emDocs Logo
X-twitter Facebook-square Linkedin-in Youtube-square Ti-instagram

em@3am

em@3am logo

EM@3AM: Cortical Hand-Knob Stroke Mimicking Peripheral Nerve Injury

Leave a Comment / em@3am /

A 95-year-old man presents after waking with sudden inability to move the fingers and thumb of his right hand. He can lift his arm, flex and extend his wrist normally, and reports intact sensation. He denies numbness, facial droop, dysarthria, headache, gait disturbance, chest pain, or dyspnea. He has 0/5 strength in finger flexion and extension as well as in the intrinsic hand musculature, with preserved proximal upper extremity strength and intact sensation. He has no other appreciable deficits and normal vital signs. What is the diagnosis?

EM@3AM: Cortical Hand-Knob Stroke Mimicking Peripheral Nerve Injury Read More »

em@3am logo

EM@3AM: Scleroderma and Severe Sequelae

Leave a Comment / em@3am /

A 45-year old African American woman presents with progressive fatigue over the past week and has experienced intermittent episodes of severe hand pain that typically self-resolve. She has also noted a worsening headache over the last day. Her blood pressure is 197/105 mm Hg and heart rate is 90 bpm. The physical exam is notable for smooth and taut skin on the patient’s face and hands. Laboratory values show a creatinine of 3.1 mg/dL. What is the likely diagnosis?

EM@3AM: Scleroderma and Severe Sequelae Read More »

em@3am logo

EM@3AM: Meningococcal Disease

Leave a Comment / em@3am /

A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?

EM@3AM: Meningococcal Disease Read More »

em@3am logo

EM@3AM: Septic Abortion

Leave a Comment / em@3am /

A 24-year-old female G4P1 who is 9 weeks pregnant presents with abdominal pain and vaginal bleeding for 3 days. Vital signs include HR 115, BP 100/76, T 38.7, RR 13, SpO2 99% on RA. She is ill-appearing and has tenderness to palpation of the bilateral lower quadrants and suprapubic region. Pelvic exam reveals blood in the vaginal vault and foul-smelling discharge from the cervix with no other abnormalities. What is the likely diagnosis?

EM@3AM: Septic Abortion Read More »

em@3am logo

EM@3AM: Suppurative Labyrinthitis

Leave a Comment / em@3am /

A 58-year-old male presents with 1 day of severe vertigo associated with nausea and vomiting, tinnitus, and sudden-onset hearing loss. He reports several days of left-sided ear pain and discharge from his left ear. Vital signs reveal T 38.9C, HR 120, BP 138/96, RR 18, SpO2 99% on room air. He is ill-appearing with an HEENT exam notable for an inflamed left external auditory canal with purulent drainage and an erythematous tympanic membrane with evidence of perforation. He has left-sided hearing loss, left-beating horizontal nystagmus, and a mildly unsteady gait. He has leukocytosis with bandemia. CT head shows no acute intra-cranial process. What is the most likely diagnosis?

EM@3AM: Suppurative Labyrinthitis Read More »

em@3am logo

EM@3AM: Alpha-2 Agonist Toxidromes

Leave a Comment / em@3am /

A 42-year-old male with a past medical history of substance use presents to the ED for chest pain, shortness of breath, nausea, and vomiting. He reported snorting fentanyl two days ago and has a remote history of IV drug use. Vital signs include 98.8°F, HR 150, RR 23, SpO2 98% on RA, and BP of 180/100. He is anxious-appearing and diaphoretic, with dilated pupils (6mm, equal, round, and reactive) and full body rigors; ankle clonus is absent. Labs demonstrate a potassium of 2.8 mEq/L and a lactate of 3 mg/dL. He receives electrolyte repletion, fluid resuscitation, and broad-spectrum antibiotics. Concerned for opioid withdrawal, the treating physicians orders multiple doses of buprenorphine and full opioid agonists, without evidence of clinical improvement. What is the diagnosis?

EM@3AM: Alpha-2 Agonist Toxidromes Read More »

em@3am logo

EM@3AM: Morel-Lavallée Lesion

Leave a Comment / em@3am /

A 30-year-old female presents after sustaining a motorcycle collision at highway speeds. She was wearing protective equipment, including a helmet, gloves, knee and elbow pads, and riding boots. She denies loss of consciousness but reports severe right lower extremity pain rated as 10 out of 10. Vital signs reveal BP 93/78 mmHg, HR 122 bpm. During the secondary survey, a rapidly expanding mass is noted over the right lateral thigh. The overlying skin is tense and tender to palpation.

EM@3AM: Morel-Lavallée Lesion Read More »

em@3am logo

EM@3AM: Cranial Nerve Syndromes

Leave a Comment / em@3am /

A 15-year-old female with PCOS, obesity, asthma, and recurrent otitis media with bilateral tympanostomy tube placement reports three weeks of increasing sanguineous drainage, ear pain, fevers, and worsening left-sided headaches not improving with NSAIDs.  She localizes the pain behind the left eye and additionally reports loss of lateral vision in her left eye, as well as double vision when looking to the left. On exam, she has a thickened, inflamed appearing left tympanic membrane with sanguinopurulent drainage from the left tympanostomy tube. She additionally has tenderness and swelling to the left mastoid process. Examination of the eyes reveals normal, symmetric, and reactive pupils.  The patient has binocular horizontal diplopia on left lateral gaze and downgaze, which resolves with covering either eye.  She has decreased vision in the lateral visual fields of the left eye on confrontational field exam.

EM@3AM: Cranial Nerve Syndromes Read More »

Subscribe
Subscribe
A small and open house full of memories and charm blinds advisor and more. Inspiring tale archives – english. Puff boyz nn dmt.