Medical Diagnoses in ER: A Comprehensive Review of Medical Conditions in Season 10
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Season 10 of ER marks a transition, moving away from the large-scale bioterrorism arcs of the previous season to refocus on intimate, complex medical mysteries and the grinding reality of trauma care. The season explores the intersection of social issues and medicine, featuring cases of international humanitarian crises, domestic abuse disguised as accidental trauma, and the devastating impact of poverty on pediatric health. From the rare diagnosis of Autoimmune Hemolytic Anemia in a trauma victim to the tragic loss of a newborn due to Necrotizing Enterocolitis, the medicine remains as compelling and heartbreaking as ever.
Below is a comprehensive, episode-by-episode review of the medical cases, diagnoses, and treatments presented in Season 10.
Content ⁉️
Episode 1
Autoimmune Hemolytic Anemia (AHA) and Trauma
Denise Johnson. A driver in a rollover MVA presented with profound anemia (HemoCue 8.1) and hypotension (60/40) disproportionate to her injuries. Diagnosis: Laboratory analysis revealed microspherocytes and a high reticulocyte count, confirming Autoimmune Hemolytic Anemia. The anemia likely caused her to syncopize while driving. Treatment: Stabilized with O-negative blood transfusions, avoiding type-specific blood to prevent renal failure.
Other Medical Diagnoses and Conditions Discussed
Femur Fractures: Requiring traction.
Flail Chest: Rib fractures with paradoxical movement.
Hyperkalemia: Potassium 8.3 treated with insulin/glucose.
Candidal Esophagitis: AIDS-defining illness.
Infected AV Graft: Dialysis complication requiring I&D.
Colon Cancer: Differential diagnosis for constipation in the elderly.
Episode 2
Malaria (Congo)
Dr. Luka Kovac. Presumed dead in the Congo, Dr. Kovac was found alive but critically ill. Diagnosis: Malaria, characterized by high fevers despite prophylactic Fansidar. Treatment: IV Quinine was indicated but initially refused by the patient to save supplies for a child. He was eventually evacuated via medical transport.
Other Medical Diagnoses and Conditions Discussed
Gross Hematuria: Sign of renal or bladder trauma.
Pertussis: Whooping cough outbreak in the clinic.
Abdominal GSW: Penetrating trauma requiring surgery.
Episode 3
Primary Pulmonary Hypertension
Elle Ryser. A young patient presented with shortness of breath and heart failure. Diagnosis: Primary Pulmonary Hypertension (PPH). Prognosis: Fatal without transplant; unlikely to survive to adulthood. Treatment: Nitric oxide and Isoproterenol drip.
Ruptured Abdominal Aortic Aneurysm
Forest Herman. A patient waiting for back pain medication arrested. Diagnosis: Ruptured AAA. Treatment: Emergency thoracotomy and aortic cross-clamping in the ER.
Other Medical Diagnoses and Conditions Discussed
Premature Labor: Rupture of membranes at 36 weeks.
Spider Bite: Suspected Black Widow envenomation.
Unstable Mandible Fracture: Trauma requiring plastic surgery.
Fecal Impaction: Requiring manual disimpaction.
Episode 4
Carotid Dissection (Stroke)
Ed Gamble. A 28-year-old male presented with expressive aphasia, initially dismissed as psychosomatic. Diagnosis: A syncopal episode led to the discovery of a Carotid Artery Dissection via ultrasound. Treatment: Anticoagulation to allow the tear to heal; TPA considered.
Other Medical Diagnoses and Conditions Discussed
Gram-Negative Osteomyelitis: Complication of open fracture.
Ureteral Colic: Kidney stones.
Scombroid Poisoning: Histamine toxicity from spoiled fish.
Thrombosed Hemorrhoid: Painful rectal mass.
Cerebrospinal Fluid Leak: Indicating skull base fracture.
Episode 5
Digoxin Toxicity
Ben Hollander. An elderly patient with macular degeneration presented with vomiting and arrhythmias (scooped ST segments). Diagnosis: Digoxin Toxicity secondary to an intentional overdose (suicide attempt) due to depression over failing vision. Treatment: Digoxin-specific antibody fragments (Digibind) and psychiatric intervention.
Other Medical Diagnoses and Conditions Discussed
Anserine Bursitis: Mimicking knee trauma.
Ileus: Non-mechanical bowel obstruction.
Smoke Inhalation: Airway injury from fire.
Bullous Myringitis: Ear infection caused by Mycoplasma.
Rhabdomyolysis: Complication of crush injury.
Episode 6
Preterm Labor and Uterine Atony
Denny. A 27-year-old presented at 24 weeks gestation. Outcome: Delivered a 506g micro-preemie in a taxi. Complication: Severe Postpartum Hemorrhage due to Uterine Atony, exacerbated by prior tocolytics. Treatment: Massage, Pitocin, Methergine, and massive transfusion.
Other Medical Diagnoses and Conditions Discussed
Diffuse Axonal Injury: Fatal brain injury from MVA.
Diabetic Ketoacidosis (DKA): Hyperglycemia and ketosis in a child.
Digoxin Overdose: Suspected in a blind patient.
Scaphoid Fracture: Wrist injury requiring snuffbox check.
Episode 7
Perforated Appendix
Mr. Persky. A patient with abdominal pain was discharged but returned febrile. Diagnosis: Perforated Appendix (rupture masked pain initially). Treatment: Emergent open laparotomy and washout.
SVT (Methamphetamine)
Franny Meyers. A mother presented with palpitations. Diagnosis: Supraventricular Tachycardia (SVT) caused by crystal meth use. Treatment: Adenosine.
Other Medical Diagnoses and Conditions Discussed
Subdural Hematoma: Non-accidental trauma in an infant.
Acute Myeloid Leukemia (AML): Septic neutropenia in a child.
Rectal Fissure: Trauma from sexual assault.
Croup: Pediatric respiratory infection.
Episode 8
Uterine Fibroids and Hysterectomy
Loren. An HIV-positive pregnant patient presented with massive hemorrhage. Diagnosis: Uterine Fibroids involving the uterine artery, causing uncontrollable bleeding. Treatment: Emergency hysterectomy after myomectomy failed.
Other Medical Diagnoses and Conditions Discussed
Delusional Parasitosis: Belief of bugs under skin (Scabies).
Rhabdomyolysis: Muscle breakdown from trauma.
Occult Splenic Injury: Slow bleed requiring surgery.
Ruptured Globe: Severe eye trauma.
Episode 9
Fatal Anaphylaxis (Contrast Dye)
Hank Benitez. A patient with suspected PE underwent a pulmonary angiogram. Complication: Severe Anaphylactic Reaction to the contrast dye. Outcome: Cardiac arrest (PEA) and death, sparking debate over the necessity of the test versus empiric heparin.
Other Medical Diagnoses and Conditions Discussed
17a-Hydroxylase Deficiency: Rare congenital adrenal hyperplasia.
Hypothermia: Pediatric core temp 86.7°F.
Aortic Dissection: Hypotension and back pain.
Multiple Sclerosis: Neurological history.
Episode 10
Pneumocystis Pneumonia (AIDS)
Lamia. A 5-year-old child of an HIV-positive mother presented with hypoxia. Diagnosis: Pneumocystis Pneumonia (PCP). Outcome: Death due to lack of pediatric ARVs and oxygen in a resource-poor setting (Congo).
Other Medical Diagnoses and Conditions Discussed
Cholera/Dysentery: Risks of contaminated water for formula.
Toxoplasmosis: CNS infection causing weakness.
Foreign Body: Ingested Christmas ornament.
Episode 11
Iatrogenic Cervical Cord Injury
Martin Brodie. A driver with Ankylosing Spondylitis ("bamboo spine") required intubation. Complication: The procedure caused a fracture of the fused spine, resulting in Quadriplegia (C-5 cord contusion).
Abdominal Aortic Aneurysm
Larry Brodie. The passenger in the same crash. Diagnosis: 8cm AAA found on trauma scan. Treatment: Surgical repair.
Other Medical Diagnoses and Conditions Discussed
Cardiomyopathy: Requiring Swan-Ganz monitoring.
AIDS-Related Lymphoma: Mass in a young female.
Valvular Heart Disease: Mitral regurgitation.
Malnutrition: Starvation signs in a family.
Episode 12
Critical Coarctation of the Aorta and NEC
Jacob Kolber. A newborn presented with shock and acidosis. Diagnosis: Critical Coarctation of the Aorta. Treatment: Prostaglandin E1 to maintain ductal patency. Complication: Developed Necrotizing Enterocolitis (NEC) with total bowel infarction. Outcome: Fatal.
Other Medical Diagnoses and Conditions Discussed
Neonatal Abstinence Syndrome: Withdrawal from meth/heroin.
Intracranial Hemorrhage: ECMO complication.
Meconium Aspiration: Respiratory distress.
Congenital Cystic Adenomatoid Malformation (CCAM): Lung lesion.
Episode 13
Bullet Embolism to the Heart
Male Patient. A patient with a leg GSW had no exit wound. Diagnosis: The bullet embolized through the venous system to the Right Ventricle. Treatment: Endovascular retrieval using a snare, avoiding open-heart surgery.
Other Medical Diagnoses and Conditions Discussed
Wegener's Granulomatosis: Vasculitis causing lung issues.
Pertussis: Community outbreak.
Bilateral Calcaneal Fractures: Fall from height.
Frostbite: Toe injury.
Episode 14
Multi-Drug Resistant Tuberculosis (MDR-TB)
Miguel Rivas. A patient with a swollen knee. Diagnosis: MDR-TB (skeletal and pulmonary relapse). Public Health: Mandatory isolation and Directly Observed Therapy (DOT).
Ventricular Tachycardia (MVA Cause)
Gus Loomer. A driver in a mass casualty event. Diagnosis: Cardiac monitor interrogation revealed Ventricular Tachycardia caused syncope leading to the crash.
Other Medical Diagnoses and Conditions Discussed
Gonococcal Arthritis: Monoarticular joint pain.
Scalping Injury: Severe head trauma.
Pregnancy: Incidental finding in trauma.
Episode 15
Carbon Monoxide Poisoning (Fetal Protection)
Bennett Family. A family found unconscious. Diagnosis: Carbon Monoxide Poisoning. Pathophysiology: The pregnant mother was conscious because the fetus (with higher hemoglobin affinity) absorbed the CO, protecting her but critically poisoning the baby. Treatment: Hyperbaric oxygen for the newborn.
Other Medical Diagnoses and Conditions Discussed
Methamphetamine Psychosis: Agitation and delusions.
Subcutaneous Emphysema: Hyperbaric complication.
Prostate Cancer: Back pain and weakness.
Episode 16
Myocardial Infarction and Tamponade
Frank Martin. An ER clerk collapsed. Diagnosis: Anterior MI. Complication: Coronary artery rupture during angioplasty caused Cardiac Tamponade. Treatment: Emergency pericardiocentesis and CABG.
Other Medical Diagnoses and Conditions Discussed
Testicular Torsion: Surgical emergency.
Epididymitis: Differential for testicular pain.
Bleeding Esophageal Varices: Liver disease complication.
Episode 17
Serotonin Syndrome
Luis Sanchez. A trauma patient on MAOIs (Phenelzine) was given Demerol. Diagnosis: Serotonin Syndrome (Hyperthermia, rigidity, instability). Outcome: Fatal cardiac arrest due to drug interaction.
Other Medical Diagnoses and Conditions Discussed
Sickle Cell Splenic Sequestration: Pediatric shock.
New-Onset Diabetes: Polydipsia and hyperglycemia.
Laryngeal Cancer: History in a trauma patient.
Episode 18
Fatal Trauma and DIC
Sandy Lopez. A firefighter with crush injuries. Diagnosis: Liver laceration and pelvic fractures leading to Disseminated Intravascular Coagulation (DIC). Outcome: Died from uncontrollable hemorrhage intra-operatively.
Other Medical Diagnoses and Conditions Discussed
Shingles: Herpes Zoster rash.
Diabetic Foot Ulcer: Peripheral neuropathy complication.
Retrohepatic Caval Injury: Suspected source of bleeding.
Episode 19
Splenic Injury
Rena Carlson. MVA victim with hypotension. Diagnosis: Splenic Laceration. Treatment: Emergency Splenectomy.
Other Medical Diagnoses and Conditions Discussed
Elbow Dislocation: Reduced with sedation.
Pseudo-Seizure: Conversion disorder.
Anosmia: Loss of smell from trauma.
Episode 20
Conversion Disorder (Psychogenic Seizures)
Jordan Dunn. A pregnant patient presented with seizures. Diagnosis: Psychogenic Non-Epileptic Seizures (PNES) confirmed by negative EEG. Treatment: Sodium Amytal interview revealed repressed trauma regarding a prior SIDS death.
Other Medical Diagnoses and Conditions Discussed
Wolff-Parkinson-White Syndrome: Complicating SVT.
White Coat Hypertension: Anxiety-induced BP spike.
Thermal Burns: Hand injury.
Episode 21
Hypertensive Heart Failure
Elgin. A teen with untreated hypertension presented in distress. Diagnosis: Congestive Heart Failure secondary to Left Ventricular Hypertrophy (LVH). Treatment: Diuretics and nitrates.
Other Medical Diagnoses and Conditions Discussed
True Knot: Umbilical cord accident causing stillbirth.
Mesenteric Occlusion: Ischemic bowel.
Dementia: Behavioral disturbance in elderly.
Episode 22
Catastrophic Trauma (Bronchial Tear)
Michael. A 7-year-old MVA victim with persistent air leak. Diagnosis: Transected Left Mainstem Bronchus. Treatment: Surgical repair.
Other Medical Diagnoses and Conditions Discussed
Bilateral Amputation: Outcome for the mother with crush injuries.
Opiate Overdose: Driver treated with Narcan.
End-Stage Colon Cancer: Metastatic disease.
🔖 Key Takeaways
🗝️ Iatrogenic Tragedies: The season highlights fatal errors, such as the serotonin syndrome death from a drug interaction and the quadriplegia caused by intubating a patient with ankylosing spondylitis.
🗝️ Global Medicine: The disparity in care is starkly portrayed through Dr. Kovac's malaria and the death of a child from opportunistic AIDS infections in the Congo due to lack of basic supplies.
🗝️ Pediatric Critical Care: High-stakes pediatric cases were prominent, including the fatal NEC in a newborn, congenital heart defects, and non-accidental trauma investigations.
🗝️ Chronic Disease Management: The consequences of non-compliance were evident in cases of hypertensive heart failure in a teen and diabetic complications like DKA and hyperosmolar coma.
🗝️ Diagnostic Zebras: Rare conditions like Autoimmune Hemolytic Anemia and Wilson's Disease (diagnosed via Kayser-Fleischer rings) showcased the importance of broad differential diagnoses.
Keywords: Medical Diagnoses ER Season 10
Medical Diagnoses ER Season 10
