SAEM Clinical Image Series: Double Vision

Chief complaint: Double vision

History of Present Illness: 61 year old female with history of HTN, DM, hyperlipidemia, and chronic low back pain presenting with double vision. She received an epidural spinal injection yesterday for the 4th time for low back pain. She was sedated for the procedure and woke up with headache, neck stiffness, and left eye “jumping around,” which progressed to double vision 1 hour later.

There was no blurry or double vision with either eye closed. She had 1 episode of emesis. She presented to the ED 24 hours later with continued headache and double vision.

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By Richard Wang, MD|2019-10-30T21:13:07-07:00Oct 14, 2019|Neurology, Ophthalmology, SAEM Clinical Images|

SAEM Clinical Image Series: Bumps and Balls

A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia.

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By Anwar Ferdinand, MD|2019-11-10T21:41:57-08:00Oct 14, 2019|Dermatology, Infectious Disease, SAEM Clinical Images|

SplintER Series: A Case of Knee Pain

$segond fracture xray$

A 45-year-old male presents with right knee pain after he pivoted and felt a “pop” while making a move playing pickup basketball. You obtain knee x-rays and see a lateral irregularity in the AP view (photo courtesy of Dr. Gerry Gardner at Radiopaedia.org).

What is the most likely diagnosis, commonly associated injury, and appropriate management plan?

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By Alex Wertheimer, MD|2019-10-09T12:46:48-07:00Oct 9, 2019|Expert Peer Reviewed (Clinical), Orthopedic, Radiology|

Mastering procedural sedation can make your shifts safer, more efficient, and more comfortable for your patients. But what defines a sedation? What and who do I need? Does my patient need to be fasting? How should I choose and dose my medications? Below is a brief guide to help you be more confident in your definitions, preparation, and medications. Included is a guide card you can print out and clip behind your badge! Read on and be a pro for your next on-shift sedation.

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By Mac Chamberlin, MD|2019-10-08T20:12:27-07:00Oct 7, 2019|Expert Peer Reviewed (Clinical), Tox & Medications|

You need to perform an ultrasound on your patient. You walk up to the ultrasound and upon grabbing the machine, you notice it’s stuck! You look down and realize the ultrasound probe cable (particularly the linear probe) is impeding the wheel from rolling. You push the machine back, pick the cable up off the floor and off you go to scan to find that the probe is not working. As you try to figure out why it’s not working, you realize that the cable is exposed after repeated damage from the countless times the wheels on the machine rolled over the cable. Let’s prevent this from happening!

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By Leoh N. León II, MD|2019-09-28T08:29:44-07:00Oct 4, 2019|Tricks of the Trade, Ultrasound|

ACMT Toxicology Visual Pearls: Getting Caught Yellow-handed

Which bodybuilding supplement is associated with hyperthermia and this clinical image?

2,4-dinitrophenol (DNP)
Beta-carotene
Caffeine
Creatine
Dimethyl amylamine (DMAA)

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By Francisco Javier Andrade Jr., MD|2019-11-12T19:01:54-08:00Oct 2, 2019|ACMT Visual Pearls, Environmental, Tox & Medications|

[Click for larger view]

Chief complaint: Left eye pain, redness, and foreign body sensation

History of Present Illness: 39 year old man presents after metal grinding without protective eyewear three days prior.

He had felt something strike his left eye. He developed “burning” pain, tearing, and redness. Pain worsens with extraocular movements. He notes that vision in his right eye has always been worse than the left. Denies any other visual complaints.

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By Roger Roxas, MD|2019-09-27T21:17:56-07:00Sep 30, 2019|Ophthalmology, SAEM Clinical Images|