Not as Simple as Canker Sores
BY NANA P. MATSUMOTO, & DEREK MEEKS, DOA 16-year-old boy presented to a rural ED with a swollen jaw, painful blisters in the mouth, and earache for the past day. One week before, he had a fever with chills, sore throat, and dry coughs. He was not taking any medications, and his immunizations were up-to-date. He had a mild learning disorder but no significant past medical or surgical history.An apthous ulcer, the most common and one of the earliest signs of Behçet's disease.The patient's vital signs were within normal limits, and his physical examination revealed anterior cervical lymphadenopathy, sinus con...
Source: The Case Files - October 11, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Rare but Growing Cause of Abdominal Pain
BY MARK GRANT, DO, & SARAH CARIGNAN, PA-CThe patient had been playing a round of golf a week earlier, and thought he had strained a muscle in his right lower back while swinging a golf club. The patient continued his golf workouts throughout the week, which included lifting weights and swinging a golf club with minimal pain.The day prior to ED presentation, he began having worsening right-sided back pain, and began ibuprofen and ice treatment, which helped minimally. The patient woke up experiencing worsening back pain that radiated from his right flank to his right lower abdominal area. He reported increased pai...
Source: The Case Files - September 13, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Rare Gas-Producing Infection of the Renal Pelvis
BY Dhimitri A. Nikolla, DOAn 82-year-old man with a history of dementia, multiple urinary tract infections, insulin-dependent diabetes mellitus, and an admission a month earlier for Fournier gangrene presented to the emergency department with reports of confusion and hypotension from his nursing home. His vital signs were normal, but he was disoriented with a mildly tender abdomen. His genital examination revealed a suprapubic catheter without evidence of soft tissue infection. A CT with contrast of the abdomen and pelvis revealed the images shown.What is the diagnosis? What is the treatment?The CT images demonstrate...
Source: The Case Files - July 25, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Unusual Presentation after Crack Cocaine Use
BY SEMERE TEDLA, MD; WESLEY EILBERT, MD; & JOSEPH COLLA, MDA 59-year-old man with a history of frequent crack cocaine use presented with difficulty breathing for four hours. He had no prior medical problems or known allergies. He admitted to smoking crack cocaine four days before his symptoms began. He reported a one-day history of productive cough but denied chest pain, sore throat, and fever.He was a well-developed man in mild distress. His temperature was 36.5°C, pulse 90 bpm, blood pressure 188/108 mm Hg, and respiratory rate 20 bpm. His oxygen saturation was 100% on four liters by nasal cannula. Inspi...
Source: The Case Files - July 12, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Elusive Association
This study has been limited for interpretation due to its small sample size and not being the primary focus of the original study.Coronal view showing bilateral polycystic ovaries.A more recent study compared separately the risk of PCOS and its relations to endometrial, ovarian, and breast cancers, which originally showed on analysis that ovarian cancer was not significant (OR 1.41;95% CI,0.93-2.15 p<0.11), but further stratification of the population to include only women younger than 54 showed the risk became significantly elevated (OR 2.52; 95% CI 1.08-5.89, p<0.03). (Hum Reprod Update 2014;20[5]:748.)With PCO...
Source: The Case Files - June 27, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
When Constipation Reaches its Breaking Point
BY ALEJANDRO E. MACIAS; BILLY ZHANG; KRISTEN HUGHES; SHAMIM KHAN, MD; FRANCISCO JACOME, MDA 73-year-old man with a past medical history of hypertension, type 2 diabetes, and hyperlipidemia and a surgical history for a coronary artery bypass presented with sudden, severe lower abdominal pain. He characterized his pain as 8/10 and was tender to palpation.Laboratory studies showed a white blood cell count of 7.51 with a glucose of 759, no bands, a platelet count of 230,000, and a lactic acid level of 6.7. Urinalysis showed +5 ketones and a glucose count of greater than 500. An abdominal CT showed possible microperforations...
Source: The Case Files - June 27, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Rethink Fluid Resuscitation in Pediatric Septic Shock
BY SUAT BIÇER, MD; YAKUP SÖĞÜTLÜ, MD; OLCAY ŞAHNew recommendations on fluid resuscitation in septic children were included in the last pediatric resuscitation guidelines published by the American Heart Association. (Circulation 2015;132[16 Suppl 1]:S177.) Early and rapid intravenous administration of isotonic fluids has been widely accepted as a cornerstone in treating septic shock. A large randomized controlled study revealed that the administration of intravenous fluid boluses in pediatric patients with severe febrile disease in a resource-limited setting might be associated with poor outcomes. (Indian ...
Source: The Case Files - June 13, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Rethink Fluid Resuscitation in Pediatric Septic Shock
BY SUAT BIÇER, MD; YAKUP SÖĞÜTLÜ, MD; OLCAY ŞAHNew recommendations on fluid resuscitation in septic children were included in the last pediatric resuscitation guidelines published by the American Heart Association. (Circulation 2015;132[16 Suppl 1]:S177.) Early and rapid intravenous administration of isotonic fluids has been widely accepted as a cornerstone in treating septic shock. A large randomized controlled study revealed that the administration of intravenous fluid boluses in pediatric patients with severe febrile disease in a resource-limited setting might be associated with poor outcomes. (In...
Source: The Case Files - June 13, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Unusual Diagnosis that Started with Abdominal Pain
BY BILLY ZHANG; KRISTEN HUGHES; SHAMIM KHAN, MD; FRANCISCO JACOME, MDA 51-year-old woman presented to the emergency department with severe mid-abdominal pain that had begun early that morning and progressively worsened. The patient also reported having loose bloody stools, bouts of nausea, and several episodes of vomiting yellow bilious fluid.Her medical history was negative for similar episodes. Past medical history was significant for asthma, gastroesophageal reflux disease, hyperlipidemia, hypertension, colonic polyps, constipation, and thyroid disease. Surgical history included cholecystectomy, C-section, and N...
Source: The Case Files - May 23, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
