SAEM Clinical Image Series: Fever and Aches

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.

(more…)

By Brianna Miner, MD|2020-01-13T15:24:23-08:00Jan 13, 2020|Dermatology, Infectious Disease, SAEM Clinical Images|

EMRad: Can’t Miss Adult Wrist Injuries

Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Last post, we reviewed the elbow. Now, the “Can’t Miss” adult wrist injuries.

(more…)

By Stephen Villa, MD|2020-05-14T22:36:19-07:00Jan 8, 2020|EMRad, Orthopedic, Radiology, Trauma|

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Last post, we focused on the elbow. Now: the wrist.

(more…)

By Stephen Villa, MD|2020-05-14T22:36:28-07:00Jan 8, 2020|EMRad, Orthopedic, Radiology, Trauma|

ACMT Toxicology Visual Pearls: Painful Hand

What is the recommended treatment for a patient with this hand injury following a sting by the marine creature shown?

(more…)

By Angela Rombola, MD|2020-01-02T23:11:26-08:00Jan 1, 2020|ACMT Visual Pearls, Environmental, Expert Peer Reviewed (Clinical), Tox & Medications|

SplintER Series: A Rare Cause of Traumatic Thumb Pain

A 45 year-old male presents with right thumb pain and deformity after falling off his bicycle. You obtain hand x-rays and see the following images. What is the most likely diagnosis, differential diagnosis, and management plan?

Figure 1. AP and oblique views of the hand. Author’s own images.

(more…)

By Victor Huang, MD|2019-12-29T11:26:41-08:00Dec 30, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

SplintER Series: The 2 minute ankle exam | Leg Day #5

Welcome to Leg Day #5 of the SplintER Series. The focused history and physical ankle exam of the patient with an acute ankle injury is a crucial tool often overlooked in the Emergency Department (ED). Our hope is that after enough practice, you will be able to complete your ankle exam within 2 minutes! The key is to practice, practice, and practice some more.

(more…)

By Julien Jean Francois, MD|2019-12-27T15:02:29-08:00Dec 25, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

SAEM Clinical Image Series: A Multifactorial Skin Eruption

A 9-year-old male with no past medical history, brought in by his mother to the ER with a new rash on his face and torso. The rash began 10 days ago. On the day he developed the rash, the patient noted swimming in a newly chlorinated outdoor pool. That same day he also played with freshly picked oranges and limes outdoors with his friends, having squeezed the juices onto his head and body. He developed a non-painful, non-pruritic, hyper-pigmented rash on his left cheek.

Over the course of 3 days, the patient and his family went on a trip to a local river, during which the rash evolved to scattered patches on his face and dorsum of his hands with an associated burning sensation exacerbated by contact with hot water or sunscreen. He received outpatient treated by a medical provider at day 3 for presumed infection with both oral and topical antibiotics. He completed the antibiotics, with worsening of his skin lesions. They have since formed blisters and affected his torso.

The patient never had any similar symptoms, or allergies. He had no sick contacts or travel outside the U.S. He denies any history of trauma, thermal burns, or arthropod exposure. The patient has not had fevers, respiratory symptoms, gastrointestinal symptoms, or urinary symptoms.

(more…)

By Erwin Kong, MD|2019-12-23T18:35:31-08:00Dec 24, 2019|Dermatology, SAEM Clinical Images|