Visual Diagnosis in Emergency and Critical Care Medicine

CHRISTOPHER P. HOLSTEGE MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia ALEXANDER B. BAER MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia JESSE M. PINES MD, Center for Health Care Quality, Department of Emergency Medicine and Health Policy, George Washington University WILLIAM J. BRADY MD, Department of Emergency Medicine, University of Virginia

List of contributors, ix Foreword, xii Preface, xiv Illustration credits, xv Part I Case Presentations and Questions, 1 1 Slash Wound to the Neck, 3 Kevin S. Barlotta, MD and Alexander B. Baer, MD 2 I ve Got Blood in My Eye , 3 Chris S. Bergstrom, MD and Alexander B. Baer, MD 3 Forearm Fracture After Falling, 4 Alexander B. Baer, MD 4 A Neonate with Fever and Rash, 4 David L. Eldridge, MD 5 A Missing Button Battery, 5 Brendan G. Carr, MD and Sarah E. Winters, MD, MSCE 6 Anorexia, Hair Loss, and Fingernail Bands, 6 Christopher P. Holstege, MD 7 Wide Complex Tachycardia in a Young Adult, 6 William J. Brady, MD 8 Wide Complex Tachycardia in an Older Male Patient, 7 William J. Brady, MD 9 Muscle Spasms Following a Spider Bite, 8 J. Michael Kowalski, DO and Adam K. Rowden, DO 10 Necrotic Skin Lesion, 8 David A. Kasper, DO, MBA, Aradhna Saxena, MD and Kenneth A. Katz, MD 11 Intense Pain Following High-pressure Injection Injury, 9 David T. Lawrence, DO 12 Prenatal Vitamin Overdose, 9 Christopher P. Holstege, MD and Adriana I. Goldberg, MD 13 Blurred Vision Following Yard Work, 10 Allyson Kreshak, MD 14 Foot Pain in a Gymnast, 11 Hoi K. Lee, MD 15 A Child with Bruises of Different Ages, 11 David L. Eldridge, MD 16 Sudden Shortness of Breath after Removal of a Central Line, 12 Christopher P. Holstege, MD 17 My Eyes Are Yellow! , 13 David T. Lawrence, DO 18 Pleuritic Chest Pain in a Young Adult Male, 13 William J. Brady, MD 19 Exposed During a Blizzard, 14 Joseph D. Forrester, MD and Christopher P. Holstege, MD 20 FAST Evaluation of a Trauma Patient, 15 John S. Rajkumar, MD and James H. Moak, MD, RDMS 21 Chest Pain with Sudden Cardiac Death, 15 William J. Brady, MD 22 Wrist Sprain in a Child, 16 Jennifer S. Boyle, PharmD, MD 23 Acute Eye Pain and Blurred Vision in an Elderly Female, 17 Chris S. Bergstrom, MD and Alexander Baer, MD 24 Heel Pain Following a Fall, 17 Jennifer S. Boyle, PharmD, MD 25 Confl uent Rash on a Child, 18 Sarah E. Winters, MD, MSCE and Brendan G. Carr, MD 26 Bradycardia Following an Herbal Ingestion, 18 Alexander B. Baer, MD 27 A Pain-free Adult with Persistent T Wave Abnormalities, 19 William J. Brady, MD 28 Caustic Ingestion with Cardiotoxic Effects, 20 Heather A. Borek, MD and Christopher P. Holstege, MD 29 Chemical Eye Exposure, 21 Chris S. Bergstrom, MD and Alexander B. Baer, MD 30 Acute Abdominal Pain in Pregnancy, 22 James H. Moak, MD, RDMS and John S. Rajkumar, MD 31 Coma Following Head Trauma, 22 Andrew L. Homer, MD and William J. Brady, MD 32 Tongue Swelling in a Hypertensive Female, 23 Kevin S. Barlotta, MD and Alexander B. Baer, MD 33 Purulent Eye Discharge in an Adult, 24 Chris S. Bergstrom, MD and Alexander B. Baer, MD 34 Shoulder Pain Following Direct Blow, 24 Nathan P. Charlton, MD 35 A Gagging Child, 25 Maureen Chase, MD and Worth W. Everett, MD 36 Adult Male with a Sudden, Severe Headache, 25 Andrew L. Homer, MD and William J. Brady, MD 37 New Facial Droop, 26 Andrew D. Perron, MD and Christopher T. Bowe, MD 38 Eye Pain After Tree Branch Strike, 26 Chris S. Bergstrom, MD and Alexander B. Baer, MD 39 An Elderly Woman with Groin Pain, 27 Brendan G. Carr, MD 40 Rash and Joint Pain in a Child, 28 Mara L. Becker, MD 41 Radiology Findings after Laparoscopy, 28 Munish Goyal, MD 42 Postprandial Abdominal Pain in an Elderly Woman, 29 Hoi K. Lee, MD 43 Pink Eye in a Contact Lens Wearer, 30 Chris S. Bergstrom, MD and Alexander B. Baer, MD 44 Suspicious Hand Pain, 30 Rex G. Mathew, MD 45 Fever and Rash in a Child, 31 David L. Eldridge, MD 46 An Alcoholic with Dyspnea, 31 James H. Moak, MD, RDMS and John S. Rajkumar, MD 47 Dark Urine from an Immigrant, 32 Suzanne M. Shepherd, MD 48 Chest Pain and Lead aVR ST Segment Elevation, 33 William J. Brady, MD 49 Hand Pain after Striking a Wall, 34 William J. Brady, MD and Kevin S. Barlotta, MD 50 A Refugee with Skin Lesions, 35 Roger A. Band, MD and Jeanmarie Perrone, MD 51 Pain out of Proportion to Examination, 35 J. Michael Kowalski, DO and Adam K. Rowden, DO 52 Leg Pain Following a Motor Vehicle Collision, 36 Nathan P. Charlton, MD 53 Deformed Globe Following Trauma, 36 Worth W. Everett, MD 54 Foot Pain Following Breaking, 37 Munish Goyal, MD 55 Lamp Oil Ingestion, 38 David L. Eldridge, MD 56 Intermittent Abdominal Pain in a Female, 38 John S. Rajkumar, MD and James H. Moak, MD, RDMS 57 Hallucinations in a Botanist, 39 Joseph D. Forrester, MD and Christopher Holstege, MD 58 Altered Mental Status with an Abnormal Electrocardiogram, 40 William J. Brady, MD 59 Fishing in the Stomach, 41 Joseph D. Forrester, MD and Christopher P. Holstege, MD 60 Overdose-induced Boiled Lobster Skin, 41 Heather A. Borek, MD and Christopher P. Holstege, MD 61 Back Pain Following a Fall, 42 Andrew D. Perron, MD and Christopher T. Bowe, MD 62 Painful Facial Rash, 42 Chris S. Bergstrom, MD and Alexander B. Baer, MD 63 Intense Wrist Pain Following Trauma, 43 Rex G. Mathew, MD 64 Fever and Drooling in a Child, 44 Sarah E. Winters, MD, MSCE and Brendan G. Carr, MD 65 Syncope and Flank Pain in an Elderly Man, 44 John S. Rajkumar, MD and James H. Moak, MD, RDMS 66 Get Them Undressed!, 45 Munish Goyal, MD 67 A Blue Hue Following Endoscopy, 46 Saumil Vaghela, PharmD and Christopher P. Holstege, MD 68 Acute-onset Blurred Vision, 46 Chris S. Bergstrom, MD and Alexander B. Baer, MD 69 Elbow Pain in a Child After a Fall, 47 Elizabeth Cochran Ward, MD and Alexander B. Baer, MD 70 Confusion, Anemia, and Abdominal Pain in a Toddler, 47 Christopher P. Holstege, MD and Joseph T. Vance 71 A Ground-level Fall with Ankle Pain, 48 Christopher T. Bowe, MD 72 Traumatic Eye Pain and Proptosis, 49 Chris Bergstrom, MD and Alexander Baer, MD 73 Diffuse Ankle Pain Following a Fall, 49 Andrew D. Perron, MD and Christopher T. Bowe, MD 74 Rash Following Brush Fire, 50 Christopher P. Holstege, MD and Alejandro C. Stella, MD 75 Abdominal Pain in a Trauma Victim, 51 Esther H. Chen, MD 76 Skin Target Lesion, 51 Mara L. Becker, MD 77 Chest Pain and a Confounding Electrocardiogram Pattern, 52 William J. Brady, MD 78 Sudden Sedation in a Student, 53 David T. Lawrence, DO 79 Skin Lesions in a Comatose Patient, 53 Christopher P. Holstege, MD and Matthew D. Wilson, MD 80 Raccoon Eyes, 54 Angela M. Mills, MD 81 Fall on an Outstretched Hand in a Young Adolescent, 55 William Brady, MD and Kevin S. Barlotta, MD 82 Eye Pain and Facial Swelling, 55 Adam K. Rowden, DO and Chris S. Bergstrom, MD 83 Wrist Pain Following Fall on an Outstretched Hand, 56 William J. Brady, MD and Kevin S. Barlotta, MD 84 Rash on a Child with Epilepsy, 56 Heather A. Borek, MD and Christopher P. Holstege, MD 85 Abdominal Pain in an Alcoholic, 57 Angela M. Mills, MD 86 Chest Pain with Electrocardiographic ST Segment and T Wave Abnormalities, 58 William J. Brady, MD 87 A Heroin Abuser with Multiple Skin Lesions, 58 Christopher P. Holstege, MD and Ashley L. Harvin, MD 88 Chest Pain in a Middle-aged Male Patient with ST Segment Elevation, 59 William J. Brady, MD 89 Fire Victim with Hoarseness, 60 Kathryn Mutter, MD and Christopher P. Holstege, MD 90 A Gardener with a Non-healing Rash, 60 Roger A. Band, MD and Steve Larson, MD 91 A Bite to the Leg in Tall Grass, 61 Alejandro C. Stella, MD and Christopher P. Holstege, MD 92 An Elderly Man with Diffuse Facial Edema, 62 Kevin S. Barlotta, MD and Alexander B. Baer, MD 93 Acute-onset Double Vision, 62 Chris S. Bergstrom, MD and Alexander B. Baer, MD 94 Low Back Pain in a Car Accident Victim, 63 Edward G. Walsh, MD and William J. Brady, MD 95 Pain and Rash Following Contact with a Caterpillar, 64 Nathan P. Charlton, MD and Mairin Smith, MD 96 Moonshine-induced Basal Ganglion Necrosis and Metabolic Acidosis, 64 Nathan P. Charlton, MD and Christopher P. Holstege, MD 97 A Rock Climber with Finger Pain, Swelling, and Redness, 65 Joseph D. Forrester, MD and Christopher P. Holstege, MD 98 Vomiting and Syncope Following Ingestion of Ramps, 66 Christopher P. Holstege, MD and Justin H. Price, MD 99 Chest Pain and Subtle ST Segment Elevation, 66 William J. Brady, MD 100 Herbalist with Bradycardia and Vision Changes, 67 William J. Brady, MD 101 Painless Penile Ulcer, 68 Andrea L. Neimann, MD 102 Hyperthermia, Autonomic Instability, and Confusion in a Traveler, 68 Christopher P. Holstege, MD and Alexander B. Baer, MD 103 An Immigrant with Neck Swelling, 69 Suzanne M. Shepherd, MD and William H. Shoff, MD 104 Eyelid Laceration Following a Brawl, 70 Chris S. Bergstrom, MD and Alexander B. Baer, MD 105 Young Athlete with Back Pain, 71 Edward G. Walsh, MD and William J. Brady, MD 106 Chest Pain and Hypotension in an Adult Male Patient, 71 William J. Brady, MD 107 Adult Male with Atraumatic Lower Back Pain and Leg Weakness, 72 William J. Brady, MD 108 Facial Swelling in a Patient with Poor Dentition, 73 Alexander B. Baer, MD and Christopher P. Holstege, MD 109 Weakness and Bradycardia in an Elderly Female Patient, 73 William J. Brady, MD 110 Lightning Strike Induced Skin Changes, 74 Christopher P. Holstege, MD Part II Answers, Diagnoses, and Discussion, 75 Index, 183