To our followers:
First of all, thank you guys and gals for following this site. We’ve had a lot of fun writing these posts every month! We are so thrilled to share with you a piece of Kings County ED. We will be moving our image post to a different site starting next month. The Kings County Emergency Medicine department has it’s own blog: The Original Kings of County. We will begin posting our images there from now own.
Love,
Karen, Ray, Adam, and Mark
20 yo M w/ no PMH presents after skateboarding injury. He states he was skateboarding around a construction site when he felt a sharp object cut the back of his right leg. Vitals are within normal limits.
57 yo M w/ COPD, HIV (on HAART, unknown last cd4) presents for skin lesion w/ pain. Pt states he noticed a small bump on his arm about 2-3 months ago. It has has been growing and developed into the lesion pictured above. He states it’s been painful. It has not been pruritic. Denies any fevers, chills, weight loss, pus drainage, allergies, or other similar lesions.
35yo M w/ no PMH presents w/ skin rash as pictured above. Pt states it started as an area of erythema and tenderness around the ankle around 2-3 days ago and has been spreading. Vitals are within normal limits.
37 yo M w/ hx of dm, pancreatitis, and chronic pain presents to the ED with high FSG. FSG was 467 in triage, rest of vitals unremarkable. During your exam, patient states he needs his pain medication. He has chronic pain for which he takes 4mg Dilaudid every 6 hours. You ask about any toxic habits (specifically opioids) and patient denies. As you help your pt change into a gown, you notice syringes filled with a brown substance. When you ask the patient what is it, he states it’s is insulin. On exam, you note multiple skin lesions as pictured above.
1. What do you suspect the lesions are from?
2. On labs, you suspect the patient may be in DKA- What key findings would see on labs?
3. How would you manage this patient? How would you manage his pain? Dispo?
76yo M w/ no known DM and HTN presents for refill of medication. On your physical exam you notice nodules like the ones pictured above.
16 yo M w/ no PMH presents to the ED with left arm injury and pain. He states he tripped while walking down the stairs and grabbed the rail as he was falling. He heard a pop and has been in pain since. During your exam, you note that he cannot flex, extend, supinate or pronate at the elbow joint without pain. Radial pulses are +2 b/l and sensation is grossly intact b/l.
56yo homeless male with unknown PMH is bibEMS found unresponsive on a park bench. In the ED, pt opens eyes to commands, moves spontaneously, but does not produce any comprehensible speech. Pt has no complaints. On your physical exam you note his vitals are Temp 89.9F, HR99, RR20, O2 sat 96%, FSG 89. You also note that the patient’s left lower extremity looks as pictured above.
37 yo M w/ hx of HTN presents intoxicated with the injury seen above. According to EMS report, pt had tumbled down a flight of stairs. As you’re doing your physical exam, you note his right DP is weak/diminished compared to the left.
8mo male brought in by his mother hysterical for bloody bowel movements. Pt is up to date with vaccinations and was born at 35wks via vaginal delivery w/out any complications. Over the past 5 days, mother states child has not been feeding as well and has been tired with periods of fussiness and crying. Pt has had 4 episodes of NBNB vomiting over 2 days. Vitals on presentation 90/60BP, 100HR, 27RR@100%, 98.7F. During your exam, you take off the pt’s diaper to see this.
