Visual Diagnosis in Emergency and Critical Care Medicine

CHRISTOPHER P. HOLSTEGE MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia ALEXANDER B. BAER MD, Division of Medical Toxicology, Department of Emergency Medicine, University of VirginiaJESSE M. PINES MD, Center for Health Care Quality, Department of Emergency Medicine and Health Policy, George Washington UniversityWILLIAM J. BRADY MD, Department of Emergency Medicine, University of Virginia

“Image quality, a critical aspect of a work of this type, and succinct but clear presentations, make this book successful.”  (Doody’s, 27 April 2012)"These discrepancies detract only slightly from the overall quality of the book, however, and it can be recommended for purchase by any ED library." (Emergency Nurse, 1 December 2011)

• List of contributors ixForeword xiiPreface xivIllustration credits xvPart I Case Presentations and Questions 11 Slash Wound to the Neck 3Kevin S. Barlotta MD and Alexander B. Baer MD2 “I’ve Got Blood in My Eye” 3Chris S. Bergstrom MD and Alexander B. Baer MD3 Forearm Fracture After Falling 4Alexander B. Baer MD4 A Neonate with Fever and Rash 4David L. Eldridge MD5 A Missing Button Battery 5Brendan G. Carr MD and Sarah E. Winters MD MSCE6 Anorexia Hair Loss and Fingernail Bands 6Christopher P. Holstege MD7 Wide Complex Tachycardia in a Young Adult 6William J. Brady MD8 Wide Complex Tachycardia in an Older Male Patient 7William J. Brady MD9 Muscle Spasms Following a Spider Bite 8J. Michael Kowalski DO and Adam K. Rowden DO10 Necrotic Skin Lesion 8David A. Kasper DO MBA Aradhna Saxena MD and Kenneth A. Katz MD11 Intense Pain Following High-pressure Injection Injury 9David T. Lawrence DO12 Prenatal Vitamin Overdose 9Christopher P. Holstege MD and Adriana I. Goldberg MD13 Blurred Vision Following Yard Work 10Allyson Kreshak MD14 Foot Pain in a Gymnast 11Hoi K. Lee MD15 A Child with Bruises of Different Ages 11David L. Eldridge MD16 Sudden Shortness of Breath after Removal of a Central Line 12Christopher P. Holstege MD17 “My Eyes Are Yellow!” 13David T. Lawrence DO18 Pleuritic Chest Pain in a Young Adult Male 13William J. Brady MD19 Exposed During a Blizzard 14Joseph D. Forrester MD and Christopher P. Holstege MD20 FAST Evaluation of a Trauma Patient 15John S. Rajkumar MD and James H. Moak MD RDMS21 Chest Pain with Sudden Cardiac Death 15William J. Brady MD22 Wrist “Sprain” in a Child 16Jennifer S. Boyle PharmD MD23 Acute Eye Pain and Blurred Vision in an Elderly Female 17Chris S. Bergstrom MD and Alexander Baer MD24 Heel Pain Following a Fall 17Jennifer S. Boyle PharmD MD25 Confluent Rash on a Child 18Sarah E. Winters MD MSCE and Brendan G. Carr MD26 Bradycardia Following an Herbal Ingestion 18Alexander B. Baer MD27 A Pain-free Adult with Persistent T Wave Abnormalities 19William J. Brady MD28 Caustic Ingestion with Cardiotoxic Effects 20Heather A. Borek MD and Christopher P. Holstege MD29 Chemical Eye Exposure 21Chris S. Bergstrom MD and Alexander B. Baer MD30 Acute Abdominal Pain in Pregnancy 22James H. Moak MD RDMS and John S. Rajkumar MD31 Coma Following Head Trauma 22Andrew L. Homer MD and William J. Brady MD32 Tongue Swelling in a Hypertensive Female 23Kevin S. Barlotta MD and Alexander B. Baer MD33 Purulent Eye Discharge in an Adult 24Chris S. Bergstrom MD and Alexander B. Baer MD34 Shoulder Pain Following Direct Blow 24Nathan P. Charlton MD35 A Gagging Child 25Maureen Chase MD and Worth W. Everett MD36 Adult Male with a Sudden Severe Headache 25Andrew L. Homer MD and William J. Brady MD37 New Facial Droop 26Andrew D. Perron MD and Christopher T. Bowe MD38 Eye Pain After Tree Branch Strike 26Chris S. Bergstrom MD and Alexander B. Baer MD39 An Elderly Woman with Groin Pain 27Brendan G. Carr MD40 Rash and Joint Pain in a Child 28Mara L. Becker MD41 Radiology Findings after Laparoscopy 28Munish Goyal MD42 Postprandial Abdominal Pain in an Elderly Woman 29Hoi K. Lee MD43 “Pink Eye” in a Contact Lens Wearer 30Chris S. Bergstrom MD and Alexander B. Baer MD44 Suspicious Hand Pain 30Rex G. Mathew MD45 Fever and Rash in a Child 31David L. Eldridge MD46 An Alcoholic with Dyspnea 31James H. Moak MD RDMS and John S. Rajkumar MD47 Dark Urine from an Immigrant 32Suzanne M. Shepherd MD48 Chest Pain and Lead aVR ST Segment Elevation 33William J. Brady MD49 Hand Pain after Striking a Wall 34William J. Brady MD and Kevin S. Barlotta MD50 A Refugee with Skin Lesions 35Roger A. Band MD and Jeanmarie Perrone MD51 Pain out of Proportion to Examination 35J. Michael Kowalski DO and Adam K. Rowden DO52 Leg Pain Following a Motor Vehicle Collision 36Nathan P. Charlton MD53 Deformed Globe Following Trauma 36Worth W. Everett MD54 Foot Pain Following Breaking 37Munish Goyal MD55 Lamp Oil Ingestion 38David L. Eldridge MD56 Intermittent Abdominal Pain in a Female 38John S. Rajkumar MD and James H. Moak MD RDMS57 Hallucinations in a Botanist 39Joseph D. Forrester MD and Christopher Holstege MD58 Altered Mental Status with an Abnormal Electrocardiogram 40William J. Brady MD59 Fishing in the Stomach 41Joseph D. Forrester MD and Christopher P. Holstege MD60 Overdose-induced Boiled Lobster Skin 41Heather A. Borek MD and Christopher P. Holstege MD61 Back Pain Following a Fall 42Andrew D. Perron MD and Christopher T. Bowe MD62 Painful Facial Rash 42Chris S. Bergstrom MD and Alexander B. Baer MD63 Intense Wrist Pain Following Trauma 43Rex G. Mathew MD64 Fever and Drooling in a Child 44Sarah E. Winters MD MSCE and Brendan G. Carr MD65 Syncope and Flank Pain in an Elderly Man 44John S. Rajkumar MD and James H. Moak MD RDMS66 Get Them Undressed! 45Munish Goyal MD67 A “Blue Hue” Following Endoscopy 46Saumil Vaghela PharmD and Christopher P. Holstege MD68 Acute-onset Blurred Vision 46Chris S. Bergstrom MD and Alexander B. Baer MD69 Elbow Pain in a Child After a Fall 47Elizabeth Cochran Ward MD and Alexander B. Baer MD70 Confusion Anemia and Abdominal Pain in a Toddler 47Christopher P. Holstege MD and Joseph T. Vance71 A Ground-level Fall with Ankle Pain 48Christopher T. Bowe MD72 Traumatic Eye Pain and Proptosis 49Chris Bergstrom MD and Alexander Baer MD73 Diffuse Ankle Pain Following a Fall 49Andrew D. Perron MD and Christopher T. Bowe MD74 Rash Following Brush Fire 50Christopher P. Holstege MD and Alejandro C. Stella MD75 Abdominal Pain in a Trauma Victim 51Esther H. Chen MD76 Skin Target Lesion 51Mara L. Becker MD77 Chest Pain and a Confounding Electrocardiogram Pattern 52William J. Brady MD78 Sudden Sedation in a Student 53David T. Lawrence DO79 Skin Lesions in a Comatose Patient 53Christopher P. Holstege MD and Matthew D. Wilson MD80 Raccoon Eyes 54Angela M. Mills MD81 Fall on an Outstretched Hand in a Young Adolescent 55William Brady MD and Kevin S. Barlotta MD82 Eye Pain and Facial Swelling 55Adam K. Rowden DO and Chris S. Bergstrom MD83 Wrist Pain Following Fall on an Outstretched Hand 56William J. Brady MD and Kevin S. Barlotta MD84 Rash on a Child with Epilepsy 56Heather A. Borek MD and Christopher P. Holstege MD85 Abdominal Pain in an Alcoholic 57Angela M. Mills MD86 Chest Pain with Electrocardiographic ST Segment and T Wave Abnormalities 58William J. Brady MD87 A Heroin Abuser with Multiple Skin Lesions 58Christopher P. Holstege MD and Ashley L. Harvin MD88 Chest Pain in a Middle-aged Male Patient with ST Segment Elevation 59William J. Brady MD89 Fire Victim with Hoarseness 60Kathryn Mutter MD and Christopher P. Holstege MD90 A Gardener with a Non-healing Rash 60Roger A. Band MD and Steve Larson MD91 A Bite to the Leg in Tall Grass 61Alejandro C. Stella MD and Christopher P. Holstege MD92 An Elderly Man with Diffuse Facial Edema 62Kevin S. Barlotta MD and Alexander B. Baer MD93 Acute-onset Double Vision 62Chris S. Bergstrom MD and Alexander B. Baer MD94 Low Back Pain in a Car Accident Victim 63Edward G. Walsh MD and William J. Brady MD95 Pain and Rash Following Contact with a Caterpillar 64Nathan P. Charlton MD and Mairin Smith MD96 Moonshine-induced Basal Ganglion Necrosis and Metabolic Acidosis 64Nathan P. Charlton MD and Christopher P. Holstege MD97 A Rock Climber with Finger Pain Swelling and Redness 65Joseph D. Forrester MD and Christopher P. Holstege MD98 Vomiting and Syncope Following Ingestion of Ramps 66Christopher P. Holstege MD and Justin H. Price MD99 Chest Pain and Subtle ST Segment Elevation 66William J. Brady MD100 Herbalist with Bradycardia and Vision Changes 67William J. Brady MD101 Painless Penile Ulcer 68Andrea L. Neimann MD102 Hyperthermia Autonomic Instability and Confusion in a Traveler 68Christopher P. Holstege MD and Alexander B. Baer MD103 An Immigrant with Neck Swelling 69Suzanne M. Shepherd MD and William H. Shoff MD104 Eyelid Laceration Following a Brawl 70Chris S. Bergstrom MD and Alexander B. Baer MD105 Young Athlete with Back Pain 71Edward G. Walsh MD and William J. Brady MD106 Chest Pain and Hypotension in an Adult Male Patient 71William J. Brady MD107 Adult Male with Atraumatic Lower Back Pain and Leg Weakness 72William J. Brady MD108 Facial Swelling in a Patient with Poor Dentition 73Alexander B. Baer MD and Christopher P. Holstege MD109 Weakness and Bradycardia in an Elderly Female Patient 73William J. Brady MD110 Lightning Strike Induced Skin Changes 74Christopher P. Holstege MDPart II Answers Diagnoses and Discussion 75Index 183