The 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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The patient is a 61-year-old male with non-insulin dependent diabetes, hypertension, coronary artery disease status post CABG in 2019 who presented with blurry vision of the left eye after being hit on the face with a blunt object by his roommate approximately ten days prior to presentation. The patient reports that over the past year his roommate had been abusing him physically. Ten days prior to presentation, the patient was hit in the face with an unknown blunt object, causing him to lose consciousness for an unknown period. He awoke with left eye swelling and blurry vision in the left eye which he has had since. He denies headache, dizziness, eye pain, tearing or discharge, foreign body sensation, or double vision.
Jordyn Cohen, MD
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A 42-year-old right hand dominant male with no known past medical history presents with pain in his right thumb. He works as a painter and was using an industrial paint sprayer when he injected a water-based paint into his right distal thumb pad. He states he had significant pain initially, but it quickly settled to a dull throbbing. He waited five days from the injury to visit his primary care doctor who instructed him to come directly to the ED. His vital signs are within normal limits. There is a small punctate wound on the volar surface of the distal right thumb that is mildly tender to palpation without surrounding erythema, swelling, or drainage. There is no tenderness more proximally. Compartments of the hand and forearm are soft and compressible. The digit is neurovascularly intact excluding an area of decreased sensation at the tip of the thumb. X-ray of the right hand and thumb are shown below.
Adam Roussas, MD
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