Answer VizD Vol 3.1

Visual Diagnosis

Winners

Marjan Siadat                 Kyle Perry                        Katie Ohlendorf

Katie Dobratz                  Brian Junnila                 Matt Steimle

Sam Lee                           Devon Moore                  Donnell Newman

Shereaf Walid                 Dan Seitz                         Eric Tosh

Case 2.2

A 7-year-old boy is brought to the ED by his mother after she noticed the rash below on his body.  The mom states that the rash first appeared on her son’s face  and then rapidly spread to his neck, back, chest, and legs.  Mom states that her son complained of a sore throat for the last couple of days and he had a low-grade fever.  Mom states that her son is vaccinated with all vaccines except those that have live viruses.  On exam, you note postauricular and posterior lymphadenopathy.  The rash is pink to red and maculopapular.

rash1

1. What is the diagnosis?

Rubella (German Measles) – caused by infection with Rubivirus

Click here for a Lancet review on Rubella

2. What vaccine could have prevented this condition?

Mumps, Measles, Rubella – a live-attenuated virus

rubella

3. What is the most concerning complication of this condition?

-Congenital rubella syndrome (exposure occurs during the first trimester of pregnancy)

Click here for a review on Congenital Rubella Syndrome

-Subacute sclerosing panencephalitis

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

Visual Diagnosis Vol 3.1

Visual Diagnosis

Case 3.1

A 7-year-old boy is brought to the ED by his mother after she noticed the rash below on his body.  The mom states that the rash first appeared on her son’s face  and then rapidly spread to his neck, back, chest, and legs.  Mom states that her son complained of a sore throat for the last couple of days and he had a low-grade fever.  Mom states that her son is vaccinated with all vaccines except those that have live viruses.  On exam, you note postauricular and posterior lymphadenopathy.  The rash is pink to red and maculopapular.

rash1

1. What is the diagnosis?

2. What vaccine could have prevented this condition?

3. What is the most concerning complication of this condition?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

Answer VizD Vol 2.1

Winners

Bindu Vanapalli                Samuel Lee                Richard Gordon

David Mishkin                  Marjan Siadat             Chris Guyer

Julie Nguyen                     Allison Loynd             Maria Pak

Answer Case 2.1

A 23-year-old man presents to your ED after being in a bar fight.  The patient states he received multiple punches to his head and face.  You note the following finding on exam.

ear1

1. What is the diagnosis?

Pinna hematoma – characterized by swelling, discoloration, ecchymosis, and flocculence.

2. What is the treatment in the ED?

This should undergo incision and drainage or large needle aspiration followed by the application of a pressure dressing to prevent reaccumulation of the hematoma.The patient should receive antistaphylococcal antibiotics and referred to an ENT surgeon.

3. What is a complication of this condition?

Failure to adequately drain a pinna hematoma results in reaccumulation of blood and increases the chances for perichondritis and ear disfigurement (cauliflower ear)

cauliflowerear

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

VizD Vol 2.1

Case 2.1

A 23-year-old man presents to your ED after being in a bar fight.  The patient states he received multiple punches to his head and face.  You note the following finding on exam.

ear1

1. What is the diagnosis?

2. What is the treatment in the ED?

3. What is a complication of this condition?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

Answer VizD 1.5

Case 1.5

VizD Winners

Brian Kern                      Chris Guyer                Rob Klever

Scott Ottolini                  Devon Moore             David Mishkin

Kevin MacWilliams          Marjan Siadat             Allison Loynd

A 53-year-old woman presents to your ED after tripping down a flight of steps. On exam, you note marked swelling of her right orbit with proptosis of the right eye. You ask the patient to look to the side but she cannot move her eye.

Questions:
1. What is the procedure being performed?
2. What is the most common reason to perform the procedure?
3. What complication are you trying to prevent in performing this procedure?

Answer:

This week, Dr Susi Vassallo, author of the seminal work on emergency canthotomy, and previous EM resident at Detroit Receiving Hospital, will discuss the answer to this weeks VizD

Receiving: When indicated, why is it so important to perform a lateral canthotomy?
Dr Vassallo: Performance of lateral canthotomy is critical to decompression of the orbit and relief of pressure on the optic nerve. Otherwise, there is risk for ischemia to the optic nerve resulting in blindness.
Receiving: In your opinion, what is the most important technical aspect in performing this procedure?
Dr Vassallo: The most important technical aspect in performing the procedure is palpating the lateral canthal tendon and cutting it. It is more easily palpated than visualized.
Receiving: How often do you see this procedure performed? (no pun intended)
Dr Vassallo: This procedure is performed more often than one would think. When I first wrote this article, Dr. Peter Rosen, then editor of the Journal of Emergency Medicine did not think it was an emergency medicine procedure. We happened to be talking years later when Dr. Rosen was practicing in Jackson Hole Wyoming. He told me that one of his former residents had to perform the procedure without ophthalmology assistance; this is when he realized it was important for emergency physicians to understand the indications for the procedure and to know how to do it.
Receiving: How does it feel that Roberts and Hedges Procedure book uses your article and images for their chapter on lateral canthotomy?
Dr Vassallo: I am happy to see the pictures from our article in the book by Roberts and Hedges. Jim Roberts is one of my hero clinicians.
Receiving: Thank you for your time!
Dr Vassallo: Of course, you are very welcome!

Check out Dr Vassallo’s article

Here is video of the actual procedure

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

VizD Vol 1.5

Case 1.5

A 53-year-old woman presents to your ED after tripping down a flight of steps. On exam, you note marked swelling of her right orbit with proptosis of the right eye. You ask the patient to look to the side but she cannot move her eye.

Questions:
1. What is the procedure being performed?
2. What is the most common reason to perform the procedure?
3. What complication are you trying to prevent in performing this procedure?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

Answer VizD 1.4

Case 1.4

A 35-year-old woman presents to your ED with pain to her right leg.  The patient states that she was swimming in the ocean approximately one hour ago and felt a sharp pain around her knee.  She thought her pain was due to the paddle ball game she was playing earlier in the day.  What do you think?

Questions:

1. What is the diagnosis?

2. What is the most effective treatment?

3. Name one complication of this patient’s presentation?

Answers:

1. Jellyfish sting – envenomation occurs through nematocysts, which are sharp stinging cells.  Nematocysts are enclosed in venom sacs and present in tentacles.

2. On scene, vinegar is ideal.  Sea water is acceptable.  Tap water should be avoided as it may lead to a worsening of the envenomation.  Patients should receive tetanus toxoid if mandated.

3. Anaphylactoid reaction, leading to hypotension, dysrhythmias. bronchospasm, and cardiovascular collapse.

Here is an article from the Australian experts on Marine Envenomations

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

VizD Vol 1.4

Case 1.4

A 35-year-old woman presents to your ED with pain to her right leg.  The patient states that she was swimming in the ocean approximately one hour ago and felt a sharp pain around her knee.  She thought her pain was due to the paddle ball game she was playing earlier in the day.  What do you think?

Questions:

1. What is the diagnosis?

2. What is the most effective treatment?

3. Name one complication of this patient’s presentation?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

Answer VizD 1.3

VizD Winners:

Devon Moore          Brian McMichael

Chris Guyer            Maria Pak

Answer to Case 1.3

Name that Bodily Fluid

1. A 23-year-old man after performing 30 minutes straight of leg-squats.

2. A 66-year-old woman with abdominal pain and distension.

3. A 42-year-old man with epigastric pain that radiates to his back.

Questions for each image above:

1. What is the fluid?  What condition it is associated with?

2. What is the fluid?  What condition is it associated with?

3. What is the fluid?  What condition is it associated with?

Answers:

1. Myoglobinuria. Associated with Rhabdomyolysis.  Urine color may be reddish-brown due to the presence of myoglobin.  Positive for blood on dipstick exam, but no RBCs are seen on microscopic exam.

2. Bilious emesis. Associated with obstruction distal to the Sphincter of Oddi (location where bile enters digestive tract).  The presence of bilious emesis excludes the presence of gastric obstruction. Bilious emesis in children is associated with malroation and volvulus and requres emergent intervention.

3. Melena. Black, tarry stool asscoiated with GI hemorrhage (most commonly peptic ulcer disease).  The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

VizD Vol 1.3

Case 1.3

Name that Bodily Fluid

1. A 23-year-old man after performing 30 minutes straight of leg-squats

2. A 66-year-old woman with abdominal distension

3. A 42-year-old man with epigastric pain that radiates to his back

Questions for each image above:

1. What is the fluid?  What condition is it associated with?

2. What is the fluid?  What condition is it associated with?

3. What is the substance?  What condition is it associated with?

Please post your answer in the “reply box” or click on the “comments” link You will not see your answer post until next week when all of the submitted answers will be posted. Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

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