Posts in Community EM
Domestic Violence and the Emergency Department Patient

A 25-year-old woman with a past medical history of anxiety presents to the emergency department with right sided chest pain. She describes approximately two hours prior to arrival, she tripped in the bathroom while bathing her child, striking the right side of her chest on the tub. She denies head strike or loss of consciousness, shortness of breath or abdominal pain…

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EPSS As a Proxy for Ejection Fraction

A 68-year-old male presents to the emergency department (ED) with one week of worsening shortness of breath. He has no known cardiac history and has rarely seen a physician. He reports shortness of breath with exertion, mild non-productive cough, and subjective fever. He is not having chest pain. He is a long-time smoker but denies other drugs. Vitals are as follows: heart rate (HR) of 102, blood pressure (BP) of 105/70, afebrile, 89% on room air (RA), respiratory rate of 20. On exam the patient exhibits labored breathing, crackles in bilateral lower lung fields and +1 pitting edema in bilateral lower extremities…

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Red, Hot, Legs: Thrombophlebitis of the Superficial Veins of the Lower Extremity

A 34-year-old female with medical history notable for varicose veins presents with complaint of left medial thigh pain. The patient states the pain started 3 days ago. She denies any fevers. She states the area is very painful to the touch. No antecedent trauma or injury. She has been taking Tylenol with minimal relief. She has a remote history of varicose vein ablation to her left leg..

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“Gotta Go Right Now”: Use of Whole Bowel Irrigation in the Treatment of Lithium Toxicity

A 30-year-old female with a history of bipolar disorder presented after intentional lithium overdose. The patient reported feeling increasingly depressed for several weeks with intermittent suicidal thoughts. She reported getting into a verbal altercation with family while drinking alcohol and subsequently ingested a nearly full bottle of lithium (approximately 40 tablets, each with a concentration of 300 mg). She reported mild blurred vision and anxiety, but otherwise denied any other subjective complaints…

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Island Med: Challenges of Remote Healthcare

A 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…

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