A 45-year-old male presents to the emergency department with a chief complaint of a fishhook injury. He was fishing on the beach this morning and caught a large fish. When he attempted to unhook the fish, he accidentally embedded the fishhook into his left hand. He attempted to remove the hook unsuccessfully prior to arrival. His tetanus status is…
Read MoreA 60-year-old man with a history of hypertension and smoking presents to the medical center with chest pain. Over the weekend, he developed chest pain while cleaning out his gutters that resolved with rest. This morning, he was working at his computer when he developed chest pain radiating to his left arm. It has since resolved, but he presents to the clinic for evaluation. An EKG obtained on arrival is unremarkable, but he soon develops chest pain again…
Read MoreA 28-year-old male with no past medical history presents to the emergency department with two days of gradually worsening right index finger pain and swelling. The patient reports that he works on a saltwater fishing boat and frequently has cuts on his hand. A few days ago, he noticed worsening pain and swelling to a cut on his right index finger. Today, the pain worsened and he is having difficulty bending his finger. He states that the pain radiates from his index finger up his hand and right forearm. He has not had any fevers and there is no associated numbness or tingling…
Read MoreAn otherwise healthy 16 year-old-male presents to the Emergency Department (ED) with a rash on his chest that began one month prior to presentation. The patient reports that his dad noticed the rash today, prompting him to present to the ED. The patient denies any systemic symptoms including fevers, nausea, malaise, or abdominal pain. He states the rash is painless and does not itch. He has no memory of a tick bite but does spend time outdoors…
Read MoreYou’re seeing a patient in the community emergency department with a primary headache disorder. Based on your history & physical examination skills, you have considered and ruled out all dangerous secondary headache causes such as intracranial hemorrhage, sentinel bleed, meningoencephalitis, abscess, tumor, temporal arteritis, hypertensive encephalopathy, acute angle closure glaucoma, etc. With many classes of treatments available, providers have typically used some form of a ‘migraine cocktail’ including IV prochlorperazine, IV ketorolac, IV diphenhydramine, IV dexamethasone, and/or IV normal saline…
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