SAEM Clinical Image Series: Flu-like symptoms, oral ulcers, and rash

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Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash

History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of:

Flu-like symptoms
Progressive lip pain/swelling
Mouth pain
Oral ulcers
Eye redness
New erythematous rash involving the palms/soles and lower extremities

The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented to an outside emergency department (ED) 12 hours prior, where he was told that he had a viral infection, given pain medication, and discharged home. He has not taken any other medications. The patient presents to this ED due to progression of symptoms, including the development of a pruritic rash on his palms, soles, and lower extremities. Upon further questioning, the patient also reports vaginal itching and a fishy odor. He has a history of bacterial vaginosis and states that these symptoms feel similar. The patient denies genital sores, vaginal discharge, and vaginal bleeding. He is currently sexually active with men and women, and does not regularly use barrier protection.

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By Nicholas Stark, MD|2019-07-28T21:30:17-07:00Jul 22, 2019|Allergy-Immunology, Dermatology, Genitourinary, SAEM Clinical Images|

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. ¹ Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control.

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By Kara Bragg DNP, APRN, FNP-C, ENP-BC|2019-07-15T18:29:18-07:00Jul 17, 2019|Gastrointestinal, Tricks of the Trade|

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

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By Shannon Flood, MD|2021-08-15T10:21:49-07:00Jul 15, 2019|ENT, Guideline Review, Infectious Disease, Pediatrics|

Welcome to Leg Day #4 of the SplintER Series! Ankle dislocations are an emergent condition in the Emergency Department (ED) that requires expert-level examination and management. We review the pertinent and subtle sports medicine examination and management techniques that will help you feel in control from time of presentation to disposition.

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By Summer Chavez, DO MPH|2019-09-09T13:56:43-07:00Jul 10, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

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Chief Complaint: Right lower extremity injury while spear fishing

History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He got out of the water and walked 2 miles unassisted before finding help and hospital transport.

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By Michael Parsa, MD|2019-07-28T21:31:42-07:00Jul 8, 2019|SAEM Clinical Images, Trauma|

SplintER Series: A Case of Traumatic Wrist Pain After Fall on Outstretched Hand

A 46 year-old male presents with wrist pain after sustaining a mechanical fall and catching himself on his outstretched hand. An anteroposterior (left) and lateral (right) plain films of the wrist are obtained (photo credit).

What is the diagnosis (hint – there are 2 findings), injury classification system, associated findings, and the recommended management plan?

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By Tabitha Ford, MD|2019-09-10T14:00:40-07:00Jul 3, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

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Chief Complaint: Abdominal distention

History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he is unable to communicate but is accompanied by his mother who provides his medical history. The patient’s mother states that he had a loose bowel movement this morning, which is normal for him. He has had a history of bowel problems since the age of 14. Two months previously the patient was admitted for abdominal distention and had a rectal tube placed which relieved his symptoms. The patient has not experienced nausea, vomiting, or changes in bowel movements.

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By Benjamin Gibson|2019-07-28T21:32:13-07:00Jul 1, 2019|Gastrointestinal, SAEM Clinical Images|