THE PITT // CASEBOOK

Accurately Charting Cases from The Pitt

A peer-reviewed medical casebook documenting every emergency department patient from The Pitt. Each case is charted by a real physician with clinical timelines, differential diagnoses, and high-yield medical pearls.

Episode
Specialty
Showing 33 of 33 cases
Patient arriving via ambulance with severe preeclampsia symptoms.
S02E15 Complex
30s · Female

Judith Lastrade

10/10 headache and blurred vision at 36-37 weeks gestation

Judith Lastrade is a G1P0 female at approximately 36-37 weeks gestation who presents via EMS with a 2-day history of a worsening headache, now rated 10/10, accompanied by blurred vision and significant pitting edema. She has had a 'wild pregnancy' with absolutely no prenatal care, intending to have a 'free birth' without medical intervention. Symptoms were completely refractory to pre-hospital fentanyl administration.

ObstetricsNeurology +6 more
Patient presenting with American flag pole impaled in right chest.
S02E14 Brief
34 · Male

Barrett Dunkle

Penetrating chest trauma with retained foreign body

34-year-old male presents to the ED via EMS following a bar fight over a game of pool at a sports bar. He sustained a penetrating thoracic injury when an adversary impaled him in the right chest with an American flag pole. The object remains in situ. Patient is awake, alert, and combative on arrival.

TraumaThoracic Surgery +2 more
Patient Edith Lynch experiencing right-sided chest pain.
S02E14 Moderate
46 · Female

Edith Lynch

Right-sided chest pain for an hour

46-year-old female presenting with one hour of right-sided chest pain. Medical history is significant for hyperlipidemia. She received sublingual nitroglycerin and 4mg of morphine in the pre-hospital setting with minimal relief. Initial 12-lead EKG performed by EMS was interpreted as negative for STEMI.

CardiologyResuscitation +2 more
Patient arrived via EMS after a head-on MVC into a telephone pole.
S02E14 Moderate
53 · Male

Lyman Paine

Involved in a single-vehicle head-on collision into a telephone pole.

53-year-old male presents post single motor vehicle collision. He drove head-on into a telephone pole. Airbags deployed. He was unconscious at the scene but woke up during transport. There is no scent of alcohol; EMS suspects syncope, seizure, or falling asleep at the wheel. Initially stable upon ED arrival, he shortly develops progressive bilateral upper extremity paresthesia and impending respiratory failure.

TraumaNeurosurgery +2 more
Patient presenting in acute respiratory distress, utilizing a handheld nebulizer mouthpiece while demonstrating visible accessory muscle use and wheezing.
S02E13 Complex
16 · Male

Grady Barnhill

Severe wheezing, shortness of breath, unresponsive to home albuterol.

Patient has a lifelong history of asthma. Lost Medicaid coverage two months ago due to a missed redetermination letter, resulting in inability to afford maintenance inhalers (Symbicort, montelukast). Has only been using albuterol. Presented to the ED in severe respiratory distress after using home nebulizer every hour without relief.

PulmonologyCritical Care +2 more
Patient with visible scleral icterus and jaundiced skin.
S02E13 Moderate
48 · Female

Mrs. Davis

Nausea and yellowing of the skin (jaundice).

A 48-year-old previously healthy female presents to the ED with nausea and noticeable yellowing of her skin. The patient initially attributed the skin changes to a 100% natural sugar-beet bronzer (DHA). Triage labs revealed significantly elevated liver enzymes indicating acute hepatic inflammation. She is a strict vegan, exercises regularly, and denies all alcohol, acetaminophen, prescription medication, and illicit drug use. She denies eating raw shellfish.

ToxicologyHepatology +1 more
Patient unresponsive on backboard after 20-foot fall.
S02E13 Complex
Adulte · Male

Orlando Diaz

Unresponsive after 20-foot fall.

Orlando Diaz is a patient who was previously admitted for Diabetic Ketoacidosis (DKA). He eloped Against Medical Advice (AMA) because he could not afford to miss a paycheck at his second job. Shortly after leaving, he fell approximately 20 feet at his worksite. He was found unresponsive by coworkers after failing to answer his radio and brought back to the ED by EMS.

TraumaNeurosurgery +2 more
Ms. Stevens presenting in the ED with diffuse erythema.
S02E12 Brief
Adult · Female

Coral Stevens

Severe generalized soreness

Patient presents to the emergency department during a 4th of July heatwave suffering from a severe full-body sunburn. She feels 'stupid' for the overexposure and complains of being 'really, really sore.'

DermatologyEnvironmental +2 more
Patient restrained after ED assault
S02E12 Moderate
Adult · Male

Curtis Larson

Extreme agitation, combativeness, and subsequent head trauma (fall)

Curtis Larson, an adult male patient, was brought to the ED following reported alcohol consumption on a golf course. Upon arrival, he became profoundly combative, triggering a 'Code Hula Hoop' (hospital worker assault) after putting a nurse (Emma) in a headlock. During the scuffle, he slipped and sustained blunt head trauma resulting in a bloody nose. He was chemically restrained by another nurse (Dana) using 4mg of Midazolam (Versed) that was on hand.

ToxicologyPsychiatry +2 more
Dante arriving in the ED with a large, actively bleeding scalp laceration.
S02E12 Moderate
34 · Male

Dante Casella

Blunt trauma from a fireworks explosion in a storage unit.

Patient is a 34-year-old male who was packing class B fireworks launch tubes into a van when an explosion occurred. He was launched 10-15 feet across a garage, striking a rolled-down garage door frame. He presents with a large bleeding scalp laceration, chest pain, and tinnitus.

TraumaBlast Injury +4 more
Eddie Cohen sitting awkwardly after his wife's MVA.
S02E12 Complex
84 · Male

Eddie Cohen

Unsteady gait and cognitive/motor slowing (Noted by physician; originally presented as an uninjured driver in a low-speed MVA).

84-year-old male who presents to the ED accompanying his wife, whom he accidentally backed his car into at low speed. The patient initially denies any injuries or complaints. However, the attending physician observes an unsteady gait, slow movements, and balance issues. The patient's daughter reports a recent decline in both parents' mobility and mentions the patient has a complex medical team ('a whole team of -ologists').

GeriatricsNeurology +2 more
78-year-old female presenting with left hip pain and bruising after a low-speed motor vehicle vs. pedestrian accident.
S02E12 Complex
78 · Female

Frida Cohen

Left hip pain and bruising after a low-speed motor vehicle vs. pedestrian accident (ground-level fall).

78-year-old female presents to the ED after her husband's car backed into her at a very low speed, causing a ground-level fall. She denies head trauma, chest pain, or shortness of breath. She complains of left hip pain and has visible bruising. Past medical history is significant for hypertension, hypothyroidism, and atrial fibrillation. She is currently anticoagulated on Eliquis (apixaban).

GeriatricsTrauma +2 more
Patient arriving via private vehicle in severe respiratory distress.
S02E12 Complex
55 · Male

Oliver Haas

Severe respiratory distress and hypoxia

Oliver Haas is a patient with End-Stage Renal Disease (ESRD) on a Monday/Wednesday/Friday hemodialysis schedule. He missed his Friday session due to attending a wedding. His son attempted to take him to the local clinic on Saturday morning, but it was closed for the 4th of July holiday. With their local rural hospital (Pine Ridge) permanently closed, his 20-year-old son Mason drove him 1.5 hours to The Pitt. Patient arrived in extremis, exhibiting severe respiratory distress and altered mental status upon arrival.

NephrologyDialysis +4 more
Provider performing costovertebral angle (CVA) percussion on Mr. Green.
S02E09 Complex
Middle-aged · Male

Mr. Green

Left flank pain

Patient presents to the ED with left-sided flank pain that began at 10:00 p.m. the previous night. He has a history of kidney stones and states this episode feels exactly the same as prior occurrences. He notes his urine is 'a bit darker than normal' but denies fever or gross hematuria. He suspects he is dehydrated.

UrologyRenal Colic +7 more
Dr. Mohan sitting at the bedside of Orlando Diaz.
S02E02 Complex
Adult · Male

Orlando Diaz

Altered mental status and head trauma after a fall.

Patient was brought to the ED by a friend via private vehicle. The friend reports the patient tripped over rebar and hit his head. The patient initially refused to let the friend call 911 and was conversant, but his mental status deteriorated significantly en route to the hospital. Triage assessment noted a fruity, ketotic odor on the patient's breath.

EndocrinologyTrauma +4 more
Patient presenting with massive facial trauma and epistaxis after an e-scooter collision.
S01E02 Brief
23 · Male

Ben Kemper

Facial trauma, neck contusion, and hemoptysis following a high-mechanism e-scooter crash.

23-year-old male arrives via EMS after getting 'doored' while riding an e-scooter without a helmet. Mechanism of injury involves his neck striking the handlebar, followed by a face-plant onto the pavement. He complains of blood pooling in the back of his throat.

TraumaAirway Management +2 more
Patient arriving via EMS in restraints, visibly distressed and yelling in pain.
S01E02 Moderate
Adult · Female

Joyce St. Claire

Severe, diffuse body pain, initially flagged by EMS as 'drug-seeking behavior'.

Patient is an adult female with a known history of Sickle Cell Disease who was forcibly removed from a city bus and brought to the ED by EMS and police for 'disrupting and disturbing passengers.' Prehospital personnel labeled her as 'combative' and 'drug-seeking' because she was screaming for narcotics and possessed an empty Percocet bottle filled 5 days prior. Upon arrival, the patient was physically struggling with staff, stating her home medications were not working and that she was experiencing a severe vaso-occlusive sickle cell crisis.

HematologyPain Management +3 more
Worried Parents of the Patient
S01E02 Moderate
19 · Male

Nick Bradley

Found unresponsive in bed by parents

19-year-old college student found unresponsive in his bed by his mother. No known medical history, no daily medications, no known allergies. Found barely breathing with pinpoint pupils and a heart rate of 38. Prehospital EMS administered Narcan which improved pupillary response, but the patient failed to breathe spontaneously and required endotracheal intubation. No obvious signs of trauma, and no drugs or alcohol were reported on the scene.

ToxicologyOverdose +3 more
EMS arriving with 89-year-old patient undergoing active CPR.
S01E01 Brief
89 · Female

Unknown

Cardiac Arrest (Ventricular Fibrillation)

89-year-old female resident of a skilled nursing facility (SNF) with a past medical history of emphysema, congestive heart failure (CHF), and multiple sclerosis (MS). She was found in cardiac arrest at the facility. EMS found her in ventricular fibrillation (V-fib). Prior to ED arrival, she was unresponsive to three defibrillation shocks and two rounds of epinephrine. She was brought in as a 'full code' because the SNF staff was overwhelmed and unable to locate her advanced directive/DNR paperwork.

Cardiac ArrestResuscitation +3 more
Facial trauma presenting with avulsion of maxillary central incisor (Tooth #8).
S01E01 Brief
30s · Male

Charlie

Facial trauma and missing tooth following a bar altercation.

Patient presents to the ED following a bar fight. He sustained blunt facial trauma resulting in the complete avulsion of tooth number eight. Patient was initially evaluated, deemed stable, and prepped for discharge before the unaccounted missing tooth was noted during morning rounds.

TraumaDental +2 more
Dennis Whitaker experiencing a finger injury during a code blue.
S01E01 Brief
25 · Male

Dennis Whitaker

Acute finger pain and throbbing

Dennis Whitaker, a 4th-year medical student (MS4) on his first day in the Emergency Department, was participating in the resuscitation of an 89-year-old female patient in cardiac arrest. While assisting the team in transferring the patient from the gurney to the ED bed, he sustained a pinch or crush injury to his finger, which subsequently developed into a painful subungual hematoma.

Occupational InjuryOrthopedics +2 more
Elderly male patient presenting with confusion and fever.
S01E01 Moderate
79 · Male

Joseph Spencer

Fever and cough

79-year-old male from an assisted living facility presenting to the ED with a fever and cough. He has a history of mild Alzheimer's disease. On arrival, he is tachycardic, hypotensive, and experiencing altered mental status (asking if it is dinnertime). A POLST form from his facility indicates he is to receive IV fluids and medications, but no intubation and no chest compressions (DNI/No CPR).

Infectious DiseaseSepsis +4 more
Patient presenting with severe intoxication.
S01E01 Brief
56 · Male

Louie Cloverfield

Tolerant Severe Alcohol Intoxication

Louie Cloverfield is a known patient to the ED who presented at 11:00 PM the previous night with a potentially lethal blood alcohol content (BAC) of 0.420. Due to severe chronic alcohol tolerance, he survived the acute intoxication and is currently sobering up. He is now being evaluated for acute alcohol withdrawal.

ToxicologyAddiction Medicine +1 more
Patient with Right Lower Leg Degloving Injury
S01E01 Complex
Adult · Female

Minu Agrawal

Extremity trauma and severe pain after falling onto subway tracks.

Patient fell from a subway 'T' platform and her foot was caught between the platform and an incoming train, resulting in a severe degloving injury and open fracture dislocation of the right lower leg and ankle. The mechanism of the fall is initially unknown; bystanders report she may have fainted, tripped, or been pushed. She was rescued by a Good Samaritan who sustained a head injury in the process. Patient presents with extreme pain refractory to initial opiate administration and an inability to provide history due to a profound language barrier.

TraumaOrthopedics +2 more
Mr. Milton in the ED Exam Room
S01E01 Moderate
68 · Male

Bennet Milton

Upper abdominal pain

Patient awoke at 2:00 AM with intense upper abdominal pain that lasted approximately one hour and subsequently resolved. He reports eating a heavy, fatty meal (steak at Sullivan's) for his wife's birthday the night prior. He denies fever or vomiting. He has a history of hypertension but forgot to take his morning enalapril.

GastroenterologyPOCUS +4 more
Otis Williams presenting in triage.
S01E01 Complex
31 · Male

Otis Williams

Shortness of breath and severe fatigue after attempting a morning run.

A 31-year-old healthy male presents with shortness of breath and severe fatigue. He reports feeling fine until about two weeks ago, following the Rochester Marathon. He frequently participates in triathlons. Attempted to run this morning but had to quit after one minute due to dyspnea. No recent falls, injuries, or previous medical issues reported.

CardiologyNephrology +3 more
Patient arriving via EMS with LMA in place.
S01E01 Moderate
42 · Male

Sam Wallace

Blunt head trauma with agonal respirations after fall onto subway tracks.

42-year-old male brought in by EMS. Jumped onto the T (subway) tracks to rescue a woman who had fallen. After successfully pulling her off the tracks, he slipped while climbing back up the platform, fell backward, and struck his head. EMS noted agonal respirations. They were unable to intubate in the field and placed an LMA (Laryngeal Mask Airway) prior to transport.

TraumaNeurology +1 more
Patient awaiting surgical consult for SBO.
S01E01 Moderate
40 · Male

Unknown

Abdominal pain, lack of bowel movements (Small Bowel Obstruction)

Patient presented overnight with symptoms suggestive of a small bowel obstruction (SBO). He has been boarding in the emergency department for over three hours waiting for a surgical consult. Initial conservative management with magnesium citrate to stimulate bowel activity failed.

GastroenterologyGeneral Surgery
Thermal burn to the anterior hand
S01E01 Brief
30s-40s · Female

Sherry

Burn to the hand

Patient presents to the ED after sustaining a thermal burn to her hand from a Sterno can while allegedly making s'mores with her son. She has been waiting in the ED for hours and is anxious to leave to take her children to school.

BurnWound Care +2 more
Patient presenting with severe intractable vomiting and dehydration.
S01E01 Moderate
54 · Female

Theresa

Intractable vomiting

54-year-old female brought to the ED by her 18-year-old son, David. Patient was found on the bathroom floor and has had intractable vomiting since last night. Denies prior stomach problems, new medications, or recent travel. Husband passed away a few years ago from COVID-19.

ToxicologyPsychiatry +2 more
Lethargic 4-year-old male upon ED arrival.
S01E01 Moderate
4 · Male

Tyler Jones

Lethargic and Unarousable 4-year-old boy brought to the ED by his parents.

4-year-old male with no past medical history, no antecedent illness, no fever, and no vomiting. Brought to the ED because his parents could not wake him up in the morning. Usually a highly active child. No apparent access to locked medications, no known trauma, and no sick contacts at his preschool.

PediatricsToxicology +1 more
MS3 Victoria Javadi collapsing in the trauma bay.
S01E01 Moderate
20 · Female

Victoria Javadi

Syncope during a medical procedure

Victoria Javadi is a 20-year-old third-year medical student (MS3) on her first day of clinical rotation in the Emergency Department. While observing a closed reduction of a gruesome Type 3 open fracture and degloving injury in the trauma bay, she experienced a sudden loss of consciousness and fell to the floor. Upon regaining consciousness, she initially denied fainting, claiming she tripped over a gurney. She was subsequently evaluated by the attending physician and sent to the staff lounge to recover.

SyncopeVasovagal +2 more
Left shoulder with entry wound from 9mm gunshot.
S01E01 Brief
30s · Male

Virgil Straker

Gunshot wound to the left shoulder

Patient sustained a 9mm gunshot wound to the left shoulder. He was evaluated overnight. CT angiogram was negative for vascular injury. The surgical team requested overnight observation, and he has been boarding in the ED.

TraumaGunshot Wound +1 more