Category Name: em@3am

em@3am

EM@3AM: Acute Necrotizing Ulcerative Gingivitis

A 45-year-old male presents to the ED for worsening, severe oral pain and acute bleeding of his gums. He has HIV and is non-compliant on HAART. You note halitosis, gingival bleeding, increased mobility of the front lower teeth, ulcerated “punched out” lesions along the interdental papillae, and anterior cervical lymphadenopathy. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Anterior Shoulder Dislocation

A 35-year-old male presents with right shoulder pain. He was playing football with some friends, and as he was in the midst of throwing the football, a friend hit his throwing arm. He is holding his arm in an internally rotated and abducted position. You are able to detect an ulnar and radial pulse ...

em@3am

EM@3AM: Pneumothorax

A 30-year-old male presents after a motor vehicle accident with chest pain and shortness of breath. He is alert, speaking in 1-2 word responses, and appears in moderate respiratory distress. He has normal left sided breath sounds, but none on the right. No lung sliding is seen with ultrasound examin...

em@3am

EM@3AM: Peritonsillar Abscess

A 15-year-old male presents to the pediatric ED for worsening sore throat and fevers for 5 days. He complains of right sided throat pain, odynophagia, and a muffled voice. He is tachycardic, febrile, uncomfortable appearing, and sitting upright.  You note trismus, swollen right tonsil, erythematou...

em@3am

EM@3AM: Malaria

A 42-year-old male presents with headache, fever, chills, nausea, and myalgias. He returned from a month-long trip to Africa several weeks ago. On examination, he is tachycardic and febrile. You do not find a rash or meningismus, but you palpate an enlarged spleen and liver.  What is your next step in evaluation and management?

em@3am

EM@3AM: Pancreatitis

A 39-year-old female presents with severe epigastric pain, nausea, and several episodes of non-bloody, non-bilious emesis. The pain is sharp and radiates to her back. On examination, she is tachycardic and tachypneic with diffuse abdominal tenderness, but afebrile. Her lipase returns at 1100 U/L. What is your next step in evaluation and management?

em@3am

EM@3AM: The Sick Neonate

A 10-day-old female presents with her parents with poor feeding and increased work of breathing. Her urine output has been poor, but her parents have not observed fevers. She is afebrile, but her HR is 188, RR is 61, and oxygen saturation is 94% on room air. She demonstrates increased work of breath...

em@3am

EM@3AM: Open Fracture

A 22-year-old male is brought in by EMS to the ED after falling 20 feet. He landed primarily on his right leg, which is now obviously deformed with broken skin and exposed bone distally. He is in obvious pain with a grossly deformed right ankle. Pulses are normal and equal bilaterally. What’s the next step in your evaluation and treatment?