A 30-year-old male presents with intense left forearm pain after cleaning an aquarium at his job 20 minutes prior to arrival. He is unsure what kind of fish were in the aquarium. Physical exam reveals a patient who appears uncomfortable holding his left arm. There is a 5 cm area of erythema to his anterior forearm that is warm to the touch. What is the diagnosis and the best next step in management?
EM@3AM: Marine Animal Bites and Stings Read More »
A 69-year-old female presents with shortness of breath, orthopnea, and lower extremity swelling. She has a pacemaker placed 3 years ago for a complete heart block. She hands you her pacemaker identification card indicating that she has a single chamber pacemaker. Triage EKG: ventricular pacing spikes followed by QRS complexes. She has crackles at the lung bases and 2+ lower extremity pitting edema. What is the diagnosis? What is your next step in evaluation? What are some the types of pacemaker complications you should be evaluating for?
EM@3AM: Pacemaker/AICD Complications Read More »
A 72-year-old female is brought to the ED during a heat wave. Her daughter found her confused in her home. She believes the power has been out for several days. The patient appears lethargic and is intermittently confused. A rectal temperature reads 105.1F. The patient’s skin is warm and dry. She is confused, but the rest of her exam is unremarkable. What is the patient’s diagnosis? What’s the next step in your evaluation and treatment?
EM@3AM: Heat Stroke 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 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 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 »
