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 »
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 »
A 30-year-old male presents after a motor vehicle accident with chest pain and shortness of breath. He is alert, speaking in 1-2 word responses, and appears in moderate respiratory distress. He has normal left sided breath sounds, but none on the right. No lung sliding is seen with ultrasound examination of the right thorax. His trachea is deviated left, and increased JVD is noted. What is this patient’s presentation consistent with? What is your next step in management?
EM@3AM: Pneumothorax Read More »
A 15-year-old male presents to the pediatric ED for worsening sore throat and fevers for 5 days. He complains of right sided throat pain, odynophagia, and a muffled voice. He is tachycardic, febrile, uncomfortable appearing, and sitting upright. You note trismus, swollen right tonsil, erythematous and elevated soft palate, and uvula deviated towards the left tonsil. What’s the next step in your evaluation and treatment?
EM@3AM: Peritonsillar Abscess Read More »
A 39-year-old female presents with severe epigastric pain, nausea, and several episodes of non-bloody, non-bilious emesis. The pain is sharp and radiates to her back. On examination, she is tachycardic and tachypneic with diffuse abdominal tenderness, but afebrile. Her lipase returns at 1100 U/L. What is your next step in evaluation and management?
EM@3AM: Pancreatitis Read More »
A 10-day-old female presents with her parents with poor feeding and increased work of breathing. Her urine output has been poor, but her parents have not observed fevers. She is afebrile, but her HR is 188, RR is 61, and oxygen saturation is 94% on room air. She demonstrates increased work of breathing and retractions and appears lethargic. Her serum glucose is 48. What is your next step in evaluation and management?
EM@3AM: The Sick Neonate Read More »
A 65-year-old with a history of ESRD and renal transplant presents to the ED with lower abdominal pain and fevers. On exam, his vitals include HR 112, BP 101/62, RR 22, T 101.1, SpO2 98% on RA. His is tachycardic with lower extremity edema and lower abdominal tenderness to palpation. What’s the next step in your evaluation and treatment?
EM@3AM: Kidney Transplant Complications Read More »
A 59-year-old man presents to the ED for acute onset low back pain that started immediately after he moved furniture. He states his lumbar pain has been unrelenting, with mild pain radiating to down both legs. He appears in pain and has mild midline and bilateral paraspinal tenderness to palpation over his lumbosacral spine. He has bilateral loss of strength in the distal lower extremities, notably in dorsiflexion. What diagnoses should you consider?