Independently interpreting plain film imaging is an essential skill for the Emergency Medicine provider. Among the most notorious of injuries likely to be missed is the Maisonneuve fracture. In this post we demonstrate the "can't miss" imaging findings to ensure that you don't make the mistake of thinking this is "just an ankle sprain!"
A 32 yo male suffering from dental pain for the past several days presents to the ED complaining of abdominal pain. He notes ingesting large quantities of acetaminophen for the pain. Your triage nurse notes he is hypoxic on RA at 86%, but oddly this does not rise when the patient is placed on oxygen....
A healthy 32 yo unvaccinated male presents with shortness of breath. "Easy, it's Covid" you think as you head for the room. But what about this other complaint? Abdominal pain? What's that about?
A 63 year old male arrives via EMS in acute respiratory distress. Medics note he is in atrial fibrillation with a heart rate in the 150s. You ponder the age old question as you walk to the resuscitation bay: "Is the high heart rate causing the respiratory distress or vice versa?"
Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.
11-year-old boy previously health who presents with testicular pain. He had sudden onset of pain that started 6 hours ago. He rates it 8/10, states it has been constant since then and is non-radiating. He denies dysuria and similar pain in the past. He further denies testicular trauma and recent fevers. He had one episode of emesis while in the waiting room.
A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.
A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?