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Sinai Daily Pearl 10/25

An infant is brought in with increased irritability x 2 days. The parents note that she hasn’t had any remarkable symptoms – no fever, cough, congestion, vomiting, diarrhea. She is tolerating feeds, but more fussy than usual. Your initial exam is normal. The mother later directs you to take a closer look at the infant’sRead more

Man with Palmar Rash

49M no sig pmhx presents c/o 4 days worsening rash, itching, mostly on his hands and wrists. No fever. Otherwise well. Here is the rash: Note the burrow – http://www.uptodate.com/contents/scabies http://www.uptodate.com/contents/scabies   So the nice thing about this is that involvement of the palms/soles narrows the differential: Worriesome causes: RMSF Scabies – pay attention toRead more

Derm Pearl

A 36 year old male presents to your resus bay complaining of allergic reaction, took first dose of Bactrim last night, started having pruritis, chills, body aches last night and now entire face, chest and back are erythematous and warm. No respiratory symptoms. Exam is notable for tachycardia, blanching diffuse erythema to face, chest andRead more

Daily Em Pearl, 5/6/12

A middle aged male p/w L-great toe pain for 3days, unresponsive to acetaminophen and ibuprofen. He denies fever or other complicating sx. On exam, the medial aspect of the L-great toe is erythematous w/TTP. No areas of fluctuance are appreciated. You need to remove this ingrown toenail. What’s your plan?Read more

Daily Em Pearl, 4/22/12

Abscess: After incision and drainage, do you pack or not? What does the literature say?Read more

Daily Em Pearl, 4/18/12

Early in the morning, a young man p/w R-great toe pain after having his foot stepped on while dancing last night (a few hours ago). On exam, you appreciate full ROM and strength but your patient is pretty uncomfortable. He took paracetamol and ibuprofen at home with minimal relief. There are no signs of infectionRead more

Daily Em Pearl 4/15/12

A pleasant 64yoM w/NIDDM and afib (on coumadin) p/w an abscess to R-medial thigh. He is afeb but there is some surrounding erythema at the abscess site. You perform a thorough incision and drainage and instruct him to return in 2days for wound check; he is discharged with bactrim DS 2tabs BID for 10days. HeRead more