A 73-year-old male with a history of hypertension presents to the ED with a 2-month history of hiccups. He reports difficulty eating and sleeping secondary to hiccups. He has tried multiple maneuvers from breath holding to biting lemons to drinking water upside-down. His vital signs and exam are normal, including neurologic exam. What is your diagnosis?
An 82-year-old female presents to the ED after falling down a flight of stairs. Patient reports falling onto her chest. She endorses right sided chest pain that began immediately after falling but denies any shortness of breath.
Vital signs: HR 90 bpm, BP 148/100, RR of 20, T of 98.8F, and SPO2 of 97%. Examination shows a frail elderly female, with ecchymosis over the right chest wall. Tenderness to palpation is pinpoint over the 5th and 6th ribs on the right. Breath sounds are equal bilaterally. What is the most likely diagnosis?
EM@3AM: Rib Fractures Read More »
A 27-year-old pregnant female presents with a painful rash to the right side of her face that started 4 days ago. She is G1P0 and currently 26 weeks pregnant with reported routine prenatal care. She had been doing well until 4 days prior when she began to experience tingling and pain to her right cheek, followed by the development of small, painful, erythematous bumps to the area. Her VS are normal. On exam, she has a vesicular rash across her right cheek in the V2 cranial nerve distribution. What is the most likely cause of this woman’s rash?
EM@3AM: Herpes Zoster Read More »
A 33-year-old male presents to the ED for odynophagia and mild dyspnea. He has had pain with swallowing for the past 24 hours and it has gotten progressively worse. He is having difficulty tolerating oral secretions. VS include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic. The ENT exam reveals a midline uvula; cervical lymphadenopathy; soft mouth floor, and no evidence of dental infection, no neck erythema, though voice changes. He has severe pain with palpation of the hyoid bone. What’s the most likely diagnosis?
EM@3AM: Epiglottitis Read More »
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: Cellulitis Read More »
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?
A 3-year-old male is brought in by his mother for severe throat pain and lethargy. She notes that he is playing less, refusing to eat, and preferring to lie supine. Review of systems is remarkable for a recent small fall with his toothbrush in his mouth. Triage vital signs include BP 91/49, HR 141, T 103.1 temporal, RR 25, SpO2 96% on room air. He appears toxic and is lying supine. The oropharyngeal exam is normal, but the patient has prominent generalized cervical lymphadenopathy, torticollis, and a painful tracheal rock. The patient has no voice changes but does not want to extend his neck. What’s the most likely diagnosis?
EM@3AM: Retropharyngeal Abscess Read More »
A 23-year-old male presents for severe throat pain and cough. He states that his neck hurts, with left sided redness and pain. Vital signs include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic. The ENT exam reveals a midline uvula; soft mouth floor; prominent generalized cervical, submandibular, and submental swelling with corresponding lymphadenopathy; but no voice changes or difficulty tolerating secretions. His neck is red and tender, with mild swelling overlying the left side of neck and a painful tracheal rock. What is the most likely diagnosis?
EM@3AM: Lemierre’s syndrome Read More »
A 23-year-old male presents with recurrent episodes of global headache, flushing, sweating, and palpitations. These episodes first started 1 month ago. They occur several times per day and last less than one hour. He has also noted a 10-pound weight loss since these episodes started. Exam reveals blood pressure 183/108 mm Hg, HR 1114 beats per minute, RR 18, temperature 98.4 C, saturation 98% on room air. His skin is flushed. Your cardiovascular, pulmonary, abdominal, and motor and sensory exams are otherwise normal. What is the likely diagnosis?
EM@3AM: Pheochromocytoma Read More »
A 43-year-old female with a history of breast cancer presents to the ED with diffuse abdominal pain and diarrhea for one week. She is experiencing over 12 episodes of non-bloody diarrhea daily. She is currently receiving Atezolizumab (Tecentriq) for breast cancer. Vital signs include BP 82/43, HR 121, T 98F oral, RR 22, SpO2 98% on RA. She appears tired, and her oral mucosa are dry. She displays diffuse abdominal tenderness to palpation, but there is no evidence of peritonitis. What is the patient’s diagnosis?
EM@3AM: Immune-Related Adverse Event from Immune Checkpoint Inhibitors Read More »
