SplintER Series: A Pain in the Elbow

$Medial epicondyle avulsion fracture$

A 12-year-old male pitcher for a traveling club baseball team complains of acute worsening of right elbow pain that has been bothering him for 3 months. The radiograph is shown below (Frontal elbow view. Case courtesy of Dr. Levente István Lánczi, Radiopaedia.org, rID: 46853). What is your diagnosis? What causes this injury? What patient demographic is most susceptible to this injury? How can this injury be prevented? What is the management of this injury in the Emergency Department?

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By Randall Beaupre, MD|2020-09-17T14:17:11-07:00Oct 7, 2020|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

ACMT Toxicology Visual Pearls: “I have a nanging feeling about this”

Chronic exposure to which substance can cause this finding on a Cervical Spine MRI?

Arsenic
Carboplatin
Nitrous Oxide
Toluene

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By Brian Lewis, MD|2020-10-04T12:14:42-07:00Oct 5, 2020|ACMT Visual Pearls, Emergency Medicine, Tox & Medications|

Is it a Pneumothorax? An Unusual Post-Thoracentesis Radiograph

A 51-year-old female with a history of metastatic ovarian cancer on chemotherapy, malignant pleural effusions requiring repeat thoracentesis, and pulmonary embolism presented to the Emergency Department with worsening shortness of breath and dry cough. Upon arrival, she was hypoxic with an oxygen saturation level of 75% on room air. She was tachycardic, tachypneic, and her blood pressure was 125/56 mmHg. Labs revealed only a mild anemia (Hgb: 10.2). It was determined that her symptoms were secondary to recurrent right-sided malignant pleural effusions. Her presenting chest X-ray is pictured above (Image 1: Author’s own image).

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By Prabdit Sidhu|2020-09-08T16:16:43-07:00Sep 30, 2020|Pulmonary|

SAEM Clinical Image Series: Man vs Pneumatic Nail Gun

A 40-year-old male presents with injury to his left hand by a nail gun. While at work, the patient accidentally shot himself with a nail gun. The nail went through pneumatic air hose tubing, his third finger, and his thumb, keeping them all connected. He immediately felt uncomfortable in his left arm, and, upon arrival to the emergency department (ED), complained of swelling in his left arm extending to his neck. He feels shortness of breath and “fullness” in his throat.

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By Jillian Merica, MD|2020-09-28T16:36:16-07:00Sep 28, 2020|Emergency Medicine, SAEM Clinical Images, Trauma|

SAEM Clinical Image Series: Worsening Sore Throat

A 40-year-old male presented to the emergency department (ED) complaining of a sore throat for one week. The patient had presented ten days earlier following a stab wound to the anterior neck that violated the platysma. There was no vascular injury noted on the computed tomography angiography (CTA) but there was extensive soft tissue damage with emphysema extending into the retropharyngeal space. The patient underwent a flexible laryngoscopy by ENT, which showed no airway injury. He was observed in the intensive care unit for two days, then discharged. Following discharge, the patient had progressive sore throat and odynophagia, so he re-presented to the ED.

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By Victoria Silver, DO|2020-09-28T16:40:11-07:00Sep 28, 2020|Emergency Medicine, ENT, SAEM Clinical Images|

A 78-year-old male is brought in from his nursing home for evaluation of hypotension. He has a prior history of multiple strokes and is bed bound. He arrives febrile, tachycardic, and hypotensive. On your physical exam, you notice that he has an indwelling foley catheter. The catheter tubing and bag have a vibrant purple color. You wonder if this unusual urine color could be caused by something insidious. Could this be related to a toxin, medication, or infection?

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By Robert Barnes, MD|2020-09-02T11:30:29-07:00Sep 23, 2020|Diagnose on Sight, Genitourinary|

SAEM Clinical Image Series: Distended Abdomen after ROSC

A 64-year-old female presented to the emergency department (ED) in cardiac arrest. Her family members heard her fall in the bathroom and started CPR. EMS intubated the patient and 20 minutes of CPR was done en route. Return of spontaneous circulation (ROSC) was achieved after fifteen minutes of resuscitation in the ED.

At baseline, the patient ambulated with her walker and was conversant. She was having abdominal pain and nausea for the past three days after recently being diagnosed with a urinary tract infection. On arrival to the ED, the patient was pulseless with ventricular fibrillation. The patient received ten doses of epinephrine, two doses of sodium bicarbonate, calcium, amiodarone, magnesium, and one dose of naloxone during the resuscitation. One defibrillatory shock was administered. She was started on a norepinephrine drip and an amiodarone drip.

Computed tomography (CT) of the head was negative. CT of the chest was significant for left pneumothorax and left-sided subcutaneous emphysema. A pigtail chest tube was placed. After a few hours, she developed worsening abdominal distension. An abdominal CT scan revealed the images shown.

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By Sheri-Ann Olivia Kaltiso, MD|2020-09-18T20:43:44-07:00Sep 21, 2020|Critical Care/ Resus, Gastrointestinal, SAEM Clinical Images, Uncategorized|