A 48-year-old female presents to the emergency department after a high-speed motor vehicle collision (MVC). She is complaining of left hip pain. Her radiographs are shown (Image 1 courtesy of Dr Ayaz Hidayatov, Radiopaedia.org, rID: 52760). What is your diagnosis? What is the likely mechanism of injury? What physical exam findings are expected? What is your management in the emergency department and when should you consult orthopedics?
A sixty-five-year-old male with a medical history of gastroesophageal reflux disease (GERD), hypertension, alcohol dependence, homelessness, and cocaine abuse presents to the emergency department with abdominal pain for three days. The patient describes his abdominal pain as knife-like, 9/10, located diffusely throughout his abdomen, with associated anorexia and nausea. He reports that he had one episode of coffee ground emesis this morning which provoked him to come to the ED. He reports frequent cocaine use with his last use three days ago. He endorses subjective fevers, chills, and no bowel movement for two days. He has had no sick contacts.
A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with a known CD4 count < 200 cells/µL. She states that the rash began two days ago and progressed to the current size. She describes the rash as burning and has never experienced these symptoms before. She has tried topical corticosteroids which did not alleviate the pain.
A 70-year-old female presents with left elbow pain and deformity after falling on an outstretched hand. You obtain shoulder x-rays and see the above images. What is the most likely diagnosis, likely mechanism of injury, expected physical exam findings, and management plan? (Image 1: AP and lateral views of the left elbow. Author’s own images)
A forty-nine-year-old male with a history of polysubstance abuse, including methamphetamine and intravenous (IV) drug use, rectal cancer, and human immunodeficiency virus (HIV) was brought into the emergency department by emergency medical services (EMS) after he was found down at the bottom of a flight of stairs by his roommate. In the emergency room, he was found to have a Glasgow Coma Scale (GCS) score of 7 and was intubated for airway protection. Non-contrast head CT was performed. Per the roommate, the patient had been “not himself,” exhibiting strange behavior and weight loss. History and review of systems (ROS) were otherwise unobtainable due to the acuity of illness.
Welcome to the AIR Renal/Genitourinary 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 renal and genitourinary emergencies. 6 blog posts within the past 12 months (as of May 2020) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module.
Interested in taking the renal/GU quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account.
| Site | Article | Author | Date | Label |
|---|---|---|---|---|
| emDocs | Complications of Nephrostomy Tubes: ED Presentations, Evaluation, and Management | Michael J. Yoo, MD | 11/11/2019 | AIR |
| RebelEM | Post Contrast Acute Kidney Injury | Salim Rezaie, MD | 1/16/2020 | HM |
| EMCrit | The Myth of Contrast Nephropathy | Josh Farkas, MD | 5/2/2019 | HM |
| EMCrit | Non-Anion Gap Metabolic Acidosis (NAGMA) | Josh Farkas, MD | 9/19/2019 | HM |
| emDocs | EM@3AM: Kidney Transplant Complications | Rachel Bridwell, MD | 12/29/2019 | HM |
| CanadiEM | Testicular Torsion | Subhrata Verma | 11/12/2019 | HM |
(AIR = Approved Instructional Resource; HM = Honorable Mention)
If you have any questions or comments on the AIR series, or this AIR renal/genitourinary module, please contact us! More in-depth information regarding the Social Media Index.
Thank you to the Society of Academic Emergency Medicine (SAEM) and the Council of EM Residency Directors (CORD) for jointly sponsoring the AIR Series! We are thrilled to partner with both on shaping the future of medical education.
A 45-year-old male presents to the emergency department (ED) with right hand pain after an e-bike accident. Physical exam shows deformity and tenderness at the 5th proximal phalanx. Radiographs are shown above (Image 1: Plain radiography of right hand with AP and oblique views. Author’s own images). What is the most likely diagnosis? What are the important aspects of the associated physical examination? What is the management in ED, including pain management? When do you consult orthopedics?
