Best case ever.

Best case ever.

Yes, this is EMK's Best Case Ever mini podcast series encyclopedia of emergency medicine,

Dr. Walter Himmel, welcome Walter back to EM cases.

Thanks, Anton. That's highly overstated.

And you've said an expectation I will never be able to meet.

Oh, come on.

But have I got a case for you?

All right. You've done a couple of best case ever's.

This one is going to be... The very best case ever. The best of the best cases ever. Absolutely. All right. Let her rip. Let's hear it, Walter. So about a year and a half ago, I saw a fellow in the Yellow Zone. The Yellow Zone is an area where we have patients who are mildly ill and they're fully the inventory. I was a third doctor

to see him in about 36 hours.

So he presented a day and a half earlier with epigastric

pain and slight nausea. He was given panthe-lock and devised to come back for an ultrasound.

He returned 12 hours later from ultrasound and it was absolutely normal. The diagnosis was

either dyspepsia or fluic illness, and he was advised to continue with his

PPI medication, which he did.

So 12 hours later, he still fills unwell, and he was complaining of nausea, increasing

epigastric pain, poor appetite, and curiously enough, he felt short of breath.

Those were the chief complaints.

I went and had a peek at him, and here was his past healthy.

He had diabetes for three years and hypertension for about five years.

He was on the thigh side, an ACE inhibitor, and of course metformin, a new drug called

...