Also known as: Ruptured aneurysm
Gary Walters presents with headache and dizziness after a fall down stairs. Despite a negative CT scan, Neela insists on a lumbar puncture which reveals blood in the CSF. An MRA identifies a 10mm aneurysm at the vertebrobasilar junction that ruptures during interventional coiling, requiring emergency neurosurgical clipping.
Also known as: Collapsed lung
Gary develops a pneumothorax from rib fractures sustained in his fall, requiring chest tube placement.
Also known as: A-fib
Gary has known atrial fibrillation for which he takes calcium blockers and Coumadin, though he is non-compliant with medications due to alcohol use. The anticoagulation complicates his management when spinal hemorrhage is suspected.
Also known as: AIP
A woman who crashed her motorcycle presents with rigid abdomen, psychotic delusions about the end of the world, seizures, and hyperpigmentation. Initially thought to need emergency surgery, Neela recognizes the constellation of symptoms as acute porphyria (a disorder of heme synthesis) using a Woods Lamp to confirm hyperpigmentation, avoiding unnecessary surgery in what becomes her case #2500.
Also known as: Alcoholism
Gary's chronic alcoholism is portrayed as self-destructive behavior tied to unresolved guilt over his son's death 10 years prior. His drinking leads to medication non-compliance and the fall that brings him to the ER.
Also known as: Grieving
Gary carries profound guilt and unresolved grief over his son Tim's drowning death 10 years ago, manifesting as self-destructive behavior and what his family describes as a 'death wish.' The anniversary of the death triggers his presentation to the ER.