A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
The patient is a 53-year-old man with a history of none who presented to the emergency department with an atraumatic painful and red left big toe for 3 days. The onset was slow and gradual, and limited to the left big toe. He had never had pain or redness like this before in his toes. He denied any trauma to the joint. No significant or debilitating pain with moving the joint, however mild pain noted. He denied fever or chills, open wounds.
Priyanka Pradhan MD and Dave Murray MD
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Figure 1. Point-of-care echocardiogram demonstrating the D-sign and a trace pericardial effusion.
The Case:
The patient is a 64-year-old female with an unknown past medical history who presented to the ED with altered mental status. Her BP was 100/80 mmHg, HR 101 BPM, RR 21 bpm, SPO2 63% on room air, and T 36.8ºC (98.3ºF). The patient was placed on a non-rebreather mask at 15L, and her oxygen saturation improved to 97%. She was given sedatives for acute agitation and delirium. On exam, the patient was tachypneic and had bilateral crackles and decreased breath sounds throughout all lung fields. Her cardiac exam was notable for a regular rhythm without murmur. The remainder of the physical exam was unremarkable.
Michael Hohl, MD
Read MoreThe Case:
25 year old man with no past medical history presents to the ED with acute left shoulder pain. He was playing soccer, jumped up for a header, and fell onto his left side 1 hour ago. On exam, his left upper extremity is adducted, internally rotated, and flexed at the elbow. He is neurovascularly intact, and range of motion is significantly limited secondary to pain. He otherwise has no obvious humerus deformity and no pain with palpation of humerus, elbow, forearm or wrist. You suspect a shoulder dislocation. Radiology is called to conduct bedside x-ray prior to reduction. However, they are busy in trauma with a multi-victim motor vehicle accident and say it may take up to 1 hour to obtain x-rays given they are short staffed today. So, you reach for your ultrasound…
Ramin Chitsaz, MD
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