Yes, and welcome back to another episode of Best Case Ever mini podcast series as part of EM cases.

I'm your host, Dr. Rajiv Thavenathan. I am joined by a very special guest today, a staff physician here at the Ottawa Hospital and assistant professor with the University of Ottawa, someone I've looked up to since medical school, Dr. Hans Rosenberg. Hey, Rejeev, thank you so much for the intro and having me here today. This is actually pretty exciting. Yeah, it's a pleasure. It's like this is actually the first episode where I've recorded someone in my home in the same room as opposed to recording someone over the internet.

And it's a beautiful home. I can't believe that the salaries that they pay you guys nowadays,

this is ridiculous. This is the R4 resident stipend is paying for the portable cabin style

dishwasher. It is beautiful. The way it slides towards us periodically and you have to push it back is fantastic. It's also worth noting that Hans is also one of the hosts of MRAP, the Canadian Edition, with Sarah Adelman, so he's no stranger to the podcasting world. That's right. That's right. Thank you. So today you're here to tell us about your best case ever. Hopefully it's something kind of interesting. What do you got first? So started off with a 59-year-old male farmer who has been found by his daughter and to be confused. And Tickipnik is one of these things that was noted in the morning of the presentation. So she brought him to the local emergency department. While he was there, they did some basic blood work, a chest x-ray,

thought he had pneumonia, stated his vitals were all normal, and they said his GCS was 15 on their

note, but probably wasn't given the confusion. However, there was some concern that he may have

an intracranial injury or perhaps even a bleed, given the sort of level of confusion for what

looked like a relatively

okay patient at that time. So he was going to be transferred to our tertiary care center for a cat scan

of his head. Then something changed along the way, though. By the time the paramedics transferred

him in, they called them in as a patch. So for us, that means that, you know, usually the patient,

there's something about the patient that they're worried about.

And they reported that his GCS was seven, and they were coming in in about five minutes.

So upon arrival, we see a patient who has a heart rate of 130 beats per minute, rest rates about 15 to 20 is recorded, and, you know, stable blood pressure.

However, his temperature was 39 degrees, and he was

diaphrodite and modeled to his chest. That GCS that was reported seven was, in fact, seven.

Exam-wise, nothing terribly remarkable. There wasn't any localizing features. His pupils were

equal and reactive. Really, the exam was pretty unremarkable other than I just remember this

poor, sick-looking sweaty guy. You know, it was so bad that the ECG leads wouldn't even stick on

him. So at this point, we sort of reached a, I guess, a decision point, and part of our differential

diagnosis at this point was considering what could make a patient confused and have a fever.

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