Med Student Corner: My Arm’s on Fire! Or the Clever Masquerade of Cellulitis

Author: Lilamarie Moko, MS4 // Editor: Michael Barrie, OSU EM Attending

It’s another late Thursday night in the ED and the waiting room is backed up with patients needing care. As you finish up with your seventh patient presenting with undifferentiated abdominal pain, your eyes rove the board for something new.  You assign yourself to a gentleman in his 60s, a “John Doe” with left arm swelling. Hopefully his abdomen has been behaving itself…

Upon entering the patient room, you see a pleasant, comfortable appearing gentleman in his mid-60s. He’s been having left arm pain and swelling that started 6 days ago. His arm is “on fire”. He first noticed some redness in his left elbow, associated swelling, tenderness, and restriction flexion and extension of his elbow. After about a day, he noticed the redness spreading down to his left wrist, with similar swelling, tenderness, and restricted flexion and extension of both wrist and fingers. He’s had a temperature to 100F, diaphoresis and chills. Also he reports some diarrhea, and urinary frequency in the past 2 days. With some further probing, he reveals that he just returned from Florida several days ago, had no noted scrapes or wounds, and spent most of his time fishing. He works as a farmer, but hasn’t been working for the past couple weeks.

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Med Student Corner: Ankle Pain – Reviewing the Ottawa Ankle Rules

Chief Complaint: Ankle Injury–Does this patient have a fracture?

Author: David Sacolick, MS4 // Editor: Michael Barrie, OSU EM Attending

Musculoskeletal injuries are common chief complaints in both emergency medicine and primary care settings. In particular, over 5 million ankle injuries occur in the United States each year. This patient population includes both young active patients as well as elderly patients. And while ligamentous sprains are more common, fractures are also common and can have long term consequences if not appropriately treated.

When a patient presents with a chief complaint of an ankle injury, how do you answer the question: Does this patient have a fracture?  Continue reading