What prompted her emergency department visit was the onset of a right sided facial droop which began about eight hours prior to arrival. She was unable to fully close her right eye and noticed drooping at the corner of her lip. She denied shortness of breath or difficulty breathing. The patient noted that she had a diarrheal illness several weeks prior to the onset of the symptoms. …
Read MoreA 56 year-old right hand dominant male presented to the emergency department with weakness in his bilateral hands, worse on the left. For the last several months, he had been having daily neck pain and frequent occipital headaches. He had been dropping things more frequently, but noticed over the previous week that he had increasing difficulty getting dressed in the morning. He used to be very active, but began using a walker last year because of frequent falls from what he described as always “feeling off-balance”. He also endorsed intermittent tingling in all fingers of his left hand.
Read MoreAn elderly man reported to the emergency room after a fall down 15 stairs at home. He was more confused than his baseline but otherwise did not have any specific complaints. Vitals and labs were within normal limits. A non-contrast CT of the brain and C-spine was performed and read as normal…
Read MoreDespite how frequently emergency physicians encounter children who have had a febrile seizure, there tends to be great variation in the diagnostic evaluation of these patients. The algorithm below was created to provide a more simplified approach to the patient presenting with a febrile seizure. The algorithm draws from the 2011 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Febrile Seizure as well as the clinical pathways published by Seattle Children’s Hospital…
Read MoreA 70 year-old male, with a past medical history of hypertension, gastroesophageal reflux disease, chronic lymphocytic leukemia on Ibrutinib, and coronary artery disease, presented with right hand weakness since waking that morning. He reported that he felt the strength of his grip was not at baseline, and his wife also noted that, while eating breakfast, the patient dropped his bagel, a dish towel, and his utensils. His last known well was 10:00 PM the night before, although he also endorsed two weeks of persistent right hand numbness and burning paresthesias in his right hand. He denied headache, fever/chills, chest/back/abdominal pain, nausea/vomiting, urinary symptoms, or diarrhea, as well as any visual symptoms, speech changes, or gait problems…
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