History of Presenting Illness A 5-year-old boy was brought to the emergency department with severe abdominal pain, fever, vomiting, rebound tenderness, and guarding. His symptoms strongly indicated acute appendicitis. The pain began just a day ago, initially accompanied by fever and localized to the right lower quadrant. Considering the child's low-grade fever, vomiting, anorexia, and …
History of Presenting Illness An 81 year old male presented to the Emergency Department with chief complaint of low blood pressure and elevated blood sugars. This patient had a medical history significant for hypertension and hyperlipidemia. This patient is highly functional at his age up until about one week ago. He is able to ambulate …
Intro: Distal digital trauma is common and often associated with cosmetic and functional disturbances.Underlying lacerations are often masked by gross deformities of the nail and hematomas.Crush and blunt force injuries are usually the mechanisms involved with nail deformities and underlying nailbed injuries.Treatment can often necessitate nail removal based on clinical judgement and suspicion of underlying …
44 year old male presents to ED with a medical history of hypertension and notes several vague complaints including numbness, fatigue, and slurred speech. Patient’s girlfriend notes that over the last several days the patient has been acting strangely, slurring his speech, appears confused, while periodically falling asleep. Physical exam is grossly negative with the …
Continue reading Toxic Alcohols and the 5 minutes before the exam
A 34 year old male with a medical history of hypertension, hyperlipidemia and chronic liver injury secondary to alcohol abuse presented to the emergency department with diffuse abdominal pain and more than 30 episodes of vomiting over the past 12 hours. The patient admitted to increased alcohol intake over the past two days, however stated …
A 76 year old woman presents to the ED with progressive leg weakness. The patient states that for several days she’s been having trouble standing from a seated position, and has had multiple falls recently. PMH includes HTN, COPD, neuropathy and chronic hyponatremia (etiology not stated in records). The patient states that for years she has …
A 69 y/o female presents via EMS with altered mental status. The patient is able to tell you her name, but can’t answer any other questions. Her husband states that she has cirrhosis and recently has been having increasing ascites as well as anorexia. She has not been compliant with her lactulose. On exam she …
Dyspnea and syncope are common complaints seen in the ED. Most of us would not hesitate to add acute coronary syndrome or pulmonary embolism to the differential, but pulmonary hypertension with right heart failure is a differential frequently left off of that list. Although not as common as some of the other causes of dyspnea, missing …
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