A 47-year-old male presents to your emergency room following a motor
vehicle accident. The second year resident gathers in the history that
he was a restrained front-seat passenger in a car that was traveling
approximately 45 mph when the car was rear-ended. Airbags were deployed
and the remainder of the passengers in his car were unharmed.
A 49-year-old, right-hand- dominant male presents to the emergency
department with right shoulder pain. The patient was playing volleyball
and immediately after spiking the ball felt severe pain to the right
shoulder. He was unable to lower the arm, and states that he feels numb
over the arm and fingers.
Distal radial fractures are among the most common fractures in
childhood, and are a frequent presenting complaint in the emergency
department. Traditionally, ED management of displaced distal radial
fractures in children has included closed reduction and splinting of
displaced fractures, usually under sedation.
An 89-year-old female presented to the emergency department with a three
to four day history of gradually worsening, sharp right lower quadrant
abdominal pain without radiation. On the day prior to the emergency room
visit, a hard, tender mass developed in the area of discomfort. The
patient usually had regular bowel movements; however she had not had a
bowel movement for the past three days.
A 40-year-old Hispanic female presented to our Emergency Department
complaining of upper abdominal pain, nausea and vomiting for 1 day. She denies fever; last bowel movement was the previous
day. She has no history of prior abdominal surgeries and past medical
history was unremarkable. Vital signs were normal except for tachycardia
at 112 bpm.
Consider this scenario. You’re nearing the end of another busy shift in
the emergency department but muster the energy to pick up one more
chart…a healthy 65-year-old female with a foot injury. The x-rays are
done. Should be a quick dispo, right?
A 45-year-old woman presents to the ED with two days of abdominal pain
which was gradual in onset and became severe and diffusely
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.