Medical Diagnoses in ER: A Comprehensive Review of Medical Conditions in Season 6
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Season 6 of ER marked a definitive shift in tone, transitioning into a grittier, more chaotic era for County General. The departure of key original cast members and the introduction of a new, often reckless class of residents pushed the medical stakes to new heights. This season is defined by its harrowing trauma arcs—ranging from the brutal stabbing of two staff members to a mass casualty school shooting—and the silent, devastating progression of illness within the staff itself. The medicine presented balanced the frantic energy of "crash" C-sections with the quiet tragedy of neurodegenerative decline and genetic mysteries.
Below is a comprehensive, episode-by-episode review of the medical cases, diagnoses, and treatments presented in Season 6.
Content ⁉️
Episode 1
Traumatic Cardiac Arrest (Perimortem C-Section)
Unnamed Pregnant Patient. A victim of a mass casualty truck crash presented with deep chest lacerations, hypotension, and decreased breath sounds. Diagnosis: The trauma team identified diffuse bilateral pulmonary contusions and a cardiac contusion, noting severe bruising to the heart and lungs. Treatment: The patient rapidly deteriorated into traumatic full arrest (asystole). In an aggressive attempt to support the failing heart, the team utilized a bypass machine in the trauma room and performed a thoracotomy. When the mother could not be saved, a Perimortem Cesarean Section was performed, successfully delivering a live baby girl.
Other Medical Diagnoses and Conditions Discussed
Shoulder Dislocation: Assessed in a survivor of the initial accident.
Rollerblade Injury: Pain management required morphine and Versed.
Migraine: Severe headache unresponsive to rectal suppositories, treated with Imitrex.
Ruptured Aorta: Resulted in rapid exsanguination and death.
End-Stage AIDS: Complicated by fulminant Pneumocystis pneumonia.
Pediatric Pneumonia: Diagnosed in a dehydrated infant, prompting HIV testing.
Anaphylactic Shock: Severe reaction requiring respiratory monitoring.
Episode 2
End-Stage Metastatic Melanoma
Amy Stehly. A 20-year-old female presented with altered mental status and respiratory distress. Diagnosis: Stage IV Melanoma metastasized to the liver, lungs, and brain, with loculated fluid around the lungs. Treatment: Dr. Greene performed a thoracentesis to drain fluid for symptom relief. Despite a signed DNR, the patient verbally revoked it during a panic attack. She was intubated but entered ventricular fibrillation and was pronounced dead after aggressive resuscitation.
Infiltrating Ductal Carcinoma
Elaine Nichols. Dr. Carter investigated the radiology files of an acquaintance initially seen for minor trauma. Diagnosis: Unexpected findings revealed Infiltrating Ductal Cell Carcinoma (breast cancer). Treatment: A mastectomy was recommended.
Other Medical Diagnoses and Conditions Discussed
Grand Mal Seizure: Post-ictal state treated with Ativan.
COPD: Oxygen intake carefully titrated to avoid suppressing respiration.
Pediatric HIV: Confirmed in an infant recovering from pneumonia.
Abdominal Ascites: Peritoneal fluid analysis performed in an elderly patient.
Episode 3
Ectopic Pregnancy
Cristal Powell. A 12-year-old presented with pain initially attributed to a sickle cell crisis. Diagnosis: A positive Beta HCG test and ultrasound revealed a mass in the fallopian tube, confirming an Ectopic Pregnancy. Treatment: Immediate surgery was required to prevent rupture.
Traumatic Aortic Rupture
David Bradley. A 9-year-old MVA victim presented with tachycardia and loss of pulse on the left side. Diagnosis: A traumatic rupture at the junction of the subclavian and aortic arch. Treatment: An emergency thoracotomy was performed in the ER to clamp the aorta and evacuate the hematoma.
Subclavian Artery Hemorrhage
Unnamed Male. A 17-year-old presented with gunshot wounds and severe hypotension. Treatment: Dr. Greene utilized a Foley catheter inserted directly into the wound, inflating the balloon to tamponade the subclavian artery from the inside—an "old army trick."
Other Medical Diagnoses and Conditions Discussed
Physical Abuse: Diagnosed via skeletal survey showing healed rib fractures.
Ulnar Artery Laceration: Controlled with a tourniquet.
Minor Head Trauma: Intracranial hemorrhage ruled out via Radovici's sign.
Otitis: Pediatric ear infection treated with antibiotics.
Episode 4
Acute Iron Poisoning
Robin Bourke. A 4-year-old initially discharged with gastroenteritis returned in full cardiac arrest. Diagnosis: Dr. Finch realized the child had ingested iron-containing vitamins, leading to Acute Iron Poisoning. Outcome: Despite high-dose epinephrine, the patient died. The failure to include toxicity in the initial differential resulted in a missed opportunity for intervention.
Other Medical Diagnoses and Conditions Discussed
Acute Appendicitis: A "hot appy" requiring surgical consult.
Splenic Flexure Syndrome: Gas pain requiring movement for relief.
Cellulitis: Treated with Oxacillin.
Attempted Suicide: Hanging victim requiring fiberoptic intubation.
Bat Bite: Required rabies vaccination series.
Episode 5
Traumatic Liver Laceration (Cystic Fibrosis)
Benjamin Hearn. A 16-year-old with Cystic Fibrosis presented with abdominal guarding after an MVA. Diagnosis: Ultrasound revealed a Liver Laceration. Treatment: Immediate surgery was required. Blood cross-matching incidentally revealed the father was not the biological parent.
Chemical Pneumonitis
Victor Sutherland. A teacher involved in a school explosion presented with respiratory distress. Diagnosis: Chemical Pneumonitis and pulmonary edema caused by chlorine gas inhalation. Treatment: Immediate intubation and chest decompression.
Other Medical Diagnoses and Conditions Discussed
Laryngeal Trauma: Airway obstruction requiring bagging following an assault.
Toxic Ingestion: Paint ingestion complicated by cocaine toxicity.
Open Colles' Fracture: Wrist fracture assessed for angulation.
False Labor: Braxton Hicks contractions.
Episode 6
Early-Onset Alzheimer’s Disease
Dr. Gabriel Lawrence. The staff physician exhibited subtle cognitive decline, including confusion with patients and forgetting orders. Diagnosis: A PET scan showing bilateral hypoperfusion to the parietal areas confirmed Early-Onset Alzheimer’s Disease. Outcome: Aricept proved ineffective, and Dr. Lawrence was forced to retire.
Pediatric Type II Diabetes
Eddie. A 12-year-old presented with abdominal pain and a blood sugar of 278. Diagnosis: Type II Diabetes linked to lifestyle factors. Treatment: Glucose control and diet changes were recommended, though the mother resisted the diagnosis for insurance reasons.
Other Medical Diagnoses and Conditions Discussed
Stab Wound (Left Ventricle): Required immediate thoracotomy.
Congestive Heart Failure: Complicated by ventricular tachycardia.
Hip Fracture: Surgical emergency following a mass casualty event.
Episode 7
Strychnine Poisoning
Unnamed Male. A diabetic patient presented with refractory seizures and severe acidemia (pH 6.95). Diagnosis: Dr. Lawrence identified Strychnine Poisoning based on the specific combination of hyperexcitation and acidemia. Treatment: Pavulon was administered to paralyze muscles and stop the seizures.
Other Medical Diagnoses and Conditions Discussed
Liver Laceration: Repaired using an argon beam coagulator.
Carotid Artery Transection: Treated with a vascular shunt and fluid infusion.
Visual Agnosia: Inability to recognize objects indicating neurological degeneration.
Carbon Monoxide Poisoning: Suspected in a group presenting with headaches.
Episode 8
Jamaican Vomiting Sickness
Shelly Robinson. An 18-year-old presented with altered mental status and hypoglycemia (glucose 42) after returning from Florida. Diagnosis: Jamaican Vomiting Sickness, caused by ingesting unripe Akee fruit. Treatment: Fluids, Compazine, and glucose infusion.
Prolapsed Umbilical Cord and Postpartum Hemorrhage
Nurse Carol Hathaway. Presented in labor with twins. After the vaginal delivery of Twin A, the cord prolapsed for Twin B. Treatment: An emergency crash C-section was performed. Following delivery, the patient suffered uterine atony and massive hemorrhage. The O’Leary Stitch (hypogastric artery ligation) was utilized to control bleeding and save the uterus.
Other Medical Diagnoses and Conditions Discussed
Chronic Renal Failure: Managing fluid overload without dialysis.
Pericardial Effusion: Fluid accumulation around the heart.
Ventricular Fibrillation: Caused by hyperkalemia.
Episode 9
Dilated Cardiomyopathy (LVAD Implantation)
Valerie Page. A 24-year-old with a history of cardiomyopathy presented in critical decline with an ejection fraction of 10%. Treatment: Due to the high risk of imminent death, a Left Ventricular Assist Device (LVAD) was surgically implanted as a bridge to transplant.
Acute Arterial Occlusion
Dean Rollins. A prisoner presented with a dusky right leg and no pulses. Diagnosis: Acute Arterial Occlusion caused by a clot. Treatment: Surgical thrombectomy was performed to prevent gangrene and amputation.
Other Medical Diagnoses and Conditions Discussed
Abdominal Aortic Aneurysm: Pulsatile mass requiring repair.
Ischemic Bowel: Progression from severe gastroenteritis.
Talus Dislocation: Orthopedic injury requiring reduction.
Episode 10
Recurrent Lymphoma
Jason Bender. An 11-year-old presented with shortness of breath initially thought to be pneumonia. Diagnosis: Imaging revealed a mediastinal mass surrounding the heart, confirming a recurrence of Lymphoma. Prognosis: The condition was deemed inoperable.
Gonococcal Arthritis
Mr. Sumpter. A patient with worsening knee pain underwent joint aspiration. Diagnosis: Although initially suspected to be staph, the Gram stain confirmed Gonococcal Arthritis, a systemic complication of Gonorrhea.
Other Medical Diagnoses and Conditions Discussed
Lindane Toxicity: Neurological side effects following lice treatment.
Body Dysmorphic Disorder: Proposed for a patient with intense pruritus.
Scaphoid Fracture: Wrist injury immobilized for safety.
Episode 11
Stroke Post-Transplant
Valerie Page. While recovering from heart transplant surgery, the patient developed a fever suggesting LVAD infection. Complication: Post-surgery, she suffered a Cerebrovascular Accident (Stroke) due to a clot. Outcome: The patient entered a permanent vegetative state, initiating a "domino heart" procedure discussion.
Other Medical Diagnoses and Conditions Discussed
Axillary Artery Laceration: Resulting in hypovolemic shock.
Theophylline Overdose: Asthma medication toxicity causing seizures.
Aplastic Anemia: Traced to illegal injections at a back-room clinic.
Flail Chest: Trauma presenting with Pulseless Electrical Activity (PEA).
Episode 12
Aorto-enteric Fistula
Jeremy Barnes. A patient with a history of AAA repair presented with flu-like symptoms but rapidly decompensated with hematemesis. Diagnosis: Aorto-enteric Fistula, where the aortic graft eroded into the bowel. Treatment: Emergency laparotomy in the ER to clamp the aorta, followed by surgical repair.
Infectious Endocarditis
Marty. A young patient injecting illegal growth hormone presented with a fever and heart murmur. Diagnosis: Infectious Endocarditis caused by dirty needles. Treatment: IV antibiotics and cardiac echo.
Caregiver-Induced Illness (Munchausen by Proxy)
Conner Brant. A child with Duchenne's muscular dystrophy presented with chronic vomiting. Diagnosis: A "sting operation" revealed the mother was poisoning the child’s G-tube with stomach acid, confirming Induced Illness by Caregiver.
Other Medical Diagnoses and Conditions Discussed
PCP Intoxication: Drug-induced psychosis leading to open fractures.
Frostbite: Requiring rapid rewarming.
Episode 13
Superior Vena Cava Syndrome
Dr. George Hudson. A physician with a history of oat cell carcinoma presented with headache and flushing. Diagnosis: A mediastinal mass causing Superior Vena Cava Syndrome (SVCS). Treatment: The patient developed elevated intracranial pressure requiring intubation and emergent radiation therapy.
Other Medical Diagnoses and Conditions Discussed
Insulinoma: Pancreatic tumor causing hypoglycemia.
Tension Pneumothorax: Required bilateral chest tubes.
Urosepsis: Suspected in an elderly patient.
Episode 14
Penetrating Trauma and Pulmonary Embolism
Dr. Lucy Knight. A staff member suffered a violent knife attack by a schizophrenic patient. Injuries: Multiple stab wounds leading to tracheal laceration and damage to the proximal aorta and liver. Treatment: Emergency thoracotomy, aortic repair, and splenectomy. Complication: She developed a massive Pulmonary Embolism post-op. Despite heparin and attempts to remove the clot, she succumbed to the injuries.
Other Medical Diagnoses and Conditions Discussed
Schizophrenia: The assailant's underlying condition (first psychotic break).
Spinal Cord Injury: Missed injury in a stab victim.
Cardiac Tamponade: Potential cause of hypotension in trauma.
Hypothermia: Observed in the assailant after running naked outdoors.
Episode 15
Bleeding Diverticulum
Ron Perth. A patient post-hemorrhoid banding presented with rectal bleeding. Diagnosis: A nuclear medicine scan ordered on "nursing instinct" located a Bleeding Diverticulum. Treatment: Emergency laparotomy.
Traumatic Liver Injury
Laura. A 10-year-old MVA victim developed a tension pneumothorax. Complication: Needle decompression injured an artery. Diagnosis: Further assessment revealed a blown liver capsule. Treatment: Right-sided thoracotomy and atrial-caval shunt.
Other Medical Diagnoses and Conditions Discussed
Cervical Dysplasia: Abnormal cells indicative of HPV/cancer in a teen.
Poly-drug Overdose: Treated with Flumazenil and charcoal.
Herniated Disc: Confirmed by MRI.
Episode 16
Diphenhydramine Overdose
Adam Pulido. A patient presented with seizures and a wide QRS complex after ingesting Benadryl. Treatment: Charcoal Hemoperfusion was successfully used to clear the toxin and narrow the QRS complex.
Fatal Amphetamine Toxicity
Estrella. A six-month-old infant died after presenting with seizures and V-tach. Diagnosis: Toxicology revealed Amphetamine Toxicity, transmitted via breast milk from the mother's drug use.
Other Medical Diagnoses and Conditions Discussed
Addison's Disease: Syncope caused by adrenal insufficiency.
Incarcerated Hernia: Requiring surgical reduction.
Gila Monster Envenomation: Caused severe hypotension.
Episode 17
Huntington's Disease
Mr. Waters. A patient presented with erratic behavior and chorea (uncontrolled movements). Diagnosis: Huntington's Disease, a progressive, incurable genetic neurological disorder.
Hyperosmolar Coma
Eddie Bernero. A 12-year-old diabetic arrived severely dehydrated with a blood glucose of 980. Diagnosis: Hyperosmolar Coma resulting from uncontrolled Type II diabetes. Treatment: Aggressive fluid resuscitation and insulin drip.
Other Medical Diagnoses and Conditions Discussed
Sanfilippo Syndrome: Rare genetic disorder causing severe retardation.
Rhabdomyolysis: Muscle breakdown leading to renal failure.
Bisoprolol Overdose: Medication error causing MI.
Episode 18
Acute Myelogenous Leukemia (AML)
Fazio/Simpson Case. A patient falling from a ladder was diagnosed with Acute Myelogenous Leukemia (AML) based on a white count of 150,000. Correction: A lab mix-up revealed the leukemia actually belonged to another patient, Mr. Simpson, who was being evaluated for chest pain. Prognosis: The true patient faced a grim survival rate requiring a bone marrow transplant.
Other Medical Diagnoses and Conditions Discussed
Peanut Allergy Anaphylaxis: Unresponsive to albuterol.
Ketonuria: Malnutrition in pregnancy.
Alcohol Withdrawal: Requiring sedation.
Episode 19
AML Relapse
Delia Chadsey. A pediatric patient in remission presented after a car accident. Diagnosis: Labs confirmed a relapse of Acute Myeloid Leukemia. Treatment: Reinduction chemotherapy and search for a bone marrow donor, complicated by family refusal to consent to testing.
Post-Obstruction Pneumonia
David Greene. Dr. Greene's father presented with cough and fever. Diagnosis: Post-Obstruction Pneumonia secondary to lung cancer. Treatment: IV Cefotaxime and oxygen.
Other Medical Diagnoses and Conditions Discussed
Meningitis: Ruled out in a child with headache and vomiting.
Hypokalemia: Electrolyte imbalance causing kidney strain.
Episode 20
M-CAD Deficiency
Kenny. A child presented with seizures and profound hypoglycemia (glucose <40). Diagnosis: A Medline search identified Medium-chain Acyl-CoA Dehydrogenase Deficiency (M-CAD), a metabolic disorder preventing fat breakdown. Outcome: The delay in diagnosis likely resulted in permanent brain damage.
Other Medical Diagnoses and Conditions Discussed
Gangrene: Resulting from vascular insufficiency.
Insulinoma: Considered in differential for hypoglycemia.
Cardiac Tamponade: Effusion causing shock.
Episode 21
Ruptured Tubo-Ovarian Abscess (TOA)
Unnamed Female. A patient initially discharged with PID collapsed in the bay. Diagnosis: Ultrasound revealed a Ruptured Tubo-Ovarian Abscess leading to septic shock. Treatment: Emergency surgery and dopamine pressors.
Other Medical Diagnoses and Conditions Discussed
Hepatic Encephalopathy: In a terminal cancer patient.
Pyelonephritis: Serious kidney infection with fever.
Sulfa Allergy: Hives and respiratory distress from medication error.
Episode 22
Intracardiac Bullet Embolization
Nicholas. A victim of a school shooting presented with a gunshot wound to the groin. Diagnosis: The bullet migrated through the venous system and lodged in the heart (Intracardiac Embolization). Treatment: Open cardiac surgery with bypass to extract the bullet while simultaneously revascularizing the leg.
Other Medical Diagnoses and Conditions Discussed
Thyroid Storm: Hyperthyroid crisis causing agitation and hypertension.
Placental Abruption: Complication of abdominal stab wound in pregnancy.
Intussusception: Pediatric bowel telescoping requiring surgery.
Tension Pneumothorax: Secondary to clavicle fracture.
🔖 Key Takeaways
🗝️ High-Acuity Trauma: Season 6 emphasized catastrophic trauma management, including perimortem C-sections, open cardiac massages in the ER, and the management of mass casualty incidents.
🗝️ Toxicological Emergencies: Several episodes highlighted the importance of accurate history-taking in toxicology, with cases involving iron poisoning, strychnine, amphetamine toxicity via breast milk, and Jamaican Vomiting Sickness.
🗝️ Diagnostic Diligence: The season underscored the consequences of missed diagnoses, such as the initial failure to identify M-CAD deficiency or iron poisoning, contrasting with successful "instinct" diagnoses like the bleeding diverticulum.
🗝️ Chronic and Genetic Conditions: Beyond trauma, the ER managed complex chronic progressions including Huntington's Disease, Cystic Fibrosis complications, and early-onset Alzheimer's in medical staff.
🗝️ Surgical Innovation: High-risk procedures were prominent, including the implantation of LVADs as bridges to transplant and complex vascular repairs for bullet embolizations.
Keywords: Medical Diagnoses ER Season 6
Medical Diagnoses ER Season 6
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