FOAMed

EM@3AM: Rib Fractures

An 82-year-old female presents to the ED after falling down a flight of stairs. Patient reports falling onto her chest. She endorses right sided chest pain that began immediately after falling but denies any shortness of breath.
Vital signs: HR 90 bpm, BP 148/100, RR of 20, T of 98.8F, and SPO2 of 97%. Examination shows a frail elderly female, with ecchymosis over the right chest wall. Tenderness to palpation is pinpoint over the 5th and 6th ribs on the right. Breath sounds are equal bilaterally. What is the most likely diagnosis?

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EM@3AM: Herpes Zoster

A 27-year-old pregnant female presents with a painful rash to the right side of her face that started 4 days ago. She is G1P0 and currently 26 weeks pregnant with reported routine prenatal care. She had been doing well until 4 days prior when she began to experience tingling and pain to her right cheek, followed by the development of small, painful, erythematous bumps to the area. Her VS are normal. On exam, she has a vesicular rash across her right cheek in the V2 cranial nerve distribution. What is the most likely cause of this woman’s rash?

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