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em@3am

EM@3AM: Testicular Torsion

A 25-year-old male is brought to the ED by EMS after sudden onset right testicular pain. He denies any trauma or contact to his scrotum or perineum; however, he endorses severe, sudden pain associated with nausea and non-bloody, non-bilious emesis. He additionally complains of mild lower right abdominal tenderness. Review of systems is otherwise unremarkable. On exam he is uncomfortable appearing and has a nontender abdomen. He has a normal penile exam, but the the right hemiscrotum has mild erythema, a horizontal lie, and it is exquisitely tender. What’s the next step in your evaluation and diagnosis?

em@3am

EM@3AM: Rabies

A 13-year-old male presents to the ED for aggressive behavior which progressed to confusion and decreased level of consciousness. He initially was very agitated and aggressive and refused to drink any water. He then became disoriented and is now difficult to rouse. The parents note that he had recently had a fever, sore throat, and general malaise prior to this behavior but those symptoms resolved, although they note excessive salivation. Review of systems is remarkable for a bat bite for which he never sought care. He is tachycardic, tachypneic, febrile, and appears toxic. What’s the most likely diagnosis?

em@3am

EM@3AM: Epiglottitis

A 33-year-old male presents to the ED for odynophagia and mild dyspnea. He has had pain with swallowing for the past 24 hours and it has gotten progressively worse. He is having difficulty tolerating oral secretions. VS include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic.  The ENT exam reveals a midline uvula; cervical lymphadenopathy; soft mouth floor, and no evidence of dental infection, no neck erythema, though voice changes. He has severe pain with palpation of the hyoid bone. What’s the most likely diagnosis?