UOTW #83

Young adult female presents for e/o sudden onset, severe lower abdominal pain, left greater than right, since 6pm last night. Worse than normal menstrual cramping, described as constant and sharp. Associated with night sweats upon waking up from sleep on morning of presentation. Denies F, N/C, hematuria, dysuria, vaginal discharge or bleeding. Patient is sexually active. Last menstrual period (LMP) about 1 month prior. Had a positive pregnancy test at Urgent Care today and referred in for evaluation. Upon arrival to the ED, the patient had a blood pressure of 145/76, heart rate 82, respiratory rate 18, temperature 36.4, and oxygen saturation of 100% on RA. She was diffusely tender to palpation across the low abdomen. Bedside US was performed showing the below:


UOTW #82

A 19-year-old female presented to the emergency department with acute right ankle pain and inability to bear weight after falling while dancing in high heel shoes. She was otherwise healthy, with no pertinent past medical history. She endorsed pain primarily along the posterior aspect of her right ankle and lower calf. Physical exam of the right ankle was notable for no bony deformity, tenderness along the posterior ankle and distal calf, inability to actively plantarflex the right foot.

Given the patient’s presenting complaints and constellation of physical exam findings, the emergency physician performed a bedside ultrasound, confirming the suspected diagnosis. The first clip below is the normal side, the second clip is the affected side.



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UOTW #81

A 49-year-old male presents with upper back pain. He describes the pain as sharp, intermittent, and worse with deep breathing or laughing. The pain is very localized, as he points to a specific site on his left upper back. It does not radiate and has been going on since he was in a motor vehicle accident (MVA) one week ago. At that time head CT and chest xray in a local emergency department were normal. He has been prescribed muscle relaxers and NSAIDs, but they do not seem to help. He is concerned that “my spleen is lacerated!” Detailed FAST exam is negative. You then ultrasound his chest where he is hurting…