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Visual Diagnosis # 16

  This 48 yr old male presented to the emergency department with severe mid-epigastric pain worsening over the past 3 days. He describes associated nausea and vomiting without diarrhea or fever. No urinary symptoms. He admits to daily tobacco and alcohol use. He denies any recent illnesses or trauma. His …

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Do you DEWshine ?

  This article is from the Tennessee Poison Center posted on January 26, 2016 by Donna Seger, MD Medical Toxicologist  This past week, the Tennessee poison center was involved in the care of 4 teenagers from Robertson County who drank Mountain Dew mixed with racing fuel (aka Dewshine). Racing fuel (used for …

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Zika Virus

  Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947. In 2014, Zika virus was documented in Chile — the first incidence of the infection in Latin America. As of the most recent data, the countries in Latin America that have reports of Zika virus …

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Visual Diagnosis # 15

    A 45 yr old male presents with left foot pain. The patient claims he had a mechanical slip and fall down the stairs last night and his body weight fell on his left foot, which was folded beneath him. His left foot is edematous with some mild ecchymosis noted laterally. Patient …

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ECG Case Quiz # 5

  A 23-year old male presents to the emergency department with symptoms of dizziness and palpitations. He was playing basketball one hour ago, when after a brief sprint down the court he felt quite dizzy and short of breath. He sat down to rest, but the symptoms persisted. He has …

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the HINTS exam

  The HINTS exam is a three-part, rapid beside oculomotor test used to help differentiate central from peripheral vertigo. HINTS stands for Head Impulse, Nystagmus and Test of Skew. The test consists of three parts: 1 – Patients with peripheral vertigo will have abnormal (positive) head impulse testing, while patients …

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Visual Diagnosis # 14

  A 44 year-old male is brought in by EMS after an accidental heroin overdose. The patient was found sitting in his car unconcious and apneic with pin-point pupils and drug paraphernalia in the vehicle. The patient was resuscitated with 2 mg of intranasal Narcan (Naloxone) followed by another 2 …

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Visual Diagnosis # 13

  A 45 yr-old male arrives via ambulance in the emergency department found lying on the sidewalk unresponsive but with stable vital signs and no acute signs of trauma. The patient is very well known to EMS and emergency department staff and has a history of chronic alcohol abuse. Upon …

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Visual Diagnosis # 12

  A 39 year-old female presents to the emergency department by ambulance from home with worsening dyspnea and fatigue over the past 3 days. She is 6 days post-partum after an uncomplicated full-term vaginal delivery. This is her first pregnancy, during which she had developed gestational hypertension in the last …

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Breaking Dab

  Working in the emergency department it can be difficult to keep up with all the new street drugs. Here is yet another one….coming soon to an ER near you.   Dab, Dabs, Dabbing, wax, earwax, honey, honey oil, shatter and BHO are all street names for a new form …

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it’s da bomb

    A new designer drug has emerged on the teen scene. 2C-I-NBOMe, also known as “N-bomb”. This new drug is an extremely potent hallucinogenic stimulant and has been associated with multiple deaths. NBOMe is often sold under the pretense that it is LSD, however, unlike LSD, NBOMe also has …

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Visual Diagnosis # 11

  A 26 year-old male with acute alcohol intoxication presents to the emergency department with complaints of substernal chest discomfort which is made worse with deep inspiration. The symptoms began 1 hour ago after three episodes of vomiting. His vital signs and ECG are unremarkable. He has no cardiac risk …

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