recent articles

em@3am

EM@3AM: Infectious Mononucleosis

A 17-year-old male with history of asthma presents to the ED with a chief complaint of sore throat for the past 3 days, associated with decreased oral intake. He denies sick contacts. Vital signs include Temp 100.6F, BP 124/78, HR 92, RR 16, 96% on RA. On exam the patient has swollen, erythematous tonsils with grayish exudate, as well as enlarged, tender anterior and posterior cervical chain lymph nodes. What is the most likely diagnosis?

em@3am

EM@3AM: Pertussis

A 3-month-old male presents with persistent fever, decreased oral intake, and worsening cough associated with post-tussive emesis for the five days. Parents state that the patient’s older sibling has had similar symptoms for the past two weeks and that neither child has received vaccinations after birth. The patient presents with BP 98/64 mm Hg, HR 160, RR 62, T 38.1ºC. Physical exam demonstrates an ill-appearing infant with bilateral conjunctival hemorrhage, dry cough, and inspiratory “whooping” sound. What is the most likely cause of this patient’s symptoms and what are the next steps in management?

em@3am

EM@3AM: Cellulitis

A 56-year-old male with a history of type 2 diabetes presents to the ED with a rash on his right shin that started two days ago and has progressively worsened. He has associated mild pain but has not taken any analgesics. Vital signs include HR 90 bpm, BP 148/100, RR 16, T 100.2F, and SPO2 96%. Examination is significant for an obese disheveled male in no acute distress. His right shin has a large area of erythema with indistinct margins and increased warmth, as well as associated mild tenderness to palpation. What is the most likely diagnosis?

em@3am

EM@3AM: Tetanus

A 38-year-old male with a history of injection drug use presents with one day of progressively worsening, pressure-like chest pain radiating to his back. He appears diaphoretic and in moderate distress. He has had new difficulty opening his mouth. On exam, he is tachycardic, diaphoretic, and in acute distress. He endorses tenderness throughout his thoraco-lumbar spine. Neurological evaluation demonstrated increased tone in all extremities. Skin exam reveals two abscesses on his upper extremities. An MRI of the spine is unremarkable. Reexamination reveals new spasmodic neck stiffening, jaw clenching and arching of his back. What is the likely diagnosis?