Clinical Cases & Journal Review

Makhlouf Bannoud, Colleen Campbell  A 22-year-old male with no significant past medical history presented to the emergency department with right shoulder pain and visible deformity after a surfing injury. He reported that a wave forcefully pulled his surfboard while he was holding on, followed by an audible “pop.” He denied head trauma, distal numbness, weakness, or additional injuries.  Vitals: BP 151/81 | HR 104 | RR 27 | Temp 97.8°F (36.6°C) | SpO₂ 93%  On exam, the patient was in acute discomfort but alert and oriented. The right upper extremity was held in ...

Lucia Hong, Elaine Yu A 70-year-old male with a history of cirrhosis, COPD, HTN, T2DM, and large abdominal wall hernia who presented after being found down in his home by a neighbor. Upon arrival, the patient was hypotensive with systolic blood pressures in the 70s and in atrial fibrillation with RVR with heart rates in the 170s. He received 500mL intravenous fluids prior to arrival and was transported on supplemental oxygen. The patient was altered and unable to provide history. On physical examination, the patient appeared acutely ill and minimally responsive. Mucous membranes were dry...

Sanjana Sanghani, Gerald Tolbert, Rachna Subramony A 52-year-old male with a past medical history significant for hypertension and hyperlipidemia presented to the Emergency Department with two days of intermittent chest discomfort accompanied by mild epigastric pain. The pain was non-radiating, episodic, and not associated with nausea, vomiting, diaphoresis, syncope, or exertion. He denied recent trauma, heavy lifting, or prior similar episodes. There was no known personal history of vascular disease, tobacco use, or family history of aneurysmal disease. An electrocardiogram demonstrated...

Sneha Thandra, Anthony Medak Case: A 19 year old female with a history of palpitations, shortness of breath, and syncope presents to the ED with throat pain with swelling for 3 weeks. The pain was noted to be bilateral, worsened with swallowing, but she was able to tolerate some oral intake. Patient had previously been seen on multiple occasions in ED/Urgent Care and had received dexamethasone without significant relief. She had not received antibiotics. Denied fevers or cough and had no PMH or known allergies.  Vitals: BP 127/90 | Pulse 103 | Temp 98.2 °F (36.8 °C) | Resp 16 | Wt...

Eli Tran, Elaine Yu 20YO female presented to the emergency department with 4-5 days of pelvic/abdominal pain, with abrupt worsening one day prior while resting. Her pain was sharp, sudden, and improved with ED analgesics. No dizziness, lightheadedness, or vaginal bleeding. LMP 4 weeks prior. She was not using birth control. Exam: Vital signs were within normal limits. She appeared uncomfortable but non-toxic. She had pelvic and lower abdominal tenderness without guarding or rebound. No focal cardiopulmonary or neurologic abnormalities. Labs WBC 14.6 to 18.7 with neutrophilia. ...

Angela Wang, Benjamin LiottaA 66-year old male with a longstanding history of alcoholic cirrhosis presents to the ED early in the morning requesting a paracentesis with 10 days of worsening abdominal distention in the setting of running out of his home furosemide several weeks prior. He denied fever, nausea, vomiting, or abdominal pain.   Vitals:  BP 151/99, HR 101, RR 20, T 97.6F, SpO2 100% On exam, his abdomen was grossly distended with a positive fluid wave and no peritoneal signs. His last paracentesis was done 2 weeks prior with 10L of fluid removed. IR was consulted but would not ...

Carmon Controy, Akash Desai 44 y.o. male, brought by EMS from an outpatient procedure suite after sudden onset vertigo and gait instability following a right TMJ/ CNIII V3 injection. Patient experienced abrupt dizziness described as imbalance with ataxic gait, nausea, and one episode of emesis. The symptoms worsen with head movement/position change and improve at rest. No focal weakness, speech change, or headache reported.  Pertinent PMHx: HIV on ART; cognitive impairment on donepezil/memantine; lumbar stenosis s/p L5–S1 decompression. Prior episodes concerning for TIAs/CVAs.&nbs...

Martin Day, Elaine Yu A 69-year-old male with no significant past medical history presented to the emergency department after striking his right eye with the handle of a spray hose at work. He reported burning pain but denied bleeding, tearing, or other injuries. Eye movement did not exacerbate the pain. Notably, he had been chronically blind in the right eye since childhood after sustaining blunt ocular trauma from being kicked by a cow around age 12. He described no perception of light in that eye since then. Vitals: BP 138/83 | Pulse 85 | Temp 98.4F (36.9C) | Resp 17 | SpO2 98% Phy...

Kevin Vo, MD; Rachna Subramony, MD Case Presentation:A 31-year-old male with no significant past medical history presented to the Emergency Department with bilateral blurry vision, left greater than right. He had been evaluated earlier that day by an optometrist and referred for concern of retinal detachment. The patient reported flashes and floaters of uncertain duration but denied eye pain, discharge, foreign body sensation, headache, or trauma. Vital Signs: BP 132/77 mmHg | HR 60 bpm | Temp 97.3°F | RR 16 | SpO₂ 99% Physical Examination:The patient was in no acute distress. Ocul...

EJ Curtis, Colleen Sweeney, Colleen Campbell A 70-year-old man with a past medical history of hypertension, obstructive hypertrophic cardiomyopathy, atrial fibrillation status-post Watchman procedure, and end-stage renal disease secondary to polycystic kidney disease (status-post renal transplant in 2014, complicated by chronic kidney disease stage 5 of the transplanted kidney) was brought to the emergency department after being found on the floor by his daughter. On arrival, the patient had generalized weakness, lightheadedness, and epigastric pain. Vital signs: BP: 77/60 mmHg | HR: 103...