A 23-year-old male presents to the Emergency Department (ED) with 4 days of a persistent sensation of a ‘fish bone’ stuck in his throat. Patient ate fish tacos 4 nights prior to arrival. The patient describes feeling a sharp foreign body stuck along the right side of his upper throat, just proximal to the angle of his mandible. The pain is worse with swallowing, and turning his head to the right.

An 11-year-old female with no significant past medical history, presents with a five day history of right shoulder pain. The patient’s mother reports that the patient was “horsing around” with her older brother five days ago. She attempted to slap her brother using her arm when she immediately felt a “popping” sensation in her right shoulder. She was taken to a local emergency department where she was evaluated, imaged, and discharged home with the diagnosis of “shoulder strain”.

Before starting efforts at intubating any airway with laryngeal pathology, it must be appreciated by all caring for the patient that rescue ventilation may not work if the epiglottis or larynx is swollen or distorted. This applies to the LMA, King LT, and mask ventilation. If intubation through the nose or mouth doesn’t work, a rapid surgical airway will likely be required.

Christopher is a 36 year old male with a past medical history of an infected neck cyst status post incision and drainage three months prior who presented to the Emergency department for sore throat. He reported that he awoke that morning with sore throat and had trouble swallowing.

The story is simple. “My chest is killing me, and that Motrin stuff is not cutting it,” the patient says. “It really hurts to breathe.” He woke the other morning with this upper sternal, pleuritic chest pain. There are no other exacerbating features, no fever or cough. The pain does not sound cardiac in nature. Vitals are normal, including an O2 sat of 98% on RA.

A 17-year-old boy presented to the emergency department with pain in his left wrist. The onset of symptoms occurred while at bat in the second game of a four-game tournament in which he was playing that day. The pain impaired his ability to bat through the remaining games.

EMS brings you a 54 year old who slipped off a wet ladder rung and fell about 15 feet. He is boarded and collared by the paramedics and complains of R hip pain. Vitals are OK, and he complains of pain in his R hip area. “I can stand,” he tells you...

“Room 4, old septic guy with pneumonia, a trach, DNR, admitted,” says your colleague as he hands over the department. “He’s really hypoxic, but we put in a new trach collar, sats are holding at 90%. I’ve talked with the family. He fell, so we’re getting a CT of the head and C-spine that still pending. Would you check it?”

A 19-year-old man was brought by EMS after being struck by a high speed auto. The exact mechanism of injury and the site of the impact was unknown. Vital signs were normal at the scene and in the trauma room. He admitted to drinking alcohol prior to the accident, but was awake and alert and had no other major complaints aside from pain in his neck.

An 82-year-old man presented to the ED with abdominal pain. While walking in his yard he had fallen onto a two-inch-diameter piece of steel rebar. EMS reported seeing a locally expanding area while the patient was being prepared for transport. He had no history of surgery or swelling in the affected region.