Volume 16, Issue 5, September 2015.
Caroline T. Brandon, MD, et al.

A 34-year-old male with diabetes presented to the
emergency department with four days of progressively
worsening redness, swelling and pain to his left buttock.
The patient denied fevers, chills, rectal pain or purulent
drainage from his rectum. His initial vital signs were heart
rate of 82; blood pressure of 146/92; and temperature of
98.2°F. The left buttock had a poorly circumscribed area of
induration; however, there was no fluctuance or crepitace.
Rectal exam was unremarkable. Because the patient’s
buttock pain was disproportionate to his exam findings,
a point-of-care ultrasound was performed to determine
if a more extensive process was present. The ultrasound
demonstrated cobblestoning, fascial thickening with edema,
and a large 4.5cm fluid collection extending and adjacent
to the rectum.

Volume 16, Issue 5, September 2015
Jill Tirabassi, MD, et al.

A 25-year-old male presented to the ski clinic after
colliding with a tree while snowboarding. He had immediate
sharp pain at his “tailbone,” but denied numbness and
weakness. Past medical history was initially reported as
unremarkable. On exam, he demonstrated midline tenderness
over the sacrum. Pelvic radiography was performed (Figure).

Volume 16, Issue 5, September 2015.
Stephen L. Thornton, MD, et al.

A previously healthy two-year-old boy presented to the
emergency department with vomiting. He was cyanotic with
mottling of both lower extremities. He was in respiratory
distress with retractions and diminished breath sounds. His
abdomen was distended and rigid. He had a pulse of 170 beats
per minute, blood pressure of 144/69mmHg and respiratory
rate of 42 breaths per minute. He was endotracheally
intubated. Chest and abdominal radiographs demonstrated a
tension pneumoperitoneum.

Volume 16, Issue 5, September 2015.
Tomohiro Sonoo, MD, et al.

A 67-year-old woman complaining of continuous fresh
vaginal hemorrhage came to our emergency department in a
pre-shock state. Examinations revealed an irregularly shaped
mass in the uterus and active arterial bleeding. Emergent
hysterectomy and interventional radiology were not
immediately available. Foley catheter with 20mL water was
inserted into the uterine cavity, then the balloon was pulled
to obstruct the uterus output (Figure). Her vital signs became
stabilized, and she was transferred to another hospital two
days later.

Volume 16, Issue 4, July 2015.
Patrick Burns, MD, et al.

A 48-year-old male presented with body aches and a chronic rash. He had no medical history aside from two unsuccessful treatments for presumed scabies and a recent diagnosis of psoriasis. Physical exam revealed hypotension, tachycardia, and profound, diffuse yellow crusting of the skin with erythematous erosions covering non-crusted areas. The patient was resuscitated and treated for septic shock while microscopic evaluation of scrapings of the crusted skin was performed.

Volume 16, Issue 4, July 2015.
Nobuhiko Kimura, MD, et al.

A 30-year-old man presented to the emergency department
for two weeks of diffuse abdominal pain and an episode of
emesis. He denied fever, prior surgery, or any other illnesses.
The patient reported going on a “crash diet regimen” one
month prior, resulting in an intentional weight loss of 25lbs in
30 days.

Volume 16, Issue 4, July 2015.
Nappe, DO, et al.

A 26-year-old female presented to the emergency department with a chief complaint of dizziness. Further history revealed that she was experiencing generalized weakness and intractable vomiting for three days, without complaint of abdominal pain or lower gastrointestinal symptoms. Physical examination uncovered mild dehydration with stable vital signs and non-fatigable, horizontal nystagmus consistent with internuclear opthalmoplegia.

Volume 16, Issue 4, July 2015.
Christian, MD, et al.

A 54-year-old man with a history of alcohol use presented with hematochezia and syncope. Upon arrival to the hospital, his bleeding had stopped. He was hemodynamically stable with hemoglobin of 11g/dL, international normalized ratio of 1.8 and platelets of 37K/mcL. Nasogastric aspirate found bilious gastric contents without blood.

Volume 16, Issue 3, May 2015
Kubwimana M. Mhayamaguru, MD, et al.

A 61-year-old female presented to the emergency department complaining of constipation and vaginal bulge with valsalva 89 days after a robotic-assisted hysterectomy. The patient had intercourse three days prior to presentation and experienced postcoital abdominal discomfort with vaginal bleeding. She denied any other trauma. She had no other complaints and denies fevers, chills, nausea, vomiting, abdominal distension, or constipation. Physical exam revealed exposed bowel protruding through the vaginal cavity.

Volume 16, Issue 3, May 2015
Demis N. Lipe, MD, MSc, et al.

A 42-year-old man with history of esophageal strictures and esophageal dilation presented to the emergency department with 12 hours of dysphagia and non-bloody emesis. His symptoms started upon waking and included sharp retrosternal pain during each attempt at swallowing. Dysphagia occurred with both solids and liquid. He denied difficulty initiating swallowing, pain with eating the previous night, halitosis and hematemesis.

Volume 16, Issue 2, March 2015
Pablo Aguilera, MD et al.

A 22-year-old healthy male university student presented to the emergency department (ED) complaining of syncope. He had five episodes of loss of consciousness from 10 to 40 seconds in length, with loss of postural tone and full recovery without intervention in the last month.

Volume 16, Issue 2, 2015
Michael Butterfield, MD et al.

A nine-month-old girl was brought to the emergency department because of right neck swelling. She had recently been discharged from the same hospital after a brief admission for pneumonia that had followed influenza.

Volume 16, Issue 2, March 2015
Thomas M. Nappe, DO et al.

An 18-year-old female presented to the emergency department with three days of worsening left flank pain. Past medical history included asymptomatic bacteriuria. She denied prior similar episodes or inciting events, and was currently being treated with trimethoprim sulfamethoxazole by an urgent care center for a urinary tract infection, although she denied having any urinary symptoms.