You are caring for a 7mo child who is not moving the LUE; a plain film shows a fracture. Child maltreatment is high on your differential. You want to order a skeletal survey and your medical student wants to know precisely what you’re…
A middle aged man presents complaining of foreign body sensation in his eye, subjective fever, pain with spontaneous eye opening and ipsilateral ear pain. On exam, you don’t see any foreign bodies, but you do note multiple corneal infiltrat…
28 y.o. male felt his left knee “pop” after landing from a jump while playing basketball. Knee exam revealed limited knee extension. X-ray is shown in the link below. Diagnosis? https://…
A 53yoM presents with bilateral TMJ dislocation which he has had in the past. He receives procedural sedation and multiple attempts at reduction using conventional methods with no success. What can be done now?
A 60yoM h/o A-Fib on Dabigatran, took his medication this morning and then slipped in the shower 10 mins later, hitting his head with +LOC. He did not want to come to the emergency room at first but approximately 14 hours later, complains o…
Inspired by Tali Porat’s M&M What is the most consistant ultrasound finding in an ovarian torsion? . . . Answer: Unilateral ovarian enlargement (>4cm). Up to 73% of these has a complex adnexal or pelvoabdominal mass, which can…
A 79yoM with history of CAD s/p PCI/CABG years ago, Parkinson Disease presents with chest pain. ECG is shown below. Your ECG machine is not malfunctioning, the tech has not made a mistake, and the patient is laying calmly (no shivering or t…
A 25 year old male presents with severe asthma exacerbation requiring intubation. His blood work and chest xray are unremarkable. You place the patient on a propofol drip but he fights the vent and requires increasingly high doses. The pati…
A 50yoM with h/o MI >5 years ago presents with a heart rate of 150, only complaining of palpitations, and otherwise normal vital signs. States he was told he had some type of arrhythmia in the past with similar symptoms, and was given a…
Today’s pearl was inspired by Vincent Roddy A 38-year-old man presents to the emergency department 6 weeks after Roux-en-Y gastric bypass with recurrent abdominal pain, nausea, and bilious vomiting. He has had 3 total episodes during…
A 30yoM presents with a GCS of 7 after a trauma to the head, shallow respirations, saturating 100% RA, otherwise normal vitals. You decide that the patient needs to be intubated and begin preparing your equipment. You place the patient on…
A 6 day old baby presents pale and lethargic. HR 200, BP undetectable, O2 saturation 90%, RR: 40, finger stick 20. You give dextrose but symptoms do not improve. You suspect congenital heart disease and confirm this with a hyperoxia test. Y…
A 66yoM with advanced CHF s/p LVAD, who was in his usual state of health, presents because he felt his AICD fire multiple times. In the ED, his rhythm shows ventricular tachycardia. A pulse, blood pressure or oxygen saturation cannot be obt…
A 60yoM with h/o hypertension presents with palpitations x 24 hours. He has never had this before. In the ED, he has normal vital signs but his rhythm shows atrial fibrillation. You do blood tests including a ddimer, BMP, troponin, and a ch…
In light of the ultrasound conference that very few of us could attend: A dialysis patient presents with mild hypotension and respiratory distress. Bedside ultrasound was done with the parasternal long view shown below. You are unable to ac…
