Films and Scans

by John Dallara, MD on March 22, 2010

Here is a fun case for the 50% of you who are still reading your own plain films after hours (me too!). An elderly gentleman arrives with a dry cough and shortness of breath for several days. Family reports him to be “a little confused.” There is no history of trauma.

Fall At Nursing Home, Hit Chin

by John Dallara, MD on February 9, 2010

Paramedics bring in an elderly female who fell at the nursing home. By report, she slipped on something and fell forward, landing chin-first on the edge of a coffee table. She complained immediately of neck pain and was immobilized by EMS. Vitals are P 75, BP 180/105, RR 20, sat 95% RA. She is alert and appropriate. General exam reveals only a small contusion/laceration on the chin. Her neurologic exam is intact.

The Back Pain Differential

by Tyson Pillow, MD & Andres Splenser, MD on January 15, 2010

You’re working at a teaching hospital ED in Houston one evening when one of your residents presents a case of back pain. The patient is a 57-year-old African-American female with a history of Hepatitis C diagnosed in 2000, questionable cirrhosis, macrocytic anemia, GERD, and chronic back pain for five years.

Complaint: Hit With Bat In Chest

by John Dallara, MD on December 18, 2009

Evening shift. All the rooms are full and there’s an unspeakable number of patients in the waiting area. Triage calls with a simple request. “I have this fellow here,” he narrates, “who says he was hit with a bat in the left chest.

Shotgun Wound to the Chest

by John Dallara, MD on September 30, 2009

Wet Readings

EMS calls a trauma alert for a gentleman injured from a shotgun blast about 20 minutes ago.

As the patient rolls to CT, you review the plain films. What do they show? What actions do you anticipate?

Autism and Abdominal Pain

by John Dallara, MD on July 31, 2009

You are called to ED triage to evaluate a 30-year-old with stomach pains. “I think he has a kidney stone,” his mother volunteers by way of introduction. “You know his father had them also, and he just won’t settle down.”

What do you see in this CT scan. Read the case HERE.

Final Analysis: Outpatient Management of Mild Diverticulitis

by Dr. William Sullivan, DO, JD on July 7, 2009

This case, originally published in May of 2009, sparked a lively debate online. Here are some highlights. Continue reading for the final analysis.

Right Flank Pain

by Brady Pregerson, MD & Teresa Wu, MD on June 30, 2009

A 29-year-old female presents late in the evening to your rural emergency department, accompanied by her husband, with a chief complaint of right flank pain for approximately 3 days. It’s busy and she’s been waiting in triage for over two and a half hours, probably because she looks so good.

What does this transabdominal image show? Read the case HERE.

Hip Pain After Fall in Elderly Female

by John Dallara, MD on May 28, 2009

You evaluate an elderly female who has tripped and fallen at home. She denies any chest pain, shortness of breath or other acute medical symptoms and was well until the event.

What can you rule out from this 4-wheeler injury?

by John Dallara, MD on May 8, 2009

The paramedics call-in a trauma alert on a 45 year old who ran his 4-wheeler into a tree. He was wearing a helmet, and his only obvious injury is an open fractured distal tib-fib on the right. They splint his fracture, give him morphine 8mg IV per protocol, and apply diesel fuel to the rest of the situation.