Clinicians should always consider capturing images with their phone when possible so that key clinical findings seen in the real‐time physical examination can be memorialized in the electronic medical record.
Long‐term abuse of nasally inhaled substances such as heroin can result in life‐threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.
While CT scans without IV contrast are obtained commonly to evaluate vertebral injuries, CT angiography scans should be considered whenever a fracture site approaches known vasculature.
A 49-year-old woman presented to the emergency department with dyspnea,
a respiratory rate of 26 times per minute and a room air oxygen
saturation of 69% after nasal inhalation of heroin. A chest computed
tomography angiogram (CTA) revealed diffuse ground-glass opacities in
all five lung lobes representing hypersensitivity pneumonitis
A 25 year old presented to the emergency department with a one day
history of mildly painful and erythematous swelling of her right upper
eyelid that she believed to be a stye. The clinical team noted vesicular
lesions located exclusively on the upper eyelid, diagnosed zoster and
initiated valacyclovir.
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