A2

Myxedema

Skilled assessment of a hypothyroid patient with hypothermia, bradycardia, marked lethargy, and obtundation — findings concerning for myxedema. EMS was activated for emergent evaluation; the patient was kept warm and the airway monitored; the provider was notified at 09:15. Vital signs and mental status were monitored pending transport, and recent medication adherence and intercurrent illness documented (cross-reference Endocrine/Metabolic).

A3

Airway compromise from a mass

Skilled assessment of a patient with a large goiter who now has audible stridor and a sensation of throat tightness, with the trachea palpably deviated — findings concerning for airway compromise. EMS was activated immediately and the patient kept upright and calm; the provider was notified at 13:40. The airway and oxygenation were monitored pending transport, and nothing given by mouth (cross-reference Respiratory).

A4

Post-thyroidectomy hypocalcemia

Skilled assessment of a patient several days after total thyroidectomy with new perioral numbness, tingling of the fingers, and muscle cramps, with a positive Trousseau sign — findings concerning for hypocalcemia. The provider was notified at 11:05; orders for laboratory studies and calcium were received and treatment initiated. The patient was educated on the signs of worsening hypocalcemia (tetany, spasm, difficulty breathing) and to seek emergency care for them; calcium status and symptoms will be reassessed (cross-reference Endocrine/Metabolic).

A5

Rapidly enlarging fixed mass

Skilled assessment identifying a left-sided neck mass that has enlarged rapidly over several weeks and is now firm, fixed, and non-tender, with associated hoarseness — findings requiring urgent evaluation to exclude malignancy. The provider was notified at 10:30 and an urgent referral requested; the mass was measured for tracking. The patient was educated on the reason for evaluation and the symptoms to report; the mass will be reassessed (cross-reference Lymphatic).

A6

New goiter with compressive dysphagia

Skilled assessment of a patient with an enlarging goiter now causing difficulty swallowing solids and a choking sensation when lying flat — new compressive symptoms. The provider was notified at 14:15; orders for evaluation were received. The patient was educated to eat upright, modify texture as needed, and seek emergency care for difficulty breathing; the compressive symptoms and swallowing will be reassessed and coordinated with Taste/Swallowing (cross-reference Taste/Swallowing).