ACMT Toxicology Visual Pearl: Hiss-teria Averted
What is the predominant clinical effect of envenomation by this snake? Acute hepatic failure leading to coagulopathy Direct cardiotoxicity leading to arrhythmias Profound neuromuscular paralysis Rapid onset of shock and multisystem organ failure [Image courtesy of iStock. ID: 1311554579] [+]
Sean Flannigan, MD
Atrian Health Carolinas Medical Center
SAEM Clinical Images Series: Snake it Off
A 35-year-old male with no past medical history presented to the Emergency Department with eye redness. Two days prior, the patient reported he was cutting brush with a chainsaw when he felt something “spray” into his face. After inspecting the area, the patient found the remnants of a dead rattlesnake that unfortunately got in the way of his chainsaw. He subsequently developed bilateral eye redness without pain or vision changes, as well as a painless, pruritic facial rash. The patient denied any additional trauma, [+]
SAEM Clinical Images Series: Unusual Presentation of an Exophytic Tumor
A 60-year-old African American female without a past medical history presented to the emergency department with a complaint of a "hard, yellowish brown, growth" on her right upper abdomen. The patient reported that it had been present and slowly enlarging over a two-year period and was now causing pain when it "snags on clothing". Skin: 9.5 cm, firm, curved, exophytic, keratotic, tumor protruding from the right upper abdominal wall. Non-contributory Histopathology confirmed a diagnosis of a benign Cutaneous Horn a.k.a. Cornu Cutaneum (latin). Cutaneous horns are yellow or white [+]
EM Match Advice 46 | Program Directors Share Match Season Insights
As interview season wraps up, medical students across the country are preparing their rank lists for the upcoming Match. EM Match Advice podcast host, Dr. Sara Krzyzaniak (Stanford EM Program Director) recently sat down with Dr. Melissa Parsons (University of Florida College of Medicine - Jacksonville EM Program Director), to discuss the match process from both program and applicant perspectives. Podcast: Match Season Insights Podcast Sound Engineer: Dr. Kaitlin Bowers What's Happening on the Program Side? Programs are busy finalizing their rank lists through comprehensive meetings with their teams. Many programs, including UF Jacksonville, are intentionally completing their rank [+]
SAEM Clinical Images Series: Bilateral Periorbital Edema
A 20-year-old previously healthy student-athlete female presented with a 2-week history of bilateral periorbital swelling unresponsive to steroids and anti-histamines prescribed by her PCP. The edema had been worsening, and there was a new development of throat tightening and discomfort. She denied rash, allergies, fever, URI symptoms, urinary symptoms, or new medications. General: No acute distress. HEENT: Significant bilateral periorbital edema with an otherwise normal eye exam. 2+ bilateral tonsillar swelling and erythema, no exudates. No uvula swelling or deviation. No oral mucosal lesions. Neck: Anterior and posterior cervical lymphadenopathy. Respiratory: [+]
SAEM Clinical Images Series: Painful Weeping Scalp
An otherwise healthy 11-year-old female presented to the Emergency Department (ED) with one week of scalp pain and discharge. Her symptoms began as a dry and itchy rash in the scalp area that was unresponsive to triamcinolone 0.1% ointment. She was initially seen in clinic and was diagnosed with an abscess of the scalp and treated with Trimethoprim/ Sulfamethoxazole (TMP-SMX) for seven days. Two days before her presentation to ED, the rash started to increase in size and pain, and her mother noticed a purulent oozing coming from her scalp. The patient denied any trauma [+]
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. [+]