SAEM Clinical Images Series: Spontaneous Eye Luxation
A 55-year-old female presented with the complaint of “my right eye popped out.” Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. She endorsed right eye blurred vision and severe pain. Vitals: HR 86; RR 16; SpO2 97% on room air; BP 179/111 General: Appears uncomfortable Head: Atraumatic Ocular: OD: globe luxation with severe injection and [+]
SAEM Clinical Images Series: A Curious Case of Anisocoria
A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. The infant appeared to be asymptomatic per parents, without any behavior changes or associated symptoms noted. The patient’s mother noticed her son’s left pupil was dilated and unresponsive to light the morning of presentation. The father had applied a prescription antiperspirant containing glycopyrronium to his axillae the previous evening but denied any known exposure to the infant. Vitals: BP 85/66; HR 143; RR 42; SpO2 100%; T 98.3°F Constitutional: No distress, well [+]
SAEM Clinical Images Series: Xylazine Wounds
A 32 year-old male with PMH significant for opioid use disorder, a prior admission in 2021 for left-sided empyema s/p thoracotomy and decortication, gas bacteremia, and tricuspid endocarditis presented for a left leg wound. The patient reported a wound to his left leg that had become larger over the past 5 months. The pain worsened today, prompting him to come to the emergency department for evaluation. His mother, who was at his bedside, reported that the same type of wound occurred on his right arm “many months ago” and resulted in his arm “falling off”. [+]
SAEM Clinical Images Series: Not Your Average Eczema
A 3-year-old male with a history of severe atopic dermatitis presented for facial rash and hand pain. Mom had been applying Aquaphor and Vaseline several times a day. On the day of presentation, he woke up with a new rash over his face and hands which prompted the ED visit. He is up to date on childhood immunizations and is not prescribed any oral medications. Vitals: BP 103/61; HR 156; Temp 102.9°F; RR 30; SpO2 99%. General: He appears in no acute distress, acting appropriately for age. Interacts and follows commands. [+]
SAEM Clinical Images Series: Pediatric Forehead Swelling
A 12-year-old male with a history of autism spectrum disorder and chronic sinusitis presented for forehead swelling. His mother reported that she noticed progressive forehead swelling for about one month. She had followed up with the patient’s pediatrician and ENT and was given oral cephalexin and fluticasone nasal spray which did not make any changes in his symptoms. The patient denied any fevers or headaches. Vitals: Temp 97.4°F; BP 100/58; HR 90; RR 18; SpO2 98%. General: Patient is comfortable appearing, in no acute distress. ENT: 3x3 cm area of fluctuance centrally [+]
SAEM Clinical Images Series: My Mom Could Not See
An 87-year-old female with a history of hypertension, hyperlipidemia, chronic kidney disease stage IIIB, type 2 diabetes mellitus, and schizophrenia presented for evaluation due to sudden visual loss in her right eye, which began 12 hours before she arrived at the emergency department. She has experienced a sudden loss of vision in her right eye for more than six hours. She reports no eye pain or redness, nor has she experienced any flashing lights. Additionally, there have been no symptoms of numbness, tingling, headache, double vision, facial droop, slurred speech, temporal tenderness, jaw claudication, or [+]
SAEM Clinical Images Series: An On-Target Diagnosis
A 25-year-old female with no pertinent past medical history presented to an emergency department in Massachusetts with four days of generalized malaise, myalgias, congestion, low-grade fever, and a rash behind her left knee. The patient denied cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, and diarrhea. She lives with three roommates, none of whom were sick, and she denied any other known sick contacts. She also denied any occupational exposures or recent travel, although did endorse some recent hiking in the area. Vitals: BP 128/84; HR 88; Temp 98°F; RR 18; SpO2 (on RA) [+]
SAEM Clinical Images Series: Rash and Fever in a Returned Traveler
A 21-year-old otherwise healthy female presented to the Emergency Department with a fever after recently returning from Ghana. She reported intermittent fever, headache with photophobia, diarrhea, joint pains, and generalized weakness. She also noticed a diffuse, intermittently pruritic rash on her trunk and extremities. While in Ghana, she volunteered at a refugee hospital, ate street food, and was exposed to local animals. Prior to her stay in Ghana, she spent a week in Bali. She reported receiving vaccines before leaving but was unsure which vaccines she received. Vitals: Temp 102.9°F; HR 126; [+]
SAEM Clinical Images Series: This Rash Came Out of No Where
A 26-year-old male with a past medical history of eczema presented to the Emergency Department with a rash for two days. The patient stated he first noticed a rash on his right arm that rapidly spread to his face, chest, and left arm. He reported having similar rashes before but never to this extent. The patient stated he was given Bactrim and amoxicillin about one month ago for another rash, though he was unsure of the diagnosis. He denied any known allergies or exposures to new foods or hygiene products. He had no chest pain, [+]
SAEM Clinical Images Series: Rectal Bulge
A 13-month-old, full-term male presented due to intermittent emesis over a 3-week period. He and his parents had COVID one week prior to presentation. He had multiple episodes of non-bloody, non-bilious vomit the day before and the day of presentation. Parents noted he had been listless and unable to tolerate food. The mother was also concerned that he was straining to have bowel movements and that a mass was coming out of his bottom on the ride to the hospital. Parents reported decreased activity, decreased appetite, and decreased urine output. He was born via cesarean section [+]