Category: Sunday Scaries

Sunday Scaries

Concussion – Part 1 (Sunday Scary)

THE CASE: 20-something year old male comes into the dept with bruising and swelling to his face. Pt states he was jumped yesterday and had followed up at a CITYMD but refused transfer to the ED for further imaging. Today he has come to the ED because his face is swollen and he is in pain with a slight headache. On physical exam, Pt had good ROM of his neck w/o pain, conjunctival hemorrhages bilaterally without any corneal abrasions under wood's lamp, a little slow in answering questions. CT of face showing no acute fractures just gross edema, and no abnormalities on CT of

by Samir
Sunday Scaries

Wernicke’s Encephalopathy – Sunday Scary

THE CASE: One of our not so regular alcoholic with pmhx of DM presented to the ED with eye pain with concerns for acute angle glaucoma. Upon discharge up to the eye clinic the patient states he was unable to walk. Muscle strength 5/5 and good reflexes.What was going on here?? Was this man faking it to get an admission or was there something else going on?? WERNICKE'S ENCEPHALOPATHY vs WERNICKE-KORSAKOFF SYNDROME Wernicke's Encephalopathy -Opthalmoplegia (nystagmus and lateral rectus palsy), ataxia, and disturbances of consciousness or mental activity (ALL 3 seen i

by Alyssa Cocchiara, DO
Sunday Scaries

Burns – Sunday Scary

In honor of Thanksgiving Week this week's Sunday Scaries is going to highlight burns. Mostly because I so desperately want to deep fry a Turducken, hopefully without sinching my eyebrows! THE CASE: 28M old came in for "second degree burn" after having climbed into the bathroom sink, burning the lateral aspect of her left leg down to the foot (looking almost like de-gloving of the skin). Aside from getting ACS involved (strange and extensive burns in children must be reported), the burn team was called for debridement and evaluation of the wound. It had me thinking of

by Alyssa Cocchiara, DO
Sunday Scaries

Narcan – Sunday Scary

Case: 16yr old female (about 55kg) came in to the ED as toxic ingestion of opiates, stating that she took percocets and hydromorphone pills her parents had in the house. As the team was managing the case, 6 hours into observation they noted that she was becoming increasingly lethargic, they noted she would maintain her ventilation although noted EtCO2 of low-mid 40s (nml 35-45 mm Hg) with two periods of apnea where she would desaturate down to 86%. All labs (including tylenol level taken at 4hr from ingestion) were within normal limits (urine tox opiate and oxycodone

by Alyssa Cocchiara, DO
Sunday Scaries

Ingrown Toenail (Sunday Scary)

Case: 5 yr old girl presents to the ED with toe pain. Mom states she saw that the toe was red and painful and looked like an ingrown toenail. First, this mom is really bad at cutting toenails! after performing this procedure tell patients to not cut nails straight across as it is more likely to grow into the lateral nail fold, to stay away from tight shoes, and address rotated digits or toe deformitiesSecond, if you have a patient with this, start soaking the foot before you sit down to do the procedure, it will make your lifeso much easier! Stage I --> erythema

by Alyssa Cocchiara, DO
Sunday Scaries

PANDAS – Sunday Scary

CASE: 7 yr old female (fully vaccinated) came to the ED with sore throat of 3 days duration, sent from school for vomiting and having a full body tremor. Vitals stable, afebrile. On examination she was tremulous without any focal neuro deficits, able to follow commands and speaking in full sentences (all while continuing to shake).Exam positives included: Tremulous throughout examination with distractability (pausing during finger to nose testing) AND erythematous oropharnyx +tonsilar exudates. Tested Rapid Strep +Okay, so this kid had strep pharyngitis but what is

by Alyssa Cocchiara, DO
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