You were seen today for toe pain. Your evaluation, which included an X-ray, demonstrated ***. You should rest and ice your affected foot. For pain, you can take ibuprofen or tylenol over the counter.
Please follow up with your primary care doctor in 2-3 days.
This patient presents after a soft tissue injury to the toe. Considered, but doubt, acute fracture including open fracture. Low index of suspicion for a dislocation or Lisfranc injury. Doubt other acute causes of toe pain at this time.
Plan: plain films, pain control, reassess, likely discharge with podiatry/orthopedics followup, WBAT***
TYPICAL VASO-OCCLUSIVE CRISIS
This patient with known sickle cell disease presents with their classic pain syndrome for a vaso-occlusive crisis. Considered acute chest, stroke, splenic sequestration, and other emergent complications of sickle cell disease. Considered alternate etiologies of this patient’s pain to include fracture, MSK pain, infection/abscess, and other ischemic etiologies but doubt these are likely.
Will plan for pain control using patient’s pain management plan, basic labs/reticulocyte count, likely discharge
ACUTE CHEST SYNDROME
This patient with known SCD presents with chest/back pain consistent with vaso-occlusive crisis but concerning for acute chest syndrome; this presentation is different than the patient’s typical pain crisis. Considered alternate etiologies of chest pain including acute coronary syndromes, PE, pneumothorax or pneumonia but think this is less likely.
Plan: labs, pain control, fluids, low threshold to transfuse to Hb>9, CXR, discuss with hematology, likely admit
SPLENIC SEQUESTRATION OR STROKE
This patient with sickle cell disease presents with altered mental status, highly concerning for severe range anemia or stroke. Splenic sequestration is also on the differential, although ***given this patient’s age it is quite unlikely that they still have functioning splenic tissue. I considered, but think less likely, other etiologies of altered mental status such as infection, metabolic derangements, or ICH. This symptom constellation is concerning given the underlying medical comorbidities.
Plan: basic labs, reticulocyte count, consider hemolysis labs, XR chest, neuroimaging, probable stroke code activation, neuro and hematology consults, admit
_ patient with a vesicular rash on an erythematous base in a dermatomal pattern consistent with herpes zoster. Not immunocompromised and without signs of systemic or disseminated infection. Low suspicion for alternate etiology of rash such as SJS, drug rash, viral exanthem, or other emergent cause of rash.
Plan: acyclovir 800mg 5x/day for a week, gabapentin and other pain control, reassessment, likely discharge
LOW RISK
This *** patient presents with knee pain, suspicious for ***. Able to flex and extend although somewhat limited by pain. Considered, but doubt, tibial plateau fracture, septic arthritis, other acute unstable fracture, or significant neurovascular compromise.
Plan: XR, pain control, reassessment
HI RISK – Tibial Plateau
This *** patient presents with knee pain suspicious for a tibial plateau fracture given history, exam, and mechanism. No e/o compartment syndrome, septic arthritis, other acute fracture. Range of motion is ***. Will get plain films, consider CT, likely ortho consultation, pain control, NWB.
PEARLS:
This _ presents with leg swelling of unclear etiology, concerning for DVT vs cellulitis. DDX includes chronic venous stasis changes, lymphedema, fracture or trauma, MSK pain, and other nonemergent causes of leg swelling. Doubt atypical presentation of CHF or other volume overload states. PE is low on the differential due to normal vital signs without symptoms. Low suspicion for constitutional infection or metabolic derangements.
Plan: basic labs, DVT US, consider plain films, reassess, likely discharge
This _ presents with head trauma after a mechanical GLF. DDX includes MSK trauma, facial fractures, ICH or traumatic SAH, C-spine injury. Doubt other extracranial causes of injury. Considered nonmechanical causes of fall such as syncope, primary cardiopulmonary etiologies such as ACS/PE, but think these are unlikely. Will get head/face/neck CT, pain control, C-collar, basic labs, reassess, discharge
This _ patient presents with tremulousness, vomiting, and recent ETOH abuse suspicious for withdrawal. DDx includes intoxication, other toxidromes or withdrawal states, infection, metabolic derangements. Nontoxic appearing_. Considered other causes of patient’s vital sign abnormalities including primary cardiopulmonary etiologies such as ACS, PE, PNA but think these are unlikely. Doubt acute intraabdominal process.
Plan: BZDs, fluid resuscitation, labs, monitoring, _
presents with initial presentation of local erythema, warmth, swelling to ____ for ___ days.
Sensitivity/pain to light touch around the erythematous area.
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.
Low c/f osteomyelitis or DVT.
No immune compromise, bullae, pain out of proportion, or rapid progression c/f necrotizing fasciitis.
In ED: Erythema outlined
Rx: Cephalexin 500mg PO q6hrs
Disposition: No evidence of serious bacterial illness requiring admission for IV antibiotics. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.
_ patient with a vesicular rash on an erythematous base in a dermatomal pattern consistent with herpes zoster. Not immunocompromised and without signs of systemic or disseminated infection. Low suspicion for alternate etiology of rash such as SJS, drug rash, viral exanthem, or other emergent cause of rash.
Plan: acyclovir 800mg 5x/day for a week, gabapentin and other pain control, reassessment, likely discharge
EM DOT PHRASES 