Hilarie H. Cranmer, M.D., M.P.H.,1,2 Timothy B. Erickson, M.D.,2,3 Scott R. Beach, M.D.,4,5 and Kendra E. Wulczyn, M.D., M.P.H.6,7 
Dr. James A. Gordon (Chief Learning Officer): The Peter L. Slavin, MD Academy for
Applied Learning in Health Care is delighted to collaborate with the Department of
Emergency Medicine in jointly hosting a clinicopathological conference in the Ether
Dome, the historic teaching amphitheater of the Massachusetts General Hospital.
Dr. Aaron D’Amore (Emergency Medicine): A 28-year-old woman presented to the
emergency department of this hospital because of abdominal pain, dizziness, nausea,
and vomiting.
The patient had been in her usual state of generally good health until the night
before this presentation, when epigastric pain and vomiting developed abruptly after
the consumption of spicy food. Her partner had consumed the same food but did
not have similar symptoms. The patient had persistent vomiting and lightheadedness
and was unable to maintain adequate hydration; subsequently, she presented to the
emergency department of this hospital, accompanied by her partner.
On presentation to the emergency department, the oral temperature was 36.0°C,
the blood pressure 122/88 mm Hg, the respiratory rate 20 breaths per minute, the
heart rate 88 beats per minute, and the oxygen saturation 100% while the patient
was breathing ambient air. She reported ongoing epigastric pain and nausea, and
several witnessed episodes of emesis occurred after her arrival at the emergency
department, with vomitus that was nonbloody and nonbilious. The patient also
reported ongoing dizziness, lightheadedness, and vertigo. A review of systems was
negative for fever, chest pain, diarrhea, hematochezia, melena, anorexia, cough,
dyspnea, headache, paresthesia, vision symptoms, and motor weakness. Her partner
reported that the patient had presented to the emergency department with similar
symptoms 2 months earlier; the symptoms had been self-limited and had been
treated with antiemetic agents and antacids. The partner described the patient as
having a “sensitive stomach” and noted that she often had similar symptoms after
eating spicy foods.
