A Simple Case of Abdominal Pain in the ED?
A previously healthy 17-year-old girl presented to the ED with one month of intermittent, burning epigastric pain associated with nausea and vomiting. Pain was worsened by spicy, greasy foods, and alleviated by sparkling water. She said she came to the ED because the pain had persisted for a while and was interfering with her life. The patient denied fevers, recent travel, or a change in bowel movements. She admitted to traveling to Nicaragua many times in her life and to an unintentional 20-pound weight gain over the past year.Vitals at presentation were a heart rate of 83 bpm, temperature of 36.6°C, blood pressure...
Source: The Case Files - May 10, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Atypical Presentation of Colorectal Adenocarcinoma
BY LOUISE VESANEN, MSC, & AHMED RAZZIUDIN, MDA 53-year-old woman was brought to the ED from a nursing home for hypotension and hypoxia. She appeared septic. Her blood pressure was 80/60 mm Hg, and she was pale, cyanotic, and jaundiced. The patient was nonverbal at baseline due to underlying cerebral palsy, so information about her present illness was provided by her nursing home. Recent records listed elevated alkaline phosphatase and gallstone finding on ultrasound. Physical exam demonstrated abdominal distension and tenderness on palpation of her right upper quadrant.Initial workup included CBC, CMP, blood g...
Source: The Case Files - April 26, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Diagnosis More than Skin Deep
BY AARON SNYDER, MDInfectious processes, such as streptococcal infections, can partially masquerade as alternative diagnosis. Streptococcal infections are a frequent source of infection treated by emergency physicians, and it is crucial that the appropriate tests, antibiotics, and hospitalization are used to recognize rash patterns and to identify causes and the differential of causation.A 60-year-old woman presented from her primary medical doctor's office with fever, fatigue, tachycardia, and facial discomfort for two days that developed into a malar rash. The patient reported one day of fever, several days of sore th...
Source: The Case Files - April 26, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
An Unusual Cause of Hyperglycemia
BY CHRISTINE SHEELER; SEEMA ELAHI, MDA 46-year-old man presented to the ED with multiple complaints, including fatigue and dizziness for one day. His primary care physician had diagnosed him with diabetes the previous day, and had prescribed him an oral hypoglycemic as well as insulin. Neither, however, was started at the time of presentation. The patient had a medical history significant for HIV, with his most recent CD4 count above 500, and bilateral sensorineural hearing loss, which had progressively worsened since its initial onset in his 20s. His physical exam was unremarkable except for decreased hearing bilateral...
Source: The Case Files - April 13, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Cold n' Sweet DKA
BY SAAD CHAUDHRY; CHI ZHANG; AHMED RAZIUDDIN, MDA 62-year-old tall, thin African American man presented to the emergency department after four days of constipation and vomiting. He had decreased mental status, and was unable to provide a complete medical background. His spouse reported that the patient had diffuse abdominal pain for the past four days, and had been experiencing increased thirst and excessive urination for the past four weeks.She reported that the patient was unresponsive to over-the-counter laxatives and had been unable to produce bowel movements. The patient had no prior abdominal surgery, med...
Source: The Case Files - March 29, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Cold n' Sweet DKA
A 62-year-old tall, thin African American man presented to the emergency department after four days of constipation and vomiting. He had decreased mental status, and was unable to provide a complete medical background. His spouse reported that the patient had diffuse abdominal pain for the past four days, and had been experiencing increased thirst and excessive urination for the past four weeks.She reported that the patient was unresponsive to over-the-counter laxatives and had been unable to produce bowel movements. The patient had no prior abdominal surgery, medication use, or primary care visits. The patient used to be ...
Source: The Case Files - March 29, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Face and Neck Swelling Hint at a Daunting Diagnosis
BY MOHAMMED HASSAN-ALI, MSC, & AHMED RAZIUDDIN, MDA 56-year-old black man presented to the ED complaining of face and neck swelling. An initial history was difficult to obtain because the patient did not speak English fluently and had slurred speech. Symptoms started approximately a week earlier when the patient was at his nursing home. He denied dysphagia or odynophagia, he had no rashes, pruritus, dyspnea, or peripheral edema, his face was flushed, and he had visibly engorged neck veins. He noticed that his tongue was mildly swollen, so he took Benadryl for a week with no relief. The patient said he believed that ...
Source: The Case Files - February 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Tramadol vs. Everything: 744 Drug Interactions and Counting
BY THOMAS BARROWS, MDA 43-year-old woman presented to our emergency department with complaints of anxiety, intermittent “cramping” in her left hand, and jerking movements of her body that had been going on for five days. She had depression following the death of her son 14 months earlier, for which she was started on Effexor 37.5 mg once daily two weeks earlier.One week before this visit, the patient had back pain and headache, for which she was evaluated at a local emergency department. She had lumbar x-rays showing mild degenerative changes in her spine and a normal head CT scan. The emergency physician...
Source: The Case Files - January 17, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research
