SAEM Clinical Images Series: A Lethal Combination of Skin and Lung Findings

By |Categories: Dermatology, Pulmonary, Rheumatology, SAEM Clinical Images|

A 49-year-old female with a past medical history of recurrent diverticulitis initially presented with one month of shortness of breath and a minor nonproductive cough for which she was started on doxycycline by her primary care provider. She then developed a rash on her chest, upper back, and face. Antibiotics were switched to amoxicillin and azithromycin. She underwent a brief admission of six days for shortness of breath but did not have an oxygen requirement at that time. She was evaluated by pulmonology (evaluated for cocci, unknown results), and then discharged. She then presented again [+]

SAEM Clinical Images Series: Enigmatic Traumatic Hip Pain

By |Categories: Orthopedic, Radiology, SAEM Clinical Images|

An 84-year-old female presented with a chief complaint of right hip pain after a fall 12 hours prior to presentation. The patient reported a history of falls resulting in shoulder, rib, and left hip fractures in the past. The patient stated that upon getting out of bed, she took 4-5 steps, lost her balance, and fell backward onto the bedroom floor. She denied loss of consciousness. She denied syncope or vertigo before the fall. She was unable to bear weight due to a 7/10 intensity pain on the anterior medial aspect of her right thigh [+]

SAEM Clinical Images Series: Rapidly Spreading Rash

By |Categories: Dermatology, SAEM Clinical Images|

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. Two days prior to presentation she began to experience fevers with a Tmax of 103°F. One day before presentation she developed a rash that began on her face and slowly spread down her body, now involving her palms. The patient endorsed associated pruritus and cervical lymphadenopathy with the rash. The patient specifically denied mucous membrane involvement (mouth, eyes, genitalia), vomiting, diarrhea, dysuria, hematuria, neck stiffness, cough, dyspnea, chest pain, or exposure to ticks or [+]

SAEM Clinical Images Series: Bulge in the Belly

By |Categories: Gastrointestinal, SAEM Clinical Images|

A 45-year-old male status-post right nephrectomy secondary to a renal mass presented to the emergency department with right-sided flank pain. He endorsed low-grade intermittent right-sided flank pain since the nephrectomy one year prior, associated with an increasingly enlarging mass extending laterally from his right abdomen. Over the course of the past several days, the mass had become larger and more painful. He denied any fevers, chills, or signs of systemic illness, and reported no urinary symptoms. Vitals: T 98°F; HR 88; RR 17; BP 121/67; SpO2 97% on RA Respiratory: Clear to [+]

SAEM Clinical Images Series: Penile Lesion with a Poor Prognosis

By |Categories: Genitourinary, Renal, SAEM Clinical Images|

A 49-year-old male presented to the emergency department of an academic hospital with the chief concern of penile pain. Prior medical history is notable for end-stage renal disease on hemodialysis three times per week, but the patient has not been dialyzed in the past four days, hypertension, insulin-dependent diabetes mellitus, heart failure with reduced ejection fraction (59% two months prior), seizure disorder, prior pulmonary embolism (eight months prior), a left nephrectomy seven months ago due to a gunshot wound, bradycardia status post permanent pacemaker, duodenal ulcer, and dry gangrene of the left foot. The patient [+]

SAEM Clinical Images Series: Face and Chest Rash

By |Categories: Dermatology, Infectious Disease, SAEM Clinical Images|

A 23-year-old female with a past medical history of asthma presented with a rash that began five days ago on her face and spread to her chest. The lesions are painful and pruritic, spreading slightly to her extremities. She noted a slight sore throat and nasal congestion. She denied any known fever and had no known vaginal or oral lesions. She has a 5-year-old daughter at home with no known symptoms. She is sexually active with one male partner who has no rash or illness. She is vaccinated for COVID-19. She is unsure of childhood [+]

  • xylazine skin necrosis

ACMT Toxicology Visual Pearl: Needle to Necrosis

By |Categories: ACMT Visual Pearls, Expert Peer Reviewed (Clinical), Tox & Medications|

Which of the following agents, when injected along with heroin, is associated with the skin changes pictured? Cocaine Fentanyl Methamphetamine Xylazine Photo by Dr. Matthew Salzman [+]

Christiana Agbonghae, MD

Christiana Agbonghae, MD

Emergency Medicine Resident
Carolinas Medical Center
Christiana Agbonghae, MD

Latest posts by Christiana Agbonghae, MD (see all)

SAEM Clinical Images Series: Utility of Bedside Ultrasonography

By |Categories: Gastrointestinal, Ob/Gyn, SAEM Clinical Images, Ultrasound|

A 24-year-old G1P0010 female with a PMHx of ovarian cyst (unknown laterality) and emergency contraceptive use 3 months prior presented with sudden onset abdominal pain (upper > lower) that awoke her from sleep four hours prior to presentation with associated nausea and mild lower back pain. The pain is 10/10, sharp, stabbing, and diffuse. Additionally, she reported trace white vaginal discharge at baseline. No acute increase. She had intermittent vaginal bleeding since contraception use over the past two months, which has now resolved. She denied fever, chills, vomiting, chest pain, shortness of breath, diarrhea, or [+]

  • golden poison dart frog acmt

ACMT Toxicology Visual Pearl: Poison Dart Frog

By |Categories: ACMT Visual Pearls, Expert Peer Reviewed (Clinical), Tox & Medications|

The toxin from the golden poison dart frog most resembles which of the following in its mechanism of action? Botulinum toxin Bufotoxin Grayanotoxin Palytoxin Tetrodotoxin Photo adapted from Wilfried Berns (Wikimedia Commons) [+]

Nathaneal Franks, MD

Nathaneal Franks, MD

Emergency Medicine Resident
Carolinas Medical Center
Nathaneal Franks, MD

Latest posts by Nathaneal Franks, MD

SAEM Clinical Images Series: Pediatric Genitourinary Bleeding

By |Categories: Ob/Gyn, Pediatrics, SAEM Clinical Images|

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. There is no history of any recent falls or trauma, abdominal pain, pain to the vagina, dysuria, prior incidents of vaginal bleeding, or any noticeable behavioral changes per the grandmother. The patient lives at home [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer,
Shuhan He, MD