An 8-year-old male was brought in by his parents for continuous screaming for 12 hours. He is grabbing his groin area. He is in distress, and exam demonstrates incarceration of the glans by the foreskin with pronounced glans edema. His testicles appear normal. What’s the diagnosis, and what’s your next step in evaluation and treatment?
EM@3AM: Paraphimosis and Phimosis Read More »
An 28-year-old male presents after high-speed MVC with facial pain and loss of consciousness. He has severe facial pain and bruising, conjunctival hemorrhage bilaterally, and facial paresthesias. What is the patient’s diagnosis? What’s the next step in your evaluation?
EM@3AM: Le Fort Fractures Read More »
32-year-old male presents to the ED with vomiting and abdominal cramping. He has Crohn’s disease and has been poorly compliant with his medications. His current episode began as right lower abdominal pain 1 week ago with several episodes of watery diarrhea daily. He developed diffuse cramping, nausea and vomiting 2 days ago and has been unable to tolerate oral intake. He has not passed stool or flatus in 2 days. His abdomen is distended with hyperactive, high-pitched bowel sounds, increased tympany to percussion, and diffuse mild tenderness to palpation without rebound or guarding. What is the most likely diagnosis?
EM@3AM: Inflammatory Bowel Disease Read More »
A 43-year-old female presents with altered mental status. Her husband states she has had weight gain, constipation, fatigue, and skin changes. Vital signs include BP 92/60, HR 48, T 93.2 rectal, RR 13, SpO2 96% on room air. She is alert and oriented x 1, and her neck reveals a well-healed midline anterior neck scar. Her abdomen is soft but distended, and her extremities are cool. What’s the likely diagnosis?
EM@3AM: Decompensated Hypothyroidism Read More »
A 53-year-old male presents with nausea/vomiting and complains of turning “yellow”. He denies abdominal pain, fever, alcohol use, or acetaminophen intake. His vital signs are normal, and exam reveals icteric sclerae, jaundice of his face and chest, and hepatomegaly. He has no tenderness to abdominal palpation. What’s going on, and what’s your next step in evaluation and treatment?
EM@3AM: Jaundice in Adults Read More »
A 19-year-old male presents after an MVC. Another passenger reports that the patient hit his head on the seat in front of him. His GCS is 12, and you find hemotympanum, serosanguineous discharge bilaterally from the nares, and CN III palsy on exam. What’s the next step in your evaluation and treatment?
EM@3AM: Basilar Skull Fractures Read More »
A 12-year-old male is brought to the ED by his mom for right eye swelling and pain. The patient reports pain with extra ocular motion and decreased vision in the right eye. You see extensive right eyelid swelling. What’s the next step in your evaluation and treatment?
EM@3AM: Orbital Cellulitis Read More »
A 52-year-old male presents to the ED with chest pain that is left sided, sharp, and worse at night when he is resting flat. It is different from his prior angina. Physical exam is normal, and ECG shows diffuse ST elevations and PR segment depressions. What is the diagnosis?
EM@3AM: Pericarditis Read More »
A 35-year-old male presents for intermittent fevers, abdominal pain, and headaches for 3 weeks. On further questioning, he also states he has arthralgias. Review of systems is remarkable for a recent camping trip in the Boundary Waters Canoe Area of Minnesota. You find a bulls-eye rash on his trunk. What are your next steps?
EM@3AM: Lyme Disease Read More »
A 65-year-old male presents with altered mental status and right sided weakness. Symptoms began approximately two hours earlier when the patient began to complain of a severe headache. He has become more confused and is now unable to walk normally. Vital Signs: BP 202/98, HR 89, RR 12, T 36.7, SpO2 98% RA. Exam reveals an uncomfortable gentleman who is able to state his name, but unable to give the correct date or his location. He has profound right sided weakness in both upper and lower extremities. What’s your next step?
EM@3AM: Spontaneous Intracerebral Hemorrhage Read More »