Category Name: em@3am

em@3am

EM@3AM: 5th Metatarsal Fractures

A 23-year-old female presents with left foot pain after rolling her ankle in volleyball. She has some minor ankle pain, but her lateral foot is painful to touch or with weightbearing. On exam, the base of her 5th metatarsal is tender to palpation, with swelling and ecchymosis. What are your next steps, and what is the likely diagnosis?

em@3am

EM@3AM: Hernia

A 61-year-old male presents with lower abdominal pain on the right side. He says “I’ve had this bulge in my groin on the right for two days”. You find a small bulge in the right groin, but with no redness or discoloration of the skin. Palpation reveals mild tenderness over the site. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Gastroesophageal Varices

A 57-year-old male presents with hematemesis. He has a history of cirrhosis from alcohol abuse. He appears toxic and is rushed to the resuscitation bay.  Initial VS include T 37.2C, HR 122, BP 88/41, RR 24, SpO2 90% RA. What are your next steps, and what is the likely diagnosis?

em@3am

EM@3AM: Lisfranc Injury

A 33-year-old male comes in to the emergency department after a soccer game with right foot pain and swelling.  He has been unable to bear weight on his right foot since the injury and has noticed increased pain and swelling to the area. Physical exam reveals a patient in mild discomfort with righ...

em@3am

EM@3AM: Proximal Femur Fracture

A 77-year-old female presents with left proximal femur and hip pain after falling from a standing position. She tripped over a rug and landed on her left side. She denies LOC or other symptoms. Her left leg is shortened and externally rotated. Her pulses in the leg are normal, and she is able to move her foot and toes. What are your next steps, and what is the likely diagnosis?

em@3am

EM@3AM: Ethylene Glycol Toxicity

A 37-year-old male presents with altered mental status. He has a history of recurrent alcohol intoxication, and his wife found him on the couch after he was working in the garage. She is concerned because he seems to be much more intoxicated than is usual. She also found spilled containers of antifreeze in the garage. What could be going on with this patient? Is he just intoxicated?

em@3am

EM@3AM: Diabetic Ketoacidosis

A 37-year-old female presents with dysuria, polyuria, polydipsia, and lightheadedness. She has a history of insulin-dependent diabetes but ran out of her glucose strips at home. She has had significant nausea and suprapubic pain. She is tachycardic and tachypneic. Exam reveals dry oral mucosa and suprapubic tenderness. POC glucose is 422 mg/dL. What is the diagnosis, and what are your next steps?

em@3am

EM@3AM: Esophageal Foreign Bodies

A 52-year-old male presents with inability to swallow. He was eating steak one hour ago and swallowed a large piece without chewing. He thinks it is stuck around his upper sternal area. Physical exam reveals a patient who appears uncomfortable, sitting upright, constantly spitting into a bag. You do not see anything in his mouth. What is the next step in your evaluation and treatment?