Case: A 32-year-old male with a past medical history of diabetes presents with a 1 month history of finger pain after slamming his finger in a car door. 2 weeks after the initial incident he presented to the emergency department for worsening pain and received x-rays that were negative for acute fracture. Today he presents reporting pain radiating up the hand, arm, and into the shoulder, with associated chills. His labs are significant for hyperglycemia, hyponatremia, and an elevated erythrocyte sedimentation rate and c-reactive protein. His x-ray is seen here (figure 1 image courtesy of Daniel Rogan, MD). What is the diagnosis?
A 37-year-old female presented to the emergency department for evaluation of numbness and discoloration to her left fourth finger, which had started the day before. The patient stated that she was gardening the previous day and afterward she noticed the discoloration and pain. The patient denied taking any medications. She reported recreational methamphetamine and heroin use. She denied any chest pain or difficulty breathing. She denied any history of Raynaud’s phenomenon, venous thromboembolism, or history of trauma. The patient was afebrile with normal vital signs. Physical exam revealed cyanotic discoloration to the left distal fourth finger. Sensation was intact to light touch and strength was 5 out of 5 in the finger. The capillary refill was diminished. Radial and ulnar pulses were 2+ bilaterally. Initially, a warm pack was placed to the patient’s finger with slight improvement, but without resolution of the pain and cyanosis. What is the diagnosis?
A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.
A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she was stung by any bugs or mosquitos.
Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to infectious disease emergencies. 9 blog posts within the past 12 months (as of September 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 8 Honorable Mentions. We recommend programs give 4.5 hours (about 30 minutes per article) of III credit for this module.
A 25 year old male with a history of acute myeloid leukemia (AML) after an allogeneic stem cell transplant, which has been in remission for 6 years. He presents with a headache and rash. 4 days ago the patient noticed a rash on the abdomen that was itchy, but not painful. Today, he noticed a similar rash on his face.
The headache started yesterday, waking him up from sleep. It is now slowly getting worse. He endorses chills, nausea, neck stiffness, neck pain, myalgias, and photophobia. He denies fevers, vomiting and phonophobia. He does have small headaches regularly but this headache is one of the most painful of his life. He does not take any immunosuppressants or medications.
Did you get your flu shot? We hope so. Influenza season is upon us again and it is always helpful to review the latest 2018 Infectious Disease Society of America (IDSA) update on the diagnosis and treatment of influenza.1 Notable is that influenza-confirmed patients who present within 2 days of symptoms who are deemed low risk do not automatically warrant antiviral treatment. The subsequent question then is who is high risk? The following infographic by our Guidelines Editor, Dr. Kelly Wong, summarizes the key take-home points for emergency medicine clinicians.(more…)