SAEM Clinical Images Series: Green Foot
The patient is a 59-year-old male with a history of prior DVT, atrial fibrillation, HTN, alcohol use and COPD who presents to the Emergency Department with chest pain, dyspnea, and left lower extremity swelling and pain. He had a prior hospital admission two weeks ago for leg swelling and cellulitis. He was previously prescribed oral gentamicin and topical mupirocin for concerns of foot infection, which he has been compliant with taking. He has been working long hours as a construction worker, but knows of no chemical exposure to his feet and [+]
ACMT Toxicology Visual Pearl – Master of Deceit
What venomous marine animal is pictured? Fire coral Lionfish Sea urchin Stonefish [Image from Rapheal Duprat via Wikimedia] [+]
Andrew Scott, MD
Atrium Health Carolinas Medical Center
Latest posts by Andrew Scott, MD (see all)
SAEM Clinical Images Series: Connect the Dots
The patient is a 39-year-old female with past medical history of polysubstance use disorder and seizures who presents to the Emergency Department complaining of bilateral leg pain, primarily in her joints. She states that she was seen by her PCP today and was given a shot of Toradol, but she reports that her pain has continued to worsen to the point that she has difficulty ambulating. She states that two days ago she developed pruritic blisters on her feet and her feet began to swell. She reports the blisters have worsened [+]
SAEM Clinical Images Series: A Grain of Sand… or Something More Sinister?
A 54-year-old male with a history of Type 2 Diabetes Mellitus presented with one day of atraumatic left eye pain. He reports pain with blinking and a sandy foreign body sensation. Patient denies new discharge from the eye, though endorses increased tearing. He reports no recent trauma to the face or chemical exposures. He has had no recent rashes or sick contacts and no associated infectious symptoms. Patient does not wear contact lenses. Vitals: BP 159/98, HR 73, Temp [+]
ACMT Toxicology Visual Pearl: Sleeping with the Fishes
What recreationally used substance has been dispensed in this fish-shaped dropper? Amyl nitrite Gamma-hydroxybutyrate (GHB) Heroin Ketamine [Author’s own image] [+]
SAEM Clinical Images Series: Modern Pirate
The patient is a 72-year-old male with multiple medical problems who presents to the Emergency Department complaining of dyspnea on exertion. The patient also complains of bruising that has developed on his right leg. He states that he previously had a similar episode for which she was admitted to the hospital and had warfarin discontinued due to thrombocytopenia. He also reports that he has been unable to eat or drink much lately due to gum swelling and tenderness, and states that when he begins chewing he feels as [+]
SAEM Clinical Images Series: A Mucous Membrane Mystery
The patient is a healthy 14-year-old male without past medical history who presents to the Emergency Department with oral lesions, eye swelling, intermittent fevers, and pain with urination. Over the past 10 days he has been seen by his PCP and at an outside ED for a cough, sore throat, fevers, and oral pain. Three days ago he was seen by his PCP, had a positive rapid strep test, and was started on amoxicillin. His oral lesions and lip swelling have been progressively worsening over [+]
SAEM Clinical Images Series: An Unusual Appearing Umbilicus
The patient is a 70-year-old female with a remote history of breast cancer who presents to the Emergency Department with family due to frequent falls and disorientation. Her family reports that she previously walked independently. However, over the last several months, she has had worsening weakness and has become wheelchair-bound. Nonetheless, she frequently attempts to walk and loses her balance, leading her to falling. She is brought in today due to another fall along with worsening confusion over the [+]
SAEM Clinical Images Series: Bilateral Leg Swelling with a Uterine Twist
The patient is a 40-year-old female who presents to the Emergency Department with bilateral leg swelling. Her symptoms started six days prior and have progressively worsened. Her symptoms are associated with shortness of breath with no chest pain. The patient has taken an over-the-counter diuretic, which has helped with her symptoms. She also reports intermittent vaginal bleeding for the past two months, with a LMP that was two months prior. She is not currently on contraceptives, and does endorse unprotected intercourse over this time. The patient denies headache, blurry vision, nausea [+]
SAEM Clinical Images Series: A Curious Case of Abdominal Pain
The patient is a 22-year-old G0P0 female who presents to the Emergency Department with two days of left lower quadrant abdominal pain. The patient rates her pain as 10/10 in intensity, sharp in character, and states the pain radiates to her lower back. She notes similar intermittent pain over the past few months, but the pain became persistent over the past two days and has worsened. She also reports decreased appetite with nausea and vomiting. Her pain is exacerbated by movement. She began her menstrual period three [+]