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EM@3AM

EM@3AM: Lisfranc Injury

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A 33-year-old male comes in to the emergency department after a soccer game with right foot pain and swelling.  He has been unable to bear weight on his right foot since the injury and has noticed increased pain and swelling to the area. Physical exam reveals a patient in mild discomfort with right foot swelling and pain. He is unable to bear weight, and right foot exam is notable for midfoot edema with plantar ecchymosis. What is the diagnosis, and what are your next steps?

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EM@3AM: Proximal Femur Fracture

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A 77-year-old female presents with left proximal femur and hip pain after falling from a standing position. She tripped over a rug and landed on her left side. She denies LOC or other symptoms. Her left leg is shortened and externally rotated. Her pulses in the leg are normal, and she is able to move her foot and toes. What are your next steps, and what is the likely diagnosis?

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EM@3AM: Ethylene Glycol Toxicity

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A 37-year-old male presents with altered mental status. He has a history of recurrent alcohol intoxication, and his wife found him on the couch after he was working in the garage. She is concerned because he seems to be much more intoxicated than is usual. She also found spilled containers of antifreeze in the garage. What could be going on with this patient? Is he just intoxicated?

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EM@3AM: Diabetic Ketoacidosis

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A 37-year-old female presents with dysuria, polyuria, polydipsia, and lightheadedness. She has a history of insulin-dependent diabetes but ran out of her glucose strips at home. She has had significant nausea and suprapubic pain. She is tachycardic and tachypneic. Exam reveals dry oral mucosa and suprapubic tenderness. POC glucose is 422 mg/dL. What is the diagnosis, and what are your next steps?

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EM@3AM: DVT

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A 28-year-old female presents with right lower leg swelling and redness. She just returned from an overseas flight. She denies chest pain or shortness of breath. VS are normal, and her right lower leg is swollen, with diameter > 3 cm compared to her left. What’s the next step in your evaluation and treatment?

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EM@3AM: Acute COPD Exacerbation

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A 58-year-old male presents with severe shortness of breath, productive cough, and decreased ability to ambulate at home. He has COPD and is on oxygen at home. Several days ago he noted worsening congestion, myalgias, and cough. He is now severely short of breath and unable to complete his activities of daily living.
He is hypoxemic and tachypneic. You hear decreased air movement bilaterally and distal wheezes. What’s the next step in your evaluation and treatment?

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EM@3AM: Myocarditis

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A 18-year-old male presents with chest pain and shortness of breath for several days. Approximately one week prior he was suffering from myalgia, congestion, sore throat, and fever and was diagnosed with an upper respiratory infection. Today his vitals are HR 132, RR 28, BP 92/48, T 37.8 C, and Sats 95% on RA. What should you consider, and what are your next steps?

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EM@3AM: Pulmonary Hypertension

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A 65F presents to your ED with chest pain and shortness of breath. Her symptoms have been going on for several months and have been progressively worsening. She states that she has felt this way since she was diagnosed with a “blood clot in her lungs” several months ago. VS include T 37.5C, HR 103, RR 22, Pox 89% on RA. What should you consider, and what’s your next step in evaluation and treatment?

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