Round 18 (Fatigue)


Case Introduction

You are working a shift at EM Clerkshift General when a 20yo female accompanied by her mother checks into the ER with chief complaint of fatigue.

Initial Vitals

  • Temp 101.2F
  • HR 122
  • RR 22
  • BP 110/90
  • O2 98%

Critical Actions

  • Obtain travel history in patient presenting with fever of unknown source
  • Perform sepsis workup and treatment in patient with at least 2 SIRS criteria
  • Order thick/thin peripheral blood smear
  • Consult ID
  • Admit patient

Final Diagnosis


Tips and Tricks

  • Always obtain detailed history in patient presenting with fever without obvious source (travel history for infectious agents, IV Drug history for endocarditis, etc)
  • Utilize to determine which infections are endemic to each country that your patient traveled in

Further Reading

Malaria (EMDocs)


  1. Jotham Gikuhi

    So far zack’s best ABEM case ever , Loved it . You rock ! MD Estephan you totally nailed it.

    • Mike Estephan

      Thanks for the kind words 🙂

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