recent articles


EM@3AM: Polyarteritis Nodosa

A 59-year-old male presents to the ED with abdominal pain, hematuria, and rectal bleeding for the 5 days. His symptoms have been associated with unintentional weight loss, intermittent fevers, skin rash, and fatigue over the past 3 months. He has a past history of hepatitis B, hypertension, diabetes, and hyperlipidemia. Vital signs include blood pressure 162/103 mm Hg (last measured 118/82 5 months ago, per records), HR 101, RR 18, SpO2 98% on room air. Exam is notable for generalized abdominal tenderness, guaiac positive stool, and generalized purpuric rash over bilateral lower extremities. Labs demonstrate Cr 2.9 (baseline 1.1) and elevated ESR and CRP. What is the most likely diagnosis, and what are the next steps in management?


EM@3AM: Testicular Torsion

A 25-year-old male is brought to the ED by EMS after sudden onset right testicular pain. He denies any trauma or contact to his scrotum or perineum; however, he endorses severe, sudden pain associated with nausea and non-bloody, non-bilious emesis. He additionally complains of mild lower right abdominal tenderness. Review of systems is otherwise unremarkable. On exam he is uncomfortable appearing and has a nontender abdomen. He has a normal penile exam, but the the right hemiscrotum has mild erythema, a horizontal lie, and it is exquisitely tender. What’s the next step in your evaluation and diagnosis?