Medical Diagnoses in ER: A Comprehensive Review of Medical Conditions in Season 2
- Dec 5
- 9 min read
Season 2 of ER delved deeper into the personal and professional lives of the County General staff while continuing to deliver high-stakes medical drama. This season is notable for its exploration of medical ethics, the consequences of physician burnout, and the introduction of new surgical techniques. From the heroic "clamp-and-run" aortic repair to the heartbreaking loss of a mother due to missed preeclampsia, the medical narratives were both triumphant and tragic.
Below is a comprehensive, episode-by-episode review of the medical cases, diagnoses, and treatments presented in Season 2.
Content ⁉️
Episode 1
Gunshot Wound to the Abdomen in Pregnancy
"Valenzala". A full-term pregnant woman presented with a GSW to the abdomen. She was hypotensive with a dropping fetal heart rate. Diagnosis: The bullet was lodged in the uterus, causing fetal distress. Treatment: An emergency "crash" C-section was performed. The baby was delivered safely, and the bullet was removed from the placenta. The mother survived through-and-through thigh wounds and was treated with antibiotics.
Hypothermia and Ventricular Fibrillation
Davey. A drowning victim arrived with a core temperature of 82°F and no spontaneous respirations. Treatment: Aggressive rewarming and resuscitation. As he warmed, he went into Ventricular Fibrillation, requiring multiple shocks (200, 300, 360 joules) before a heartbeat was restored.
Other Medical Diagnoses and Conditions Discussed
Airway Obstruction: Treated with a cricothyroidotomy in an intoxicated patient.
Bipolar Disorder: Complicated by cellulitis in a non-compliant patient.
Episode 2
Traumatic Cardiac Arrest
Carlos "Payaso" Rodriguez. A 14-year-old with multiple GSWs arrived in full cardiac arrest. Despite massive fluid resuscitation, high-dose epinephrine, and open chest massage for a hemothorax, he died after 45 minutes of downtime.
Strangulated Hernia
Mr. Rawlings. A patient presented with acute groin pain and a nonreducible mass after sneezing. Diagnosis: Strangulated Hernia, a surgical emergency where blood supply to the intestine is cut off. He was rushed to the OR.
Pericardial Tamponade
Daniel. A football player hit in the chest developed hypotension and muffled heart sounds. Diagnosis: Pericardial Tamponade from blunt trauma. Treatment: Dr. Ross performed an emergency subxiphoid pericardiocentesis to drain the blood and stabilize the patient.
Other Medical Diagnoses and Conditions Discussed
Thoracic Outlet Syndrome: Compression of nerves/vessels in the neck/shoulder.
Pelvic Inflammatory Disease (PID): A leading cause of pelvic pain.
Episode 3
Fatal Cirrhosis and TIPS Procedure
Ed. A chronic alcoholic presented with shortness of breath. Dr. Carter accidentally punctured his liver during a thoracentesis. Diagnosis: End-stage Cirrhosis with Portal Hypertension. Treatment: An emergency TIPS procedure (shunt) was attempted to control bleeding varices, but the patient died of heart failure on the table.
Pediatric Dilantin Overdose
Chia-Chia Loew. A child with AIDS presented with shallow breathing. Diagnosis: Acute Dilantin Overdose due to a prescription error (receiving both Dilantin and Phenytoin, which are the same drug). Treatment: Intubation, gastric lavage, and charcoal.
Other Medical Diagnoses and Conditions Discussed
Subarachnoid Hemorrhage: Fatal outcome for a patient with malignant hypertension.
Labyrinthitis: Causing vertigo.
Episode 4
Cyanide Poisoning
Recycling Worker. A trauma patient from an industrial accident presented with acidosis and "bright red" retinal veins despite normal blood oxygen. Diagnosis: Cyanide Poisoning from illegal stripping of x-ray films. Treatment: Sodium nitrite and thiosulfate (Cyanide Kit) reversed the toxicity.
GI Cocktail Toxicity
Tom Perry. A patient drank a massive dose of a "GI Cocktail" (Lidocaine/Donnatal) left at his bedside, leading to respiratory arrest. Treatment: Immediate gastric lavage.
Finger Dislocation
Dr. Peter Benton. Dr. Benton slammed his finger in a car door, suffering a dislocation of the interphalangeal joint. It was reduced under local anesthesia (lidocaine without epinephrine).
Other Medical Diagnoses and Conditions Discussed
Diverticulitis: Awaiting admission.
Hemothorax: Complication of chest trauma.
Episode 5
Cryptococcal Meningitis in AIDS
Chia-Chia Loew. The child from Ep 3 returned with fever and altered mental status. A lumbar puncture confirmed Cryptococcal Meningitis. Outcome: Dr. Ross proposed intrathecal Amphotericin B, but Dr. Greene advised against the painful procedure given the child's terminal AIDS prognosis. The mother chose to take him home to die comfortably.
Other Medical Diagnoses and Conditions Discussed
Malignant Melanoma: Diagnosed from a mole during a finger laceration repair.
Hypovolemic Shock: In a traumatic amputation victim.
Episode 6
Type III Aortic Dissection ("Clamp and Run")
Harmon Lake. A patient presented with chest pain. Arteriogram confirmed a Type III Aortic Dissection. Treatment: Dr. Vucelich performed a "clamp and run" surgery—a rapid repair technique to minimize spinal cord ischemia. Lazerol (a steroid) was used to protect neural tissue.
Other Medical Conditions Discussed
Comminuted Femur Fracture: Severe orthopedic injury.
Croup: Treated with racemic epinephrine.
Episode 7
Severe Accidental Hypothermia
Ben Larkin. A boy trapped in a culvert was submerged in cold water. Dr. Ross performed a field tracheostomy with a pen. Diagnosis: Severe hypothermia (82°F) leading to V-fib. Treatment: Aggressive core rewarming (heated IVs, lavage) revived him.
Tension Pneumothorax and Fatal Hemorrhage
Molly Phillips. A hit-and-run victim had a tension pneumothorax treated with needle decompression. However, she later crashed due to a hidden mesenteric rupture (internal bleeding) and died despite an emergency thoracotomy.
Other Medical Conditions Discussed
Paraesophageal Hernia: Suspected cause of coffee-ground emesis.
Colles Fracture: Wrist fracture.
Episode 8
Acetaminophen Toxicity
Julia. A suicide attempt with Tylenol. Diagnosis: Acetaminophen level of 480, indicating severe liver toxicity. Treatment: Gastric lavage, charcoal, and Mucomyst (N-acetylcysteine). She was also found to be pregnant from an incestuous relationship.
Antiphospholipid Antibody Syndrome
Mrs. Briggs. A patient with lupus presented with chest pain. Dr. Carter's exhaustive testing revealed Antiphospholipid Antibody Syndrome, a clotting disorder requiring heparin.
Bell's Palsy vs. Ramsay Hunt
Wilbur. A patient with facial droop was diagnosed with Bell's Palsy. Dr. Carter did a home visit to rule out Ramsay Hunt Syndrome (herpes zoster oticus), which would present with ear vesicles.
Other Medical Conditions Discussed
Aplastic Anemia: Diagnosed in a nanny with fatigue.
Episode 9
Lidocaine Toxicity
Reba Siburry. A patient seized after receiving sutures at another facility. Diagnosis: Lidocaine Toxicity from excessive anesthetic injection. Treatment: Phenobarbital was used instead of Dilantin to manage the seizures.
Sudden Infant Death Syndrome (SIDS)
A 2-month-old infant arrived in asystole after being put to bed healthy. Despite aggressive resuscitation, the child died, diagnosed as SIDS.
Other Medical Conditions Discussed
Carotid Artery Stenosis: Surgical study topic.
Subungual Hematoma: Blood under the nail requiring drainage.
Episode 10
Acute Aortic Dissection
Mrs. Rubadoux. An elderly woman presented with "ripping" back pain and hypertension (220/140). Diagnosis: Acute Aortic Dissection. Treatment: Dr. Benton and Carter performed an emergency clamp-and-run repair, breaking the hospital speed record and saving her life.
Other Medical Conditions Discussed
Traumatic Aortic Severance: Fatal injury in a gunshot victim.
Tooth Reimplantation: Performed on a trauma victim.
Episode 11
Post-Op Complications (Aortic Dissection)
Mrs. Rubadoux. Following her surgery, Mrs. Rubadoux developed heart failure, renal insufficiency, and paraplegia. She required Dobutamine support, illustrating the severe toll of the "successful" surgery.
Cervical Cancer (Stage 1B)
Loretta Sweet. A mother presenting for a minor issue mentioned spotting. A biopsy confirmed Stage 1B Cervical Cancer. She left before receiving the diagnosis, prompting a search to find her.
Other Medical Conditions Discussed
Kwashiorkor/Marasmus: Severe malnutrition found in neglected children.
Impetigo/Ringworm: Infectious skin conditions in the same group.
Episode 12
Post-Op Ischemic Myelopathy
Mrs. Rubadoux. (Continuation) Mrs. Rubadoux returned unresponsive. She was diagnosed with Ischemic Myelopathy (spinal cord stroke) and terminal decline. Dr. Carter had to inform her husband she would never leave the hospital.
Other Medical Conditions Discussed
Traumatic Aortic Dissection: Mentioned in a trauma case.
Acute Respiratory Distress: Leading to pulmonary edema.
Episode 13
Idiopathic Dysrhythmia
Alan Wimbur. A healthy 32-year-old runner seized and went into lethal arrhythmias (V-tach, Torsades). Despite exhaustive resuscitation, he died. Diagnosis: Autopsy showed a structurally normal heart, leading to a diagnosis of Idiopathic Dysrhythmia (Sudden Cardiac Death of unknown cause).
Other Medical Conditions Discussed
Malignant Hyperthermia: Anesthetic reaction mentioned.
Pericardial Effusion: Treated with pericardiocentesis.
Episode 14
Lead Poisoning
T-Ball. A "frequent flyer" with abdominal pain was dismissed until labs showed microcytic anemia with basophilic stippling. Diagnosis: Lead Poisoning (level 80) from inhaling dust in an old building.
HIV Diagnosis
Angel. A patient presented with a cough and revealed she had AIDS. She likely had Pneumocystis Pneumonia (PCP). The episode dealt with the ethics of disclosing her status to her partner.
Other Medical Conditions Discussed
Wernicke's Encephalopathy: Risk in a hypoglycemic alcoholic given glucose without thiamine.
Episode 15
Pseudocyesis (False Pregnancy)
Ms. Clarke. A woman presented in "labor" claiming alien impregnation. She had a distended abdomen but a negative pregnancy test and ultrasound. Diagnosis: Pseudocyesis, a psychological condition where physical symptoms of pregnancy manifest without a fetus.
Other Medical Conditions Discussed
Placental Abruption: Diagnosed in a pregnant trauma patient.
Meconium Aspiration: Sign of fetal distress.
Episode 16
Thermal Burns and Carbon Monoxide Poisoning
Raul Melendez. A paramedic suffered 90% third-degree burns and severe CO poisoning (40%) in a fire. Complications: Circumferential chest burns required escharotomy to allow breathing. He developed rhabdomyolysis and renal failure. Outcome: He refused intubation and died from his injuries.
Other Medical Conditions Discussed
Bleeding Esophageal Varices: An alcoholic patient required a Sengstaken-Blakemore tube.
Episode 17
Osteosarcoma (Missed Diagnosis)
Brett Bowman. An 8-year-old presented with leg pain. X-rays revealed Osteosarcoma. Issue: A review of x-rays from 4 months prior showed the tumor was visible but missed by Dr. Ross.
Acute Myelogenous Leukemia (AML)
Mr. Ledbetter. A patient with fatigue and wheezing was found to have pancytopenia and blasts on his smear, confirming AML.
Other Medical Conditions Discussed
Traumatic Aortic Rupture: Widened mediastinum on x-ray.
Episode 18
Ethylene Glycol Poisoning
Omar Gandera. A teen with altered mental status and a metabolic acidosis (anion gap) was negative for ethanol. Diagnosis: Ethylene Glycol (Antifreeze) Poisoning. Treatment: With no medical ethanol available, Dr. Greene administered bourbon orally as an antidote to block the toxic metabolites.
Antabuse Reaction
Louis Etheridge. A patient mimicking a heart attack was actually suffering an Antabuse Reaction. His wife had been secretly dosing his coffee to stop his drinking.
Cardiac Tamponade (Foley Catheter Repair)
Trauma Victim. A car accident victim developed tamponade from a cardiac laceration. Treatment: Dr. Greene performed an ER thoracotomy and used a Foley catheter to plug the hole in the heart temporarily.
Other Medical Conditions Discussed
Transient Ischemic Attack (TIA): Warning signs of stroke.
Episode 19
Ruptured Appendicitis vs. Montezuma's Revenge
Mrs. Mendoza. A patient with GI symptoms after travel was discharged with "Montezuma's Revenge." She returned septic from a ruptured appendix.
Acute MI (Missed Presentation)
Mrs. Garvey. A difficult patient with chest pain had a normal temp but abnormal EKG/enzymes, confirming an Acute MI.
Toothpick Ingestion
Mr. Kennerly. A patient with "appendicitis" symptoms was taken to the OR. The appendix was normal, but a toothpick was found perforating the ileum.
Other Medical Conditions Discussed
Pulmonary Edema: Identified by Kerley B lines.
Episode 20
Incarcerated Hernia
Becky. A child from a house explosion had respiratory arrest. A bulge in the groin was identified as an Incarcerated Hernia, requiring emergency surgery.
Conn's Syndrome in Pregnancy
Joanne Bairos. A pregnant patient with severe hypertension and a history of fetal loss was found to have an adrenal mass. Diagnosis: Conn's Syndrome (Primary Aldosteronism). Surgical removal of the adrenal gland was curative.
Kawasaki's Disease
Pediatric Patient. A boy with prolonged fever (7 days), rash, and chapped lips was diagnosed with Kawasaki's Disease. Treatment: High-dose aspirin to prevent coronary aneurysms.
Digoxin Overdose
Mr. Dellanova. An illiterate patient overdosed on Digoxin because he couldn't read the label instructions.
Other Medical Conditions Discussed
Radiation Cystitis: Complication of cancer treatment.
Episode 21
Shaken Baby Syndrome
Grace Ramsey. A 6-month-old presented with seizures and apnea. CT showed a subdural hematoma and retinal hemorrhages, confirming Shaken Baby Syndrome.
Ascending Cholangitis (Biliary Atresia)
TC. A child with a history of a Kasai procedure for Biliary Atresia developed Ascending Cholangitis and liver failure, requiring urgent transplant listing.
AIDS Diagnosis
Al Boulet. Jeanie Boulet's husband presented with weight loss and fevers. He was diagnosed with Pneumocystis Pneumonia (PCP) and HIV/AIDS, implicating Jeanie's potential exposure.
Other Medical Conditions Discussed
Bipolar Disorder: Referred to psychiatry.
Episode 22
Hypoplastic Left Heart Syndrome (HLHS)
Joseph Morgan Randall. A 2-day-old infant presented in shock. Diagnosis was Hypoplastic Left Heart Syndrome. Treatment: Prostaglandin (Prostin) infusion to keep the ductus arteriosus open.
End-Stage Liver Failure
Talia Lucas. A patient with ascending cholangitis deteriorated to Status 1 liver failure, awaiting a transplant.
Other Medical Conditions Discussed
Intussusception/Pyloric Stenosis: Discussed as risks of early newborn discharge.
🔖 Key Takeaways
🗝️ Surgical Heroics: The season popularized the "clamp and run" technique for aortic dissection and showcased extreme measures like the Foley catheter cardiac repair and bourbon for antifreeze poisoning.
🗝️ Diagnostic Vigilance: Multiple storylines (toothpick ingestion, lead poisoning, Kawasaki's) emphasized that common symptoms often hide rare, life-threatening conditions.
🗝️ The AIDS Epidemic: The storyline involving Al and Jeanie Boulet brought the reality of HIV/AIDS into the main cast, reflecting the peak of the epidemic in the mid-90s.
🗝️ Social Medicine: Cases like the illiterate patient overdosing and the uninsured man leaving with lung cancer highlighted the social determinants of health.
🗝️ Pediatric Trauma: From shaken baby syndrome to toxic ingestions, the season heavily featured the specific vulnerabilities and diagnostic challenges of pediatric emergency medicine.
Keywords: Medical Diagnoses ER Season 2
Medical Diagnoses ER Season 2
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