The authors present a case of Sporothrix schenckii diagnosed in the emergency department, based on a thorough history. The patient presented with skin nodules that had spread proximally up the arm in various stages of healing. He reported minimal pain for the unhealed ulcer and no pain for the healing ulcers, and no other concerning symptoms. The history of a thorn prick followed by the initial red nodule on the forearm has led to the diagnosis -as it was consistent with the classic presentation of lymphocutaneous sporotrichosis. A high index of suspicion and carefully noting occupational history is required for a diagnosis of sporotrichosis. Clinicians should recommend long sleeves and gloves to their patients when they are handling soil.
Spontaneous spinal epidural hematomas (SSEHs) are neurological emergencies complicated by a wide array of presentations. In this study, we report a case of a patient who presented with neck pain and was diagnosed with an SSEH with computed tomography (CT) angiography with subsequent confirmation by magnetic resonance imaging (MRI). The high-risk location and size of the lesion guided management and surgical intervention. In a stable patient presenting to the emergency department without focal neurological deficits, clinical suspicion and assessment of risk factors are integral in the evaluation of patient risk and subsequent imaging and intervention.
Extremity trauma is a common emergency department presentation. The authors report a case of an elderly woman who sustained a trimalleolar ankle fracture. Emergency department care includes stabilization of the fracture with a splint, with careful assessment of neurovascular status. Trimalleolar fractures are unstable and thus almost always will require surgical repair. This is true even for elderly patients and those with co-morbidities. Patients who do not get a surgical repair for these fractures are at risk for significant morbidity, including compartment syndrome, arthritis, malunion, and loss of mobility.
Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.
We present the case of a patient who presented with viper-induced consumptive coagulopathy after a bite on the thumb from a decapitated eastern diamondback rattlesnake. The patient was evaluated and treated in the Emergency Department and was admitted to the intensive care unit.
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