1. Clinical Integration: Emergency Medicine Lucero, Lee, Macalintal, Magallanes, Maningas, Ombao, and Pacifico

2. Subjective  30 yo F  CC: acute diarrhea (bloody watery stools) HPI  “feeling hot”  Persistent choking sensation  Unrelieved by drinking water (+) nausea, vomiting (+) crampy abdominal pain (+) pallor, feeling faint

3. Review of Systems (-) skin lesions, pruritus (-) eye redness, itchiness, discharges and lacrimation (+) nasal stuffiness (+) slight dyspnea (-) wheezing

4. Past Medical History (+) asthma  Rx: salbutamol inhaler (+) allergy to peanuts (+) atopy  1 yr PTA: appendectomy OB-GYN History  delayed menstruation

5. Objective  awake, confused, and stretcher-borne  hypotensive  Weak extremitiy pulses  tachycardic, tachypneic, and afebrile (+) flushed skin (-) rashes (+) pale palpebral conjunctiva (+) watery nasal discharge (-)FB inside the oropharynx

6. Objective (+) bilaterally decreased breath sounds (+) appendectomy scar (+) hyperactive bowel sounds (+) slight lower abdominal tenderness (+) reddish stool on DE

7. Neurologic Examination  awake but confused  GCS is 12

8. Salient Features (+) acute diarrhea  “feeling hot”  Persistent choking sensation (+) nausea, vomiting (+) crampy abdominal pain (+) pallor, feeling faint (-) skin lesions, pruritus (-) eye redness, itchiness, discharges and lacrimation (+) nasal stuffiness (+) slight dyspnea (-) wheezing (+) asthma (+) allergy to peanuts (+) atopy  1 yr PTA: appendectomy  delayed menstruation upon consult  awake, confused, and stretcher- borne  Hypotensive, tachycardic, tachypneic, and afebrile (+) flushed skin (-) rashes (+) pale palpebral conjunctiva (+) watery nasal discharge (-)FB inside the oropharynx (+) bilaterally decreased breath sounds (+) appendectomy scar (+) hyperactive bowel sounds (+) slight lower abdominal tenderness (+) reddish stool on DE  awake but confused  GCS is 12

9. Thank you!