Clinical Cases & Journal Review

Teini Elisara Case An 82 year old female with a past medical history of anemia of chronic disease, breast cancer, diabetes mellitus, hypertension, osteoporosis, rectal adenocarcinoma, scleroderma with pulmonary involvement, and systemic lupus erythematosus presented to the emergency department after a mechanical fall the night prior. She was getting into bed when she tripped and fell on the left side of her body landing on her left arm and hitting the side of her head on the floor. Patient endorsed severe pain to her left wrist. Vitals: BP 162/64 | Pulse 67 | Temp 98 °F (36.7 °C) | ...

Josh Gieschen Case: 32yo male with no PMH who presents following a fall down the stairs with no head strike or loss of consciousness. He endorses left shoulder pain and inability to range his left shoulder. He has never dislocated his shoulder before. His pain is 8/10 and limited to the L shoulder, worse with motion or palpation. Vitals:  Temp 97.6 °F | HR 87 | RR 18 | BP 119/76 | SPo2 100% on RA Physical Exam: L arm held internally rotated, flexed, and guarded closely to torso. An obvious step-off deformity was seen directly lateral to glenoid with increased prominence of th...

Molly Chou An 83-year-old male presented to our emergency department with shortness of breath. He woke up that morning with symptoms and called EMS. On arrival, the patient was alert and oriented with SpO2 90% on room air. The patient had a recent admission for right middle and lower lobe pneumonia. He also reported a history of heart failure with mildly reduced ejection fraction, coronary artery disease, and chronic kidney disease. Vitals: BP 122/71, HR 92, RR 30, T 98.8F, spO2 90% on room air, 99% on 4LNC Exam: Normal heart sounds, tachypnea, rhonchi in bilateral lower lobes, non-te...

Alex Liang, Rachna Subramony A 48 year old male with past medical history of Crohn’s Disease, cryptogenic cirrhosis, pancytopenia, portal vein thrombosis, Factor V Leiden, and prior history of kidney stones presenting with right sided flank pain, dysuria, and hematuria worsening over the past 4 days. He reports similar symptoms in the past associated with his previous findings of kidney stones. He denies fever, nausea, vomit, diarrhea, chest pain, shortness of breath, or anuria. Vitals: BP 123/80 mmHg | Pulse: 101 | Temp: 98.5 °F (36.9 °C) | Resp: 20 | Wt: 65.8 kg (145 lb) | SpO2: 97...

Skyler Sloane, Benjamin Supat An 83-year-old man presented to the emergency department with a chief complaint of acute onset lower abdominal pain radiating to the right groin. The patient reported a history of hypertension, coronary artery disease, and nephrolithiasis.  Vitals: BP 71/51 | Pulse 84 | Temp 98.0 °F (36.6 °C) | Resp 20 | SpO2 99% on RA  On physical exam, the patient appeared to be in obvious discomfort. There was diffuse abdominal tenderness though no rebound or guarding was observed. A bedside FAST exam was performed. What do you see?  ...

Skyler Sloane & Andre Velazquez A 73-year-old male presented to our emergency department with a chief complaint of new intermittent double vision for the past two weeks. The patient noticed that he saw double when looking at signs on the freeway. These were new symptoms he had not experienced in the past. The patient reported a history of hypertension, hyperlipidemia, and recently diagnosed prostate cancer. The patient also confirmed a history of ocular migraine. The patient denied current headaches, new floaters or flashes, curtains, or clouds in his vision. Upon arrival, vital sign...

Aastha Shah A 57-year-old male with a past medical history of HIV, hyperlipidemia (on a statin), chronic obstructive pulmonary disease (COPD), lumbar stenosis, and chronic diastolic heart failure presented with a chief complaint of pain and swelling in the right inguinal region for the past 3 days. The patient reported a similar presentation in the past, during which he was told that he had a hernia. He denies associated symptoms such as fever, chills, nausea, vomiting, abdominal distention, constipation, or urinary changes. He passed stool normally this morning and has no history of prior ...

Liz Volochyna-Farber A 37-year-old male with a past medical history of retinal detachment (RD) of the left eye (OS), left eye cataract surgery and retinal tear in the rigth eye (OD) s/p laser presents to Emergency Department (ED) on a Sunday with painless worsening right eye vision. It started with a floater in the eye 2 days prior. The patient went to an outside ED, has been given a diagnosis and was told to see ophthalmology, but was unable to do that over the weekend. Meanwhile his symptoms worsened, so he came to our ED. He endorsed mild itching to the eye but denied trauma, pain, forei...

Teini Elisara Case An 82 year old female with a past medical history of anemia of chronic disease, breast cancer, diabetes mellitus, hypertension, osteoporosis, rectal adenocarcinoma, scleroderma with pulmonary involvement, and systemic lupus erythematosus presented to the emergency department after a mechanical fall the night prior. Patient reported that she was getting into bed when she tripped and fell on the left side of her body landing on her left arm and hit in the side of her head on the floor. Patient endorsed severe pain to her left wrist. She was able to move her fingers; howe...

Grace Feng Case: A 59-year-old male presented with a chief complaint of retained bullet in his abdomen. He reported a past medical history of multiple gunshot wounds in 2017 and had an exploratory laparotomy related to those injuries. He was uncertain why the bullet was not initially removed, but reported the wound site was stable until several days ago, when it began leaking serous fluid. He denied fevers, chills, and purulent discharge or pain at the wound site. Vitals: BP 112/72 | HR 72 | Temp 98.4 ºF (36.9 ºC) | Resp 16 | SpO2 98% on RA On physical examination of the abdomen, it...