SAEM Clinical Image Series: What Lies Beneath?

abscess

A 35-year-old male with a history of diabetes and pericarditis, status post pericardiectomy 3 years ago, presented with a painful lesion on his anterior chest wall. One month prior, the patient reported a bump at his sternotomy scar base which extruded a piece of suture when squeezed and subsequently healed. Two days ago, the patient developed diffuse right-sided chest pain. During the past 24 hours, an enlarging, erythematous, painful, non-draining lesion developed at the base of his scar. He reports subjective fever. He denies shortness of breath, exertional chest pain, nausea, and vomiting.

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SAEM Clinical Image Series: Left Ear Mass

ear mass

A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “pimple” and has been increasing in size for the last 6 months. He has an associated headache, dizziness, and malaise. He denies fever, trauma, drainage, known insect bite, dysphagia, dyspnea, trismus, and hearing loss. He emigrated to the United States from Honduras 8 months ago. He was seen in the emergency department 4 months prior for a similar complaint, which was diagnosed as lymphadenopathy by point-of-care ultrasound.

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SAEM Clinical Image Series: Blisters, Bullae, and Badness

blisters bullae

A 3-year-old female with a history of epilepsy presents with a rash that began one day ago. The patient started becoming fussy four days ago, saying, “I don’t feel good,” and not wanting to play outside with her siblings or finish her meals. Family noticed the patient rubbing her eyes frequently and crying when she went to the bathroom. She felt warm so they gave her Tylenol and Motrin at home. Yesterday, they noticed a rash was starting to develop with itchy, painful red spots. This morning, the rash progressed to involve some blisters on the face, chest, and back.

Medications include Tylenol, Motrin, and lamotrigine, which was started by her neurologist three weeks ago. Family history is significant for epilepsy on the father’s side of the family.

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By |2021-01-05T13:23:34-08:00Jan 4, 2021|Academic, SAEM Clinical Images|

SAEM Clinical Image Series: The Hemorrhaging Bifurcated Tongue

bifurcated tongue

A 26-year-old male with no past medical history presented to the emergency department for tongue bleeding for one day. Five days prior he had an elective cosmetic tongue bifurcation completed out-of-state. About two hours prior to arrival, he had been using a swish-and-spit saltwater rinse when he felt a suture break. Ever since he has had copious bleeding, reportedly filling his sink at home with blood. Additionally, he had about 250 milliliters of blood, including large clots, in a container in the emergency department. He denied using any blood thinners. There was no syncope, dizziness, chest pain, nausea, vomiting, shortness of breath, pain of the tongue, or numbness of the tongue. He had some difficulty speaking but said it was due to needing to retrain his bifurcated tongue.

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SAEM Clinical Image Series: Shortness of Breath

buffalo syndrome

A 60-year-old female presented to the emergency department (ED) for respiratory distress. Emergency medical services reports that the patient was in respiratory distress upon arrival, slowly becoming unresponsive en-route. They started the patient on continuous positive airway pressure, but she lost consciousness with oxygen saturation in the thirties and they switched to bag valve mask (BVM) ventilation, which improved saturations up to 100 percent. Narcan was administered without improvement as she was on narcotics following bronchoscopy earlier today at an outside hospital.

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SAEM Clinical Image Series: Oral Trauma and Mass

oral mass

A 38-year-old African American male without a significant past medical history presented with an oral mass. He was struck on the mouth by a wrench handle about two prior. Since then he has had a growing mass originating from the gum of his left front upper teeth. He is no longer able to eat solid foods and has to use a straw for all oral intake. The patient denies fevers, chest pain, shortness of breath, and weight loss.

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By |2020-12-11T15:18:37-08:00Dec 14, 2020|Academic, ENT, SAEM Clinical Images|

SAEM Clinical Image Series: Eye Pain After Assault

carotid cavernous fistula

A 33-year-old male presents with intermittent blurry vision and left eye pain for 3 months, and a left-sided orbital headache for 1 day. He reports getting punched in the left side of the head during an altercation a few months ago. The eye pain is worse with ocular movements and is associated with bilateral conjunctival injection and white/green discharge from the left eye.

The patient was seen at another emergency department 3 months prior for the same symptoms. He was then found to have left-sided proptosis, visual acuity 20/60 in the left eye, no fluorescein uptake, and a normal fundoscopic exam. The patient was instructed to follow up with ophthalmology but did not. The patient denies fevers, chills, dizziness, nausea, vomiting, and abdominal pain.

 

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