Is this man’s stomach pain a hot gallbladder?

A 31-year-old female without significant past medical history presents to the emergency department complaining of worsening shortness of breath which began three days ago. 

 A 64-year-old Hispanic female presents to your ED with a complaint of pain in the left lower extremity and difficulty walking. She states that she fell two days ago and since then noted swelling and pain in her lower leg and ankle. It has progressively worsened since the injury and is not relieved by over-the-counter analgesics. She noticed blisters beginning to develop on her leg one day after the injury. Upon further inquiry, the patient states that she had a mechanical fall after stepping on a loose floor board at home and fell through the carpet. She denies any injury to the hips or pelvis and has no complaints of pain in the contralateral extremity. Her medical history is only significant for hypertension and she has no surgical history.

Obvious cholecystitis?
Ignore the obvious and work the problem

This case illustrates a common clinical pathology in children by a not so common mechanism, especially after the institution of legislation against the use of infant walkers. Also, it is a reminder to emergency physicians to evaluate for non-accidental trauma when seeing injuries in a child who is not yet mobile.

Mark Schnellinger, MD
Manu Madhok, MD, MPH
Childrens Hospital of Minnesota
 

Your patient is a 51-year-old male immigrant from Northeast Thailand who complains of recurring syncopal episodes. The nurse says the computer is reading this as an acute MI.  What is your interpretation? (choose only one) 

A 42-year-old patient was unloading a truck when he developed sudden nausea and dizziness. He was found in a bathroom vomiting. When his co-worker approached him, he was unable to describe what happened to him. An ambulance was called 10-15 minutes later when the man complained of numbness in his right arm, his tongue, and the left side of his face. 

a Peer-Review of Expert Witness Testimony

The Case

A patient with a history of alcoholism was brought to the emergency department by ambulance after falling five days earlier. After the fall, the patient experienced significant back pain and had been laying on a mattress in his basement. His physical examination was significant for superficial bed sores and back tenderness. His neurologic status was intact, although there is testimony that the patient developed increasing weakness in one leg before he left the ED. Spinal X-rays and CT showed fractures of the posterior body and posterior element of L1, the transverse processes of L2 and L3, and a fracture of T12 with moderate distraction of fracture fragments. The X-rays also showed findings consistent with ankylosing spondylitis.