A 22-year old male presents to the ED after landing on his right thumb while playing football with some friends. The pain and swelling became progressively worse as he notes pain with any movement of his thumb. He is right hand dominant. On exam, the right MCP joint is edematous with point tenderness and ecchymosis, though the skin is closed. What’s the next step in your evaluation and treatment?
EM@3AM: Metacarpal Base Fractures Read More »
A 40-year-old female presents to your Emergency Department with three days of pain and swelling in her right index finger. On exam, her right index finger is diffusely swollen, erythematous, and held in flexion. There is a punctate wound on the dorsal finger distal to the DIP. She has significant tenderness to palpation of the flexor compartment of the finger and pain on extension. What is your next step in evaluation and treatment?
EM@3AM: Pyogenic Flexor Tenosynovitis Read More »
A 13-year-old male is brought in by EMS for altered mental status after being found in a house fire. The fire department found burned couches in the house with melted plastic covering. His vital signs include BP 78/40, HR 155, T 99.9 Oral, RR 40, SpO2 92% on 15L NRB. He is somnolent but withdraws to pain. He has soot in his nares with carbonaceous sputum, and auscultation reveals rhonchorous and wheezing breath sounds bilaterally. Point of care VBG demonstrates a lactate of 16. What’s the next step in your evaluation and treatment?
EM@3AM: Cyanide Toxicity Read More »
A 28-year-old male presents to the ED with right shoulder pain after falling on an outstretched arm two hours earlier. He denies history of prior shoulder injuries. On exam, he is holding his right upper extremity in adduction and internal rotation at the shoulder. He is unable to externally rotate his shoulder due to pain, and you note prominence to the posterior shoulder on exam. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?
EM@3AM: Posterior Shoulder Dislocation Read More »
A 22-year-old female presents to the ED after taking an entire bottle of unknown medication approximately an hour and a half ago. She describes a ringing sensation in her ears and mild nausea with no vomiting. Triage vital signs (VS): BP 122/75, HR 115, T 99.8 Oral, RR 32, SpO2 99% on RA. She is tachypneic with no increased work of breathing. What is the most likely medication overdose? What’s the next step in your evaluation and treatment? What lab tests would you like to order?
EM@3AM: Salicylate Overdose Read More »
A 51-year-old male with diabetes mellitus presents with pain in his left foot, as well as fever and chills. His physical exam is notable for a 3 cm ulcer over the plantar aspect of his left first MTP joint, with surrounding warmth and erythema. Using a sterile instrument, bone was easily probed. What is your next step in evaluation and treatment?
EM@3AM: Osteomyelitis Read More »
An 18-year-old female presents with confusion, seizures, and fever. Patient is unable to provide history, but her mother states that she began noticing confusion 2 days ago, and the patient expressed head discomfort yesterday. The patient appears lethargic and does not follow commands, and she is febrile and tachycardic. She has nuchal rigidity and is hyperreflexic with upgoing toes bilaterally. What is the patient’s diagnosis? What is the next step in your evaluation and treatment?
EM@3AM: Encephalitis Read More »
40-year-old male is brought by EMS after being struck on his left side while crossing the street by a vehicle at 20 mph. He is visibly uncomfortable, laying on his right side, and refusing to move his left leg. His left lower extremity has an obvious effusion along with localized swelling and tenderness over the lateral aspect of his knee joint. Ligament and meniscal evaluation cannot be completed due to pain on knee exam. There are no signs of neurovascular compromise on exam. What’s the next step in your evaluation and treatment?
EM@3AM: Tibial Plateau Fracture Read More »
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: Acute Necrotizing Ulcerative Gingivitis Read More »
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 in the hand of the affected arm, and his median, ulnar, and radial motor and sensory function is normal in the right hand. What’s the next step in your evaluation and treatment?
EM@3AM: Anterior Shoulder Dislocation Read More »
