An Uncommon Rash in the Emergency Department: Sporothrix schenckii.

The authors present a case of Sporothrix schenckii diagnosed in the emergency department, based on a thorough history. The patient presented with skin nodules that had spread proximally up the arm in various stages of healing. He reported minimal pain for the unhealed ulcer and no pain for the healing ulcers, and no other concerning symptoms. The history of a thorn prick followed by the initial red nodule on the forearm has led to the diagnosis - as it was consistent with the classic presentation of lymphocutaneous sporotrichosis. A high index of suspicion and carefully noting occupational history is required for a diagnosis of sporotrichosis. Clinicians should recommend long sleeves and gloves to their patients when they are handling soil.

Bounced off a Truck Out of the Blue: A Case Report of a Lightning Strike During a Thunderstorm.

Lightning strikes are a relatively uncommon emergency department presentation, and due to the very high energy involved, can present quite dramatically, including cardiac arrest. However, as with many chief complaints, sometimes these patients can be discharged home after a benign emergency department evaluation. We present one such case of a male who was struck to the ground by lightning outside his truck, which subsequently caught on fire. He demonstrated the classic Lichtenberg figures associated with a lightning injury that evolved over time but was otherwise hemodynamically stable. After an unremarkable laboratory evaluation and electrocardiogram, he was safely discharged home.

Aortic Dissection Presenting as Leg Pain.

A female in her mid-sixties presented to the emergency department with the chief complaint of leg pain. After evaluation, she was found to have a rapidly progressing aortic dissection resulting in an occlusion of the right common iliac artery. The authors highlight the variable presentations of acute aortic dissection, beyond classic tearing chest pain.

Management of Hydrofluoric Acid Burns in the Emergency Department.

Hydrofluoric acid burns are uncommon but unique among chemical burns in that they can cause visually mild burns with significant deep tissue injury and systemic toxicity through multiple mechanisms. We present the case of a patient who presented with bilateral hydrofluoric acid burns to his hands from aluminum brightener. The patient had been using an aluminum brightener with a hydrofluoric acid concentration of 10% for several months at work. On emergency department presentation, the patient endured significant tenderness to his hands and fingers. The patient suffered no serious complications, had no concerning lab or electrocardiographic findings, and was treated symptomatically with calcium gluconate gel. He was discharged home after successful symptom resolution with proper return precautions and instructions on how to safely use hydrofluoric acid containing products. Although not a very common cause of burns, acute care of these burns requires specific knowledge which is imperative for emergency personnel.

Ventriculoperitoneal Shunts in the Emergency Department: A Review.

In this paper, we review the indications, complications, and pitfalls associated with ventriculoperitoneal (VP) shunts. As most VP shunt problems initially present to the emergency department, it is important for emergency physicians to be well-versed in managing them. In the article, the possible reasons for shunt failure are explored and summarized using an infographic. We also examine potential clinical presentations of VP shunt failure.

Viper-induced Consumptive Coagulopathy from a Decapitated Eastern Diamondback Rattlesnake.

We present the case of a patient who presented with viper-induced consumptive coagulopathy after a bite on the thumb from a decapitated eastern diamondback rattlesnake. The patient was evaluated and treated in the Emergency Department and was admitted to the intensive care unit.

Designing the Third- and Fourth-Years Clerkship Schedule.

Deciding on a specialty may be one of the most daunting parts of medical school. Accordingly, it is important for medical students to make informed decisions regarding their choice of specialty. To do so, they should start planning early by contemplating possible career choices during the first 2 years of medical school, followed by properly designing their third- and fourth-year schedules. This article provides guidance and advice to medical students on how to schedule their clinical clerkships in order to optimize their ability to decide on a field of medicine to study and, ideally, to prepare them for a career in emergency medicine.

A novel use of Twitter to provide feedback and evaluations.

BACKGROUND: Inconsistencies in work schedules and faculty supervision are barriers to monthly emergency medicine (EM) resident doctor evaluations. Direct and contemporaneous feedback may be effective in providing specific details that determine a resident's evaluation. OBJECTIVES: To determine whether Twitter, an easy to use application that is available on the Internet via smartphones and desktops, can provide direct and contemporaneous feedback that is easily accessible, and easy to store and refer back to. METHODS: First- to third-year EM residents were administered a survey to assess their thoughts on the current monthly evaluation system. Subsequently, residents obtained a Twitter account and were instructed to follow a single general faculty Twitter account for ease of data collection. Following completion of an 8-week study period, a second survey was administered to assess resident thoughts on contemporaneous feedback and evaluations versus the traditional form. RESULTS: Of the 24 EM residents, 13 were available for study. A total of 220 'tweets' were provided by seven faculty members, with a mean of 11 tweets (range 8-17) per resident. The 13 residents received a total of eight formal evaluations from 19 faculty members. The second survey demonstrated that this method provided more detailed evaluations and increased the volume of feedback. CONCLUSION: Contemporaneous feedback and evaluation provides a greater volume of feedback that is more detailed than end-of-course evaluations. Twitter is an effective and easy means to provide this feedback. Limitations included the length of study time and the inability to have all of the EM residents involved in the study.

A case of traumatic proptosis.

We present a case of traumatic proptosis in a competitive football player. This entity can occur with a significant decrease in vision, but in this case it did not. Some other causes of this condition are also discussed. A review of some traumatic conditions that may cause proptosis is provided as well.

Large basilar aneurysm with posterior inferior cerebellar artery stroke and consequential fatal subarachnoid hemorrhage.

Basilar artery aneurysm presenting a stroke is rare, and we present a case of this along with a discussion of the management options available.

Self-inflicted hyperkalemia: a case report.

We present a case of a potentially lethal ingestion of potassium pills. After presentation, we briefly review the epidemiology and pathology of hyperkalemia.

Visual diagnosis: pediatric airway emergency.

We present a case of a potentially difficult airway emergency in a pediatric patient. After presentation, we briefly review critical differences between pediatric and adult airways and management of the airway during these emergencies.

Endocarditis-Induced Mycotic Brain Aneurysm following Right MCA Stroke.

The diagnosis of cerebrovascular accident is extremely common in emergency medicine; however, CVA resulting from hemorrhage following mycotic brain aneurysm following embolic stroke is extremely uncommon. This case reports such an event.

Ovarian torsion in a 5-year old: a case report and review.

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

An unusual case of abdominal pain.

Renal calyceal rupture is a usual etiology of abdominal pain in the emergency department. We present a case of unexpected renal calyx rupture in a patient with symptomatology of renal colic. A discussion and review are provided.

A case of dens fracture: a pictorial review and discussion.

Dens fractures are more common in the elderly and may present after minimal trauma and with minimal neck pain. The case reports a case of a significant fracture after minimal trauma, presenting with neurologic symptoms and minimal neck pain.

Bilateral and Simultaneous Rupture of the Triceps Tendon in a Patient without Predisposing Factors.

Tendon rupture is typically associated with predisposing features including renal failure, hyperparathyroidism, and connective tissue elastosis. We present a case in which none of these risk factors is present and in a completely healthy patient. To our knowledge, this has never been reported in the literature.

"Bath salts" intoxication: a case report.

We present a case of a potentially lethal ingestion of "Bath Salts." After presentation, we briefly review the epidemiology and pathology of "bath salts" ingestion.

Visual diagnosis: Rectal foreign body: A primer for emergency physicians.

We present a case that is occasionally seen within emergency departments, namely a rectal foreign body. After presentation of the case, a discussion concerning this entity is given, with practical information on necessity of an accurate and thorough history and removal of the object for clinicians.

Visual Diagnosis: Pearling: a case study.

We present the case of a patient who attempted to perform a type of body modification known as "pearling" or "genital beading" while in prison. This patient unfortunately caused severe trauma to his penis, requiring surgical intervention. Photographs of the traumatic injuries are presented.