TvDx
ER

ERNBC

Season 4, Episode 4

17 medical diagnoses portrayed

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Cholecystitissupporting

Also known as: Gallbladder inflammation

A 41-year-old female patient presents with right upper-quadrant pain, low-grade fever, and gas. Carter's medical student works through the diagnostic process including ultrasound to confirm gallbladder wall thickening.

Also known as: Psychosis

A 19-year-old man who believes he's an angel walks into traffic, sustaining a leg fracture. Psych consult is requested. Later revealed he went off his medication when he went to college.

ER — S04E04Patient: Jeremy Willis
Tibial fracturesupporting

Also known as: Broken leg

The psychotic patient who walked into traffic sustains an isolated right leg injury requiring x-rays and morphine for pain management.

ER — S04E04Patient: Jeremy Willis
Asthmasupporting

A pediatric patient initially diagnosed with acute asthma exacerbation (peak flow 90) and abdominal tenderness. His grandmother insists on seeing Dr. Ross, creating tension with Dr. Del Amico.

ER — S04E04Patient: Jamie Landeta

Also known as: Threadworm infection

Bronchial irritation

The parasitic infection causing Jamie's respiratory symptoms that were masking as asthma. Del Amico discovers this diagnosis through stool sample, preventing dangerous treatment with prednisone which would have worsened the condition.

ER — S04E04Patient: Jamie Landeta

Also known as: Major injuries from car accident

Ruptured spleenHead traumaFracturesNear amputation

Mass casualty event involving a school bus full of junior high students hit by a police car during a high-speed chase. Multiple children with varying degrees of trauma fill the ER, creating the episode's central crisis.

Also known as: Leg amputation

Hemorrhagic shock

A patient from the bus accident with near-complete amputation of the left arm above the elbow, hanging by a 2cm skin bridge. BP drops to 70/30 with significant blood loss requiring emergency re-implantation surgery.

Also known as: Head laceration

A 14-year-old boy from the bus accident with head trauma, GCS 12, asking repetitive questions. Requires intubation before CT scan due to declining neurological status.

ER — S04E04Patient: Brian

Also known as: Heart stopped

A boy from the bus accident arrives in asystole after being ejected from the exit door. Despite thoracotomy, internal cardiac massage, and maximal resuscitation efforts, he dies. Mark Greene delivers the devastating news to his mother.

ER — S04E04Patient: Matthew Blevins

Also known as: Collapsed lung

A man who fell off a roof while installing a satellite dish develops a tension pneumothorax requiring emergency chest tube placement by Kerry Weaver and Carter after retrograde intubation.

Also known as: Stillbirth

A crack-addicted woman presents with abdominal pain, not knowing she's pregnant. She delivers a baby boy who doesn't breathe and has no pulse. Autopsy reveals the baby died in utero two days prior. Creates ethical tension about missed pregnancy tests.

ER — S04E04Patient: Doris

Also known as: Heroin addiction

Unrecognized pregnancyFetal death

Patient is high on crack when she presents, unaware of her pregnancy. Her substance abuse is central to the ethical dilemma about missed diagnoses and preventable tragedy.

ER — S04E04Patient: Doris

Also known as: Internal bleeding

Hemorrhagic shock

The motorcycle rider fleeing police crashes and initially appears stable but later crashes with BP 50 palp. Diagnostic peritoneal lavage is positive, requiring emergency splenectomy. Carter's failure to get surgical consult earlier creates conflict with Benton.

Also known as: Neck injury

The police officer involved in the bus crash is evaluated for cervical spine injury, which is found to be normal, though he requires wrist surgery.

ER — S04E04Patient: Officer Mulvihill
Wrist fracturesupporting

Also known as: Broken wrist

The police officer from the bus crash requires pins in his wrist and is more concerned about the children's welfare than his own injury.

ER — S04E04Patient: Officer Mulvihill
Hand lacerationsupporting

Also known as: Cut hand

A patient with a pencil impaled through the hand requires x-ray, antibiotics, and tetanus before removal. The patient jokes about suing.

HIV/AIDSsupporting

Also known as: AIDS

Employment discrimination

Al returns to have stitches removed and reveals he lost his construction job due to AIDS discrimination. Creates ongoing subplot about HIV stigma. Jeanie later violates protocol by placing her hands in a chest cavity to save a patient.

ER — S04E04Patient: Al
Recurring storyline