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In Memoriam
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August 2018 Critical Care Case of the Month

Emma Simpson, MD

Banner University Medical Center Phoenix

Phoenix, AZ USA


Critical Care Case of the Month CME Information

Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours 

Lead Author(s): Emma Simpson, MD.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives: As a result of completing this activity, participants will be better able to:

  1. Interpret and identify clinical practices supported by the highest quality available evidence.
  2. Establish the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Translate the most current clinical information into the delivery of high quality care for patients.
  4. Integrate new treatment options for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine

Current Approval Period: January 1, 2017-December 31, 2018

Financial Support Received: None


History of Present Illness

A 19-year-old gravida 1, para 0 woman in her early second trimester presented to the Emergency Department with intractable vomiting, green sputum icteric sclerae, chest pain, palpitations and weakness for one week prior to presentation. She was visiting the US from an island in Micronesia. The patient has been experiencing feelings of general malaise since the beginning of her pregnancy: she experienced severe nausea and vomiting throughout her first trimester, and a 4.5 kg weight loss in the 2 months prior to presentation.


Before becoming pregnant, the patient was active and healthy. She does not smoke and her family history is unremarkable.

Physical Examination

Physical exam showed a thin, small young woman. Her physical examination showed a tachycardia of 114 and icteric sclera but was otherwise unremarkable.

Which of the following should be done? (Click on the correct answer to proceed to the second of six pages)

  1. Admit to the hospital with measurement of electrolytes, transaminases and bilirubin
  2. Discharge to home with a prescription for pyridoxine/doxylamine
  3. Ultrasound
  4. 1 and 3
  5. All of the above

Cite as: Simpson E. August 2018 critical care case of the month. Southwest J Pulm Crit Care. 2018;17(2):53-8. doi: PDF 

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