|
By Schon Roberts MD PGY-3
61yo M with h/o of metastatic adenocarcinoma p/w numbness, tingling, and weakness in B/L UE and LE X 3 weeks. This has worsened in the past 3 days. He is now unable to walk or feed himself. He denies bowel/bladder incontinence, HA, fevers, chills, N/V/D, abdominal pain. He denies any IVD. He was 3 weeks ago able to work full time as an electrician. He complains also of chronic neck and back pain. Vital Signs are unremarkable. Back is normal appearance. Pt has 4/5 strength in B/L UE and LE. He has rigidity of R arm with spasm. Decreased sensation B/L UE and LE R>L. What is the best treatment option for this pt? A. Discharge home. This is chronic back pain. B. Refer patient to both pain management and a spinal surgeon to evaluate for disc herniation C. Obtain consults from nuclear medicine, spinal surgery, and admit pt. Give steroids D. Place pt in a TLSO brace and admit to the hospital E. Start broad spectrum antibiotics: pt has an epidural abscess
0 Comments
By Schon Roberts MD PGY-3
14 mo F, seen 3 days ago in ED with fever and possible UTI p/w new onset rash. She was placed on Omnicef and followed up with her regular doctor today. He sent her for evaluation. Parents state that she has had swelling of her hands and feet. Mother states that she has had a fever for 5 days. Fever was TMax 103 F. She has had adequate PO intake with good urine output and stooling. Parents deny URI Symptoms, N/V/D, or recent travel. Vital Signs show a pulse of 179, RR of 28, Temperature of 102.1 F, and patient has a spO2 of 99% on RA. Physical exam is remarkable for injected sclera, swelling of her hands and the dorsum of her feet. She has an erythematous rash on her trunk and extremities that blanches. It spares the palms and soles. Lungs are CTABL and cardiac exam is unremarkable. What is the best treatment option for this child? A. Broaden antibiotic coverage for meningitis to include listeria coverage, LP, and admit to the hospital B. Discharge home; Pt has a URI C. PO Tylenol, wait for defervescence, and D/C if improved D. Obtain an echocardiogram, start on high dose ASA, IVIG, and admit E. Start on steroids and admit with nephrology consult |
ABOUT USVegasFOAM is dedicated to sharing cutting edge learning with anyone, anywhere, anytime. We hope to inspire discussion, challenge dogma, and keep readers up to date on the latest in emergency medicine. This site is managed by the residents of Las Vegas’ Emergency Medicine Residency program and we are committed to promoting the FOAMed movement. Archives
June 2022
Categories |
RSS Feed
CONTACT US901 Rancho Lane, Ste 135 Las Vegas, NV 89106 P: (702) 383-7885 F: (702) 366-8545 
|
ABOUT US |
WHO WE ARE |
WHAT WE DO |
STUDENTS |
RESEARCH |
FOAM BLOG |
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
LasVegasEMR.com is neither owned nor operated by the Kirk Kerkorian School or Medicine at UNLV . It is financed and managed independently by a group of emergency physicians. This website is not supported financially, technically, or otherwise by UNLVSOM nor by any other governmental entity. The affiliation with Kirk Kekorian School of Medicine at UNLV logo does not imply endorsement or approval of the content contained on these pages.
Icons made by Pixel perfect from www.flaticon.com
Icons made by Pixel perfect from www.flaticon.com