altChristopher 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.

altThe 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.

altA 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...

alt“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?”

altA 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.

altAn 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.

altTriage walks back a 42-year-old male who has been stabbed in the left shoulder by his girlfriend (OK, I admit I am curious why, but first things first). He has bilateral breath sounds, but is not taking deep breaths due to pleuritic pain on the left side.

You are asked to see a stable multiple-trauma patient, 26 years old, who has fallen out of a tree (and you thought only kids climbed trees). He is intoxicated, and apparently fell striking his right side. The brunt of the fall was borne by the right arm, and he is unable to move his right elbow. What does the x-ray show? What is your next move?

altA fifty year-old male with no past medical history presented to the ED complaining of sore throat, difficulty swallowing and feeling “bubbles” on the side of his neck for one day.

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