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Author: Hannah Hornsby, MD Co Author #1: Steven Embry, DO Senior Editor: Jessalynn Adam, MD Editor: Jeffrey Feden, MD, FAMSSM Patient Presentation: A 24-year-old African American male Air Force cadet presented to the emergency department after collapsing during exercise. History: The patient has a history of sickle cell trait (SCT) and was counseled appropriately by his primary care provider per Air Force policy. He was training for the Air Force fitness test by gradually increasing his running mileage and intensity over the preceding 6 weeks. While performing the fitness test in mid-July, he collapsed with seizure-like activity and had unstable supraventricular tachycardia requiring synchronized cardioversion before being transported emergently to a local community hospital. He complained of severe pain and numbness in both distal lower extremities. He denied any use of supplements or excessive caffeine prior to exercise and believes that he was hydrating appropriately. Physical Exam: Vital signs were notable for axillary temperature 38.3 degrees C, tachycardia, and tachypnea. Mental status was altered. Anterior and lateral compartments in his bilateral lower extremities were firm to palpation. Posterior compartments were distended but compressible. There was increased pain with passive dorsiflexion and plantarflexion of the ankles and great toes. He was unable to actively range his ankles. Sensation was decreased to light touch in the distal lower extremities bilaterally. Skin color was normal. Dorsalis pedis and posterior tibial pulses were 2+ and symmetric. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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