ID

The emDOCs podcast covers updates in Clostridioides difficile infection. 

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?

A 33-year-old male presents to the ED for odynophagia and mild dyspnea. He has had pain with swallowing for the past 24 hours and it has gotten progressively worse. He is having difficulty tolerating oral secretions. VS include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic.  The ENT exam reveals a midline uvula; cervical lymphadenopathy; soft mouth floor, and no evidence of dental infection, no neck erythema, though voice changes. He has severe pain with palpation of the hyoid bone. What’s the most likely diagnosis?

The emDOCs podcast covers HIV for this week.

When should we suspect endocarditis, and how can we improve our diagnosis?

The Surviving Sepsis Campaign published updated guidelines for the management of sepsis and septic shock, with 93 recommendations. We cover the EM Top Changes, with some discussion of the literature behind these changes, as well as other changes that impact our practice.

A 23-year-old male presents for severe throat pain and cough. He states that his neck hurts, with left sided redness and pain. Vital signs include BP 91/49, HR 130, T 102.2 temporal, RR 25, SpO2 91% on room air. He appears toxic. The ENT exam reveals a midline uvula; soft mouth floor; prominent generalized cervical, submandibular, and submental swelling with corresponding lymphadenopathy; but no voice changes or difficulty tolerating secretions. His neck is red and tender, with mild swelling overlying the left side of neck and a painful tracheal rock. What is the most likely diagnosis?

The emDocs Podcast looks at encephalitis this week.

A 3-month-old female is brought into your ED by her mother for constipation and decreased PO intake for 3 days. She was born full term without complications and is breastfed along with some soft foods. When asking about changes in diet, her mother states they only eat organic and grow most of their own food on their farm. They also can some food to prevent spoiling. Vital signs are unremarkable. It takes longer than expected for her to open her eyes, and she appears to have head lag. She will not feed while in the ED despite multiple attempts. What is the diagnosis?