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Abdominal Pain in a Young Male

 A 14 y/o M presents to the ED complaining of severe intermittent low abdominal pain x 2 hours. His symptoms began after he awoke from sleep to urinate, and have been unremitting since. No history of trauma. He vomited once, 20 minutes prior to arrival. His abdominal exam is benign. He appears very uncomfortable andRead more

55 Chinese woman, no PMH, no meds.  P/w epigastric discomfort x 2 weeks, not responding to Pepcid Maalox.  Presented to Elmhurst ED for worsening epigastric discomfort and generalized weakness.  No fever/chill. + Mild dry cough.  No chest pain. + Mild SOB with exertion.  No abd pain, n/v/d/c/dysuria.  No night sweats or weight loss, denied exposure toRead more

22 Yo Woman with 2 Days of Headache

Case as discussed in today’s morning report by Dr. Lim. Thanks to Dr. Gardner for some thought-provoking questions leading to an excellent discussion. 22F no sig pmhx presented to the ED with 2d of a global, gradual-onset, throbbing headache. No similar or frequent headaches prior. Has also had URI symptoms the past few days includingRead more

Gi Pearl

70 yo F presents with RUQ pain, fever, and AMS.  What is the diagnosis?Read more

Daily Em Pearl, 5/2/12

An elderly man presents with new bloody urine x2days and abdominal distention/fullness. He noticed some clots prior to presentation and now hasn’t urinated x5hours despite a real urge to micturate. He has a h/o BPH and is on coumadin for afib. At clinic yesterday his INR was 2. On sono you appreciate a full bladderRead more

Daily Em Pearl, 5/1/12

A middle-aged G3P2 presents at 19wks gestation c/o abd pain that started early this AM. She had some nausea but no vomiting, a subjective fever and no loose or frequent stools. Your differential is broad but at the top is appendicitis. You d/w OB/GYN and radiology. You all agree that the patient needs imaging toRead more

Daily Em Pearl, 4/25/12

How do you evaluate for an ectopic pregnancy (versus an intrauterine pregnancy)?  Read more

Daily Em Pearl, 4/19/12

A 6yoM is brought by his guardian for intermittent crying, c/o abd pain for the past two days; he has vomited 4times over the past 2days. He has had no fever and has never had anything like this before.  At home his urine has been dark, and this morning, possibly bloody. He has no medicalRead more

Daily Em Pearl 4/16/12

A 55yoM is BIBEMS after an MVC c/o RLE pain w/obvious deformity at the thigh. Distally he is NVI but is in excruciating pain. The portable plain film shows a mid shaft fracture. You order dilaudid but he’s still really uncomfortable. How can you help him?  Read more

daily EM pearl, 4/13/12

A young woman presents with a painful wrist, no trauma history. On exam, there is an effusion present, no erythema and tenderness to palpation. She is afebrile. How do you rule out a septic joint? What pathogen should be considered?  Read more