UCONN Emergency Medicine Interest Group

Posts Tagged ‘syndicated’

EM Images #11

In IMAGES, RADIOLOGY on March 11, 2012 at 2:09 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

A 55 year old man came in with diffuse abdominal pain, mostly in RLQ, with tenderness and guarding there but no rebound. Questionable Rovsing’s.  Minimal RUQ findings. No Murphy´s sign. What are the diagnoses associated with this CT?

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EM Images #10

In IMAGES on February 25, 2012 at 11:11 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

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A simple question: what is the diagnosis for these patients?

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Ultrasound Case #7

In RADIOLOGY on January 28, 2012 at 2:27 PM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

Case

CC: Right flank pain

HPI: 54 yo male with PMH HTN and high cholesterol presents to the ED with acute onset of right sided flank pain beginning 18 hours prior to arrival.  Associated with nausea, vomiting and chills.  Pain is  intermittent, 10/10 and colicky.  He denies any diarrhea, constipation or urinary symptoms.

SH: Smokes 1.5 pack year history, denies other drugs or alcohol use.

FH: DM2, HTN, Hyperlipidemia

PE: Afebrile, VSS
Abdomen is obese, soft, non-distended, tender in RUQ, + Murphy’s sign, + bowel sounds

Labs: WBC’s16.2 with left shift.  Otherwise rest of CBC and chem7 within normal limits.

UA: 10 RBC’s, >25 WBC’s, no nitrites.

Urine culture: polymicrobial.

Bedside U/S:

What do you see?

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EM Images #9

In IMAGES on December 4, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Suozzi for images and text.

Just a short hint for this case: this is from a patient that Dr. Suozzi saw in Uganda.

What is the diagnosis?

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Ultrasound Case #6

In RADIOLOGY on November 29, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: left leg swelling

HPI: 81 yo male with PMH HTN, DM2, h/o colon cancer with recent colon resection one month prior presents to ED with left leg swelling, beginning 2-3 days ago.  Denies any chest pain, fevers, chills, h/o recent travel or urinary complaints.

SH: history of 20 pack years but quit 10 years ago.  No other drugs.

FH: denies.

PE: afebrile, VSS
Left lower extremity: calf edema, remarkably larger than the right. No tenderness to palpation, no erythema.  Distal pulses intact.

Labs: WBC slightly elevated at 11.8, otherwise rest of CBC and Chem7 grossly wnl.

Bedside U/S: see above images.

Where are the 2 points that should be compressed to look for a lower extremity DVT? What was the finding in this case?

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EM Images #8

In IMAGES on November 6, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

These three people all have the same condition, which can be diagnosed bedside. Note all three have extremities that are fixed in the position in which you see them. These arms can not be moved by active or passive range of motion.
The first, an older woman, and the third, a younger man, were pedestrian versus car with outstretched hands at the moment of impact. What do they have and how do you fix it and what special considerations accrue to such a diagnosis? (click below to see answers and explanation)

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Ultrasound Case #5

In RADIOLOGY on October 23, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

Gallbladder wall

Common bile duct

CC: Abdominal pain – RUQ

HPI: 25 yo female with no PMH presents to the ED with nausea, vomiting and abdominal pain beginning the previous evening ½ hour after eating dinner.  Pain located in RUQ, 10/10 intermittent colicky pain.  Denies any fevers, chills, diarrhea, constipation, urinary symptoms or anorexia.

SH: Smokes 1.5 pack year history, denies other drugs or alcohol.

FH: DM2, HTN, Hyperlipidemia, Colon Cancer

PE: Afebrile, VSS
Abdomen is obese, soft, non-distended, tender in RUQ, + murphy’s sign, + bowel sounds

Labs: WBC’s14.9 with left shift.  H/H, Platelets and Chem7, AST, ALT, lipase and bilirubin within normal limits.  Alk Phos 141.

Bedside U/S: see above images.

How would you describe the ultrasonographic findings?

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Ultrasound Case #4

In RADIOLOGY on September 25, 2011 at 11:19 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Russell and Dr. Kleinberg for cases and images.

CC: shortness of breath

HPI: 62 yo female with no significant pmh presents with shortness of breath worsening over the last 3 days with associated lest sided chest pain, low grade fever and non productive cough.

SH: 40 pack year smoking history, occasional alcohol.  Denies drug use.

FH: Lung cancer

PE: T 100.8 BP 110/90 HR 99 RR 24 SAT 90% ra. GEN: Uncomfortable, speaking in fragmented sentences.  CV: Regular rate and rhythm, no MRG.  PULM: Moderate respiratory distress.  Absent breath sounds in the base and midway up the back on the left.  Dullness to percussion on the left compared to the right.

EKG: Normal sinus rhythm with occasional PVCs.

Labs: WBC 12.5 with left shift, remainder of CBC, Chem7, PT/INR and cardiac enzymes grossly within normal limits.

Bedside U/S: see beginning of post for 1st still image; click for video.

What is the cause of the patient’s dyspnea? (click below to see the answer below the fold)

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EM Images #7

In IMAGES on September 12, 2011 at 3:46 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

Scenario: a 47-year-old gentleman came for a follow-up visit for positive blood cultures. He had been seen 2 days earlier with a past medical history of asthma and the history that approximately two weeks earlier he had been at a campfire where apparently someone nearby was burning poison ivy. Immediately he had broken out in a rash on his hands and neck and face and all areas that were exposed and not covered by clothes. He also noticed that his symptoms of cough and shortness of breath increased after that incident. He then came to HHED where he had had blood cultures, an x-ray that showed pneumonia and had been discharged on azithromycin. His blood cultures were positive for Staph and he had been requested to return to the ED. His physical exam showed some inspiratory râles in the LLL where the infiltrate had been and some expiratory wheezes throughout. After treatment had been initiated in the ED, prior to admission, he developed another skin eruption, seen in accompanying photograph.

What was the treatment and what is this reaction? (click below to see answers below the fold)

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EM Images #6

In IMAGES on August 13, 2011 at 7:22 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London, Dr. Bolton, Dr. Hitesh Shah for images and text.

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History:
A 25 year old male presented to HH ED in May 2009 complaining of 5 days of an itchy, scattered, worsening rash over his entire body. The rash began on his back and scalp, then spread to his arms, and is now everywhere. He was seen at a nearby clinic 5 days ago and sent home with Benadryl and Hydrocodone. He saw the PMD again 2 days ago and was also given Prednisone, Keflex, Permethrin, and Triamcinolone without relief. The rash was pruritic; he reported a sore throat and dysphagia from pain of oral lesions. He denied fever, cough, SOB, URI, conjunctivitis, congestion, runny nose, difficulty breathing, sick contacts, alleviating factors, exacerbating factors. Pt is an immigrant from Honduras and lives with his parents and his 1 year old child; he has been in the US for 4 years.

Physical Exam:
Vital Signs –T 98.2, P 111, R 16 –BP 146/89, O2 Sat 98%
Gen: Hispanic male, sitting, NAD
HEENT: NC/AT, MMM, PERRL, sclera anicteric, – JVD/LAD
Chest: Tachycardic, + S1/S2, CTAB
Back: No CVAT
Abdomen: + normoactive BS, soft, NTND, no r/g/HSM
Neurological: Awake, alert, oriented, cogent, nonfocal, MAE
Extremities: wwp, no c/c/e
Skin: see images

What is the diagnosis?

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