SAEM Clinical Image Series: Strange Eyes

A 3-month-old boy, born full-term via normal spontaneous vaginal delivery to a gravida 2 para 1 mom with negative prenatal labs, presents with abnormal eye movement and position. His parents report 2 days of an increase in bulging of the soft spot, head size, and abnormal eye movement. He has not been able to look at his mother “like he used to.” This is associated with an increase in fussiness, poor feeding, and non-bilious, non-bloody vomiting. He also had increased sleepiness and difficulty waking up for feedings overnight.

The patient has normal urination with no weight loss, diarrhea, or fever.

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By Krista McEwan|2020-11-21T17:43:41-08:00Nov 16, 2020|Academic, Emergency Medicine, SAEM Clinical Images|

SAEM Clinical Image Series: An Incidental Finding

A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered.

After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip and nose, causing a lip laceration and a minor bloody nose. The patient was seen in the emergency department. The laceration was repaired, and he was discharged without imaging. The patient denied any significant residual symptoms or personality changes. The patient had no idea that a nail had discharged from the gun and lodged in his face and brain.

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By Lincoln Ropp, DO|2020-11-13T12:27:23-08:00Nov 16, 2020|Academic, Emergency Medicine, HEENT, SAEM Clinical Images, Trauma|

SAEM Clinical Image Series: Eye Injury

An 11-year-old male presented to a pediatric trauma center following a motor vehicle collision (MVC). He was the restrained front-seat passenger when his vehicle was struck head-on, causing frontal airbag deployment. His primary complaint was pain around his right eye with associated blurry vision. He denied diplopia, pain with extraocular movements, flashers, floaters, or curtains in his vision.

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By Thomas Jauch, MD|2020-10-31T22:05:30-07:00Nov 2, 2020|Academic, Emergency Medicine, Ophthalmology, SAEM Clinical Images|

SAEM Clinical Image Series: Pitching Pain

A twenty-year-old right-handed male presented to the emergency department with a past medical history of right coracoid impingement, and three months of increasing right shoulder pain that became suddenly worse. He had a right shoulder arthroscopy nine months ago and played a full season as his baseball team’s pitcher over the past four months. He endorsed no exacerbating symptoms other than movement and has only taken naproxen over the counter for this pain. He denied any family history of clotting disorders.

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By Cooper March, B.S.|2020-10-17T21:13:38-07:00Oct 19, 2020|Academic, Emergency Medicine, SAEM Clinical Images|

SAEM Clinical Image Series: Knee Pain

A fifty-six-year-old male with a past medical history of legal blindness and remote right quadricep tendon rupture presents to the emergency department via emergency medical services (EMS) after a mechanical fall, complaining of left knee pain. According to the patient, he is in his regular state of health and was walking with his cane when he had a mechanical fall on the sidewalk after tripping on an unknown object and falling onto his left knee.

The patient did not hit his head, did not lose consciousness, and has no head, neck, or back pain. The patient states that he fell directly onto his knee and felt a popping upon hitting the ground, and remembers all events surrounding the incident. The patient was not ambulatory prior to coming to the emergency department.

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By Eric R. Friedman, MD|2020-10-17T21:39:44-07:00Oct 19, 2020|Academic, Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound|

SAEM Clinical Image Series: Red, White, & Blue

A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an initial generalized redness into a blue/black lesion with blistering and extensive redness along her leg and torso. She denied fever, chills, lightheadedness, abdominal pain, nausea, vomiting, and hematuria.

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By Andrew D’Alessandro, MD|2020-10-13T21:07:28-07:00Oct 12, 2020|Dermatology, Emergency Medicine, Environmental, SAEM Clinical Images, Tox & Medications|

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|

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