas exposure.
Intestinal Prolapse: Complication of abdominal GSW.
Episode 7
Pulmonary Contusions and Aspiration
Louise Garvin. A sexual assault victim with LeFort II fractures. Diagnosis: Pulmonary Contusions. Complication: Fatal Aspiration Pneumonia after vomiting during a procedure to allow speech.
Precipitous Labor (Dissociative Denial)
Mi-Cha Pak. A patient with "abdominal pain" denied pregnancy. Diagnosis: Active labor. Outcome: Precipitous Delivery in the elevator lobby; psychological denial eventually broke.
Other Medical Diagnoses and Conditions Discussed
LeFort II Fracture: Midface instability.
Renal Colic: Kidney stone pain.
Aortic Dissection: Critical vascular tear.
Intussusception: Pediatric emergency.
Episode 8
Septic Appendicitis
Carolyn Trager. A child with fever and RLQ pain. Diagnosis: Acute Appendicitis progressing to Septic Shock. Treatment: Emergency laparoscopic appendectomy.
Carotid Artery Laceration
Eddie Escobar. A gunshot victim with a severed carotid. Treatment: Balloon occlusion. Surgery to reconnect was cancelled due to high mortality risk vs. conservative management.
Occult Splenic Laceration (Kehr's Sign)
Mr. Sakabu. A wrestling injury patient returned hypotensive. Diagnosis: Splenic Laceration identified by Kehr's sign (referred shoulder pain). Treatment: Emergency surgery.
Other Medical Diagnoses and Conditions Discussed
Traumatic Arm Entrapment: Industrial accident.
Subcutaneous Emphysema: Air in tissues.
Status Epilepticus: Pediatric seizure emergency.
Episode 9
SLE with Pulmonary Edema
Robert Sanders. A lupus patient with renal failure presented in respiratory distress. Diagnosis: Acute Pulmonary Edema from fluid overload. Treatment: Emergent dialysis initiated by ER staff when specialists delayed.
Traumatic Cardiac Tamponade
Harry. A pediatric hit-and-run victim. Diagnosis: Cardiac Tamponade. Treatment: Failed pericardiocentesis followed by an echo-guided Pericardial Window.
Other Medical Diagnoses and Conditions Discussed
Lupus Cerebritis: Brain inflammation.
Thyromegaly: Goiter.
Narcotic Withdrawal: Symptom cluster.
Episode 10
Testicular Cancer (Beta HCG)
Ms. Mitchell. A pre-op transsexual patient presented with dyspnea. Diagnosis: A positive Beta HCG test confirmed Testicular Cancer (choriocarcinoma).
Traumatic Brain Herniation
Gang Kid. A GSW patient initially stable (GCS 15) deteriorated. Diagnosis: Intracranial Hemorrhage with herniation. Treatment: Emergency Burr Hole/Ventriculostomy performed by a resident in the ER.
Other Medical Diagnoses and Conditions Discussed
Slipped Capital Femoral Epiphysis (SCFE): Adolescent hip disorder.
Bladder Trauma: Hematuria source.
Metastatic Melanoma: Advanced skin cancer.
Episode 11
Non-Accidental Trauma (Child Abuse)
Amy Packer. A foster child with a laceration. Diagnosis: Non-Accidental Trauma suspected due to a pattern of injuries (burns, bites, fractures). Outcome: Removal from the home.
Penetrating Abdominal Trauma
Michael Barnes. A GSW victim with hypotension. Diagnosis: Liver Laceration and internal hemorrhage. Treatment: Emergency exploratory laparotomy.
Other Medical Diagnoses and Conditions Discussed
Brachial Artery Laceration: Vascular emergency.
Gastritis: NSAID-induced.
Dystonic Reaction: Reaction to phenothiazines.
Episode 12
Drug-Induced Renal Failure (Zarictal)
Katie Milner. A kidney transplant recipient presented with Hyperkalemia (K+ 7.2) and cardiac arrest. Diagnosis: Drug-Induced Renal Toxicity from a new anti-seizure medication (Zarictal), confirmed by biopsy. Treatment: Emergent dialysis and re-transplant.
Other Medical Diagnoses and Conditions Discussed
Pubic Ramus Fracture: Pelvic injury.
Traumatic Brain Death: Self-inflicted GSW.
Ulnar Styloid Fracture: Wrist injury.
Episode 13
Diaphragmatic Laceration
Lysander Martin. A chest GSW patient with uncertain trajectory. Diagnosis: Diaphragmatic Laceration, confirmed by methylene blue dye appearing in the chest tube from a DPL.
Fatal Child Abuse
Thomas. A child presented in cardiac arrest after a school assault. Diagnosis: Disseminated Intravascular Coagulation (DIC) and severe physical assault. Outcome: Fatal.
Other Medical Diagnoses and Conditions Discussed
Myocardial Ischemia: Managed with cath lab intervention.
Vertigo: Cerebellar mass differential.
Torticollis: Muscle spasm treated with Benadryl.
Episode 14
Pick's Disease (Frontotemporal Dementia)
Mrs. Devon. A 60-year-old with rapid behavioral changes and self-injury. Diagnosis: Pick's Disease (Frontotemporal Dementia), distinguished by early onset and frontal lobe damage.
Other Medical Diagnoses and Conditions Discussed
Multiple Stab Wounds: "Swiss cheese" back injury without organ damage.
Diabetic Ketoacidosis (DKA): Insulin drip management.
Retinoschisis: Splitting of the retina.
Episode 15
Embolic Stroke (MERCI Retrieval)
Ellie Shore. A 35-year-old with sudden aphasia. Diagnosis: Embolic Stroke (MCA Occlusion) secondary to Atrial Flutter. Treatment: Mechanical thrombectomy using the MERCI Retrieval System.
Other Medical Diagnoses and Conditions Discussed
Hypercoagulable State: Stroke risk factor.
Intestinal Foreign Body: Body packer syndrome.
Supraventricular Tachycardia (SVT): Rapid rhythm.
Episode 16
Sepsis (Pyelonephritis)
Gopher. A pediatric patient in septic shock. Diagnosis: Pyelonephritis and Hydronephrosis. Treatment: High-frequency oscillator ventilation and triple antibiotics.
Traumatic Amputation and Replantation
Doris. A patient with bilateral arm amputations. Treatment: Bilateral Replantation surgery.
Other Medical Diagnoses and Conditions Discussed
Pulmonary Hemorrhage: Fatal combat injury.
Inhalation Burns: Airway swelling requiring intubation.
Occult Pneumothorax: Hidden chest injury.
Episode 17
Ruptured AAA
Mr. Kirkendall. A patient with back pain misdiagnosed as muscle spasm. Diagnosis: Ruptured Abdominal Aortic Aneurysm. Treatment: Emergency thoracotomy and aortic cross-clamping.
Popliteal Artery Embolism
Victor Hopkins. A pediatric GSW patient with a pulse deficit. Diagnosis: Bullet fragment embolized to the Popliteal Artery. Treatment: Surgical removal and repair.
Other Medical Diagnoses and Conditions Discussed
Biliary Colic: Gallstone pain.
Dysfunctional Uterine Bleeding: Gynecological emergency.
Tuberculosis: Public health management.
Episode 18
Metastatic Breast Cancer
Debra Graham. A trauma patient with a hip dislocation. Diagnosis: Metastatic Breast Cancer (pathologic fractures and lung mass), previously ignored due to fear.
Hyponatremia (Hunger Strike)
Elena Tabajas. A hunger striker presented with seizures. Diagnosis: Severe Hyponatremia from water intoxication. Treatment: Careful saline correction.
Subluxed Globe
Adrian. An eye exam complication where the eyeball displaced from the socket. Treatment: Emergency manual reduction using a paper clip retractor.
Other Medical Diagnoses and Conditions Discussed
Oligoanalgesia: Undertreatment of pain.
Hyperparathyroidism: Calcium imbalance.
Navicular Fracture: Thumb spica cast.
Episode 19
Critical Aortic Stenosis
Jules Rubadoux. An elderly patient with syncope. Diagnosis: Critical Aortic Stenosis (Gradient 86). Outcome: Surgery deemed too high-risk; conservative management chosen.
Other Medical Diagnoses and Conditions Discussed
Anticholinergic Toxicity: Treated with Physostigmine.
Malignant Otitis: Invasive ear infection.
Avulsed Finger: Traumatic amputation.
Episode 20
Cyanide Toxicity
Marilyn Bracken. A fire victim with hypotension and bright red retinal vessels. Diagnosis: Cyanide Toxicity from burning polyurethane. Treatment: Cyanide antidote kit (Amyl nitrate/Sodium nitrate).
Perforated Colon (Glass Shrapnel)
Megan Nesbitt. A blast victim with abdominal pain. Diagnosis: Colon Perforation from unleaded glass shrapnel (invisible on x-ray). Treatment: Surgical repair.
Other Medical Diagnoses and Conditions Discussed
Sickle Cell Crisis: Pain management.
L1 Compression Fracture: Spinal injury.
MRSA Abscess: Resistant infection.
Episode 21
Fatal Air Embolism
Shelley. A neck stab wound victim. Cause of Death: Air Embolism sucked into the jugular vein when the occlusive dressing was removed prior to intubation.
Iatrogenic Hypercapnia
Arnold Brixton. An emphysema patient on high-flow oxygen. Complication: Loss of hypoxic drive leading to Hypercapnic Respiratory Failure and arrest.
Neonatal Sepsis (Umbilical Lines)
Infant. A septic newborn requiring access. Procedure: Emergency placement of Umbilical Lines by an intern (protocol violation).
Other Medical Diagnoses and Conditions Discussed
Scalp Avulsion: Severe degloving injury.
Delirium Tremens: Alcohol withdrawal.
Hodgkin's Disease: Lymphoma.
Episode 22
Shoulder Dystocia (Symphysiotomy)
Molly. A pregnant trauma victim in labor. Complication: Shoulder Dystocia ("Turtle Sign"). Treatment: Emergency Symphysiotomy (cutting the pubic cartilage) to deliver the baby after other maneuvers failed.
Colles' Fracture
Janell. A pediatric wrist fracture. Treatment: Hematoma block and manual reduction.
Other Medical Diagnoses and Conditions Discussed
Air Embolus: Vascular obstruction.
Meningismus: Mimicking meningitis.
Paronychia: Nail infection.
🔖 Key Takeaways
🗝️ High-Stakes Procedures: The season featured rare and dramatic interventions, including a field symphysiotomy for shoulder dystocia, an HIV-positive liver transplant, and the use of the MERCI clot retrieval system for stroke.
🗝️ Iatrogenic Complications: Fatal errors were highlighted, such as the air embolism from improper neck wound management and the loss of hypoxic drive in a COPD patient given high-flow oxygen.
🗝️ Diagnostic Challenges: Cases like the "unleaded glass" colon perforation and the salicylate toxicity masquerading as concussion emphasized the need for deep diagnostic digging.
🗝️ Social Medicine: The show tackled complex social issues, including the medical consequences of hunger strikes, child abuse disguised as accidents, and the healthcare disparities in treating HIV/AIDS.
🗝️ Trauma Innovation: From emergency burr holes by residents to the management of "sucking chest wounds" and aortic dissections, the trauma bay remained a center of aggressive, cutting-edge care.
Keywords: Medical Diagnoses ER Season 11
Medical Diagnoses ER Season 11
