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em@3am

EM@3AM: Diabetic Foot Ulcer

A 58-year-old morbidly obese female patient with uncontrolled diabetes and peripheral arterial disease presents with an open wound to the central plantar aspect of her foot. She reports no pain, does not recall an injury, and is not sure how long she has had the ulcer. On exam, there is a 3.5 cm circular wound with thick yellow material in the center, and the edges of the wound are pink and warm to the touch. What is the diagnosis, and what are your next steps?

ultrasound

US Probe: E-Point Septal Separation (EPSS) in the CHF Patient

EPSS is a simple, easy to learn tool that allows a quick estimation of left ventricular function. The value of EPSS lies in its objective findings that do not require specialized training for interpretation and utilization, as shown by numerous studies. In patients without mitral or aortic valvular pathology, EPSS can be obtained from a single echocardiography view, providing quantifiable information on heart function within minutes. EPSS > 7mm is typically cited as the cut-off for abnormal ejection fraction (<50%). It offers a further tool for inexperienced emergency physicians that can be used to complement the overall assessment and risk stratification of patients with congestive heart failure.

em@3am

EM@3AM: Pulmonary Hypertension

A 65F presents to your ED with chest pain and shortness of breath. Her symptoms have been going on for several months and have been progressively worsening. She states that she has felt this way since she was diagnosed with a “blood clot in her lungs” several months ago. VS include T 37.5C, HR 103, RR 22, Pox 89% on RA. What should you consider, and what’s your next step in evaluation and treatment?