CASE A 64-year-old male with a history of hypertension, glaucoma, and central retinal vein occlusion presents to the emergency department in August with 2 weeks of progressively worsening, non-radiating abdominal pain. He describes feeling something “stuck” in his upper abdomen. He developed a dry cough around the same time as the abdominal pain and finds that coughing exacerbates the pain. He has tried milk of magnesia twice without relief. He has noticed a decreased appetite and a 7-pound weight loss. He also reports fatigue, chills, and myalgias. He is a former smoker and a former daily dri ..read more

CASE A 50-year-old male presents to the emergency department with leg swelling. The patient has a past medical history of diabetes, heart disease, and hypertension. He lives at home alone. He states that he has had a wound on his foot for the past several days. He has been wearing his shoes around the house and has been unable to take them off because his foot has become swollen. On physical exam, vitals are stable with heart rate 70, oxygen saturation 95% on room air, respiratory rate 10, blood pressure 150/80. Cardiac and lung exam is unremarkable, and abdomen is without distension or tender ..read more

CASE This is a 4-year-old female with a chief complaint of 2 days of rash. She appears to be completely unbothered by the rash, and has been afebrile without any recent infections/illnesses. A complete review of systems is negative. The patient has been eating and drinking well and her behavior is at baseline. Her mother at bedside denies any new exposures such as detergent, lotion, and food. She has no significant past medical history and does not take any medications; she is up to date on vaccines and has not received any new vaccines recently. Vital signs are within normal limits for age. T ..read more

“RUN AWAY!! RUN AWAY!!!” ~ Arthur, King of the Britons Certainly not! In our 50th edition of Money Minutes for Doctors we examine the current state of affairs in our economy. The smart money is hinting that they are not sure if we have hit the bottom of the canyon…but we may very well be near. That said, it is generally a given that we are experiencing an unprecedented fire sale on stocks. Be aware though, it looks as if a recession is in the cards coupled with consumer confidence severely on the rocks. Ms. Katherine Vessenes, CFP®, RFC, Founder and President of MD Financial Advisors, cautions ..read more

Triple “E” Syndrome: An Unusual Presentation of Severe Bilateral Arm Pain Case: A 68-year-old male with a past medical history of HTN, HLD presents reporting severe bilateral upper extremity pain. Patient has trouble providing more history due to pain, but states he woke up in bed with the pain and denies any trauma. Vitals: BP 129/68  | Pulse 64  | Temp 97.3 °F (36.3 °C)  | Resp 18  | SpO2 93% Physical Exam: You note uncomfortable appearing man, mild confusion, minimal bilateral shoulder deformity, proximal bilateral arm tenderness, decreased range of motion of bilateral s ..read more

CASE A 69-year-old female with a history of hypertension presents to the ED with near syncope. She had been walking around Newport on a hot day with her family when she began to feel lightheaded. Her family noted that she appeared pale and diaphoretic. She did not lose consciousness but she continued to feel weak and was brought to the emergency department.  On arrival, she attributes her weakness and lightheadedness to heat exposure and denies any chest pain, abdominal pain, or respiratory symptoms. Notably, her oxygen saturation is 88% and respiratory rate is 24/min. These findings rais ..read more

CASE A 51-year-old male with no past medical history presents to the ED with wrist pain after a fall. Earlier today, he lost his balance and fell down 12 stairs, landing on his outstretched hand. He has had increasing swelling of the radial aspect of his left wrist as well as extreme pain with movement. He did not strike his head or lose consciousness, and reports no other injuries. On exam, he has swelling and deformity of the left wrist with decreased range of motion secondary to pain and moderate tenderness to palpation. Sensation in the radial, median and ulnar distributions are all normal ..read more

CASE A 33-year-old male presents to the ED with ongoing left lower extremity pain and a few days of malaise. He has a history of bipolar I disorder, as well as chronic alcohol, tobacco and marijuana use. He first presented to his primary care doctor six days ago with erythema and pain over the left medial malleolus. At that time he had no other symptoms and physical exam was otherwise unremarkable. He was treated for presumed cellulitis with doxycycline, which he took at half of the prescribed dose due to a miscommunication with his doctor. Over the subsequent days, the rash on his leg did not ..read more

CASE A 57-year-old female presents to the emergency department with fatigue and weakness that have been worsening over a period of several months. She has a past medical history of chronic daily alcohol use, coagulation disorder with increased INR, and anxiety. She does not like to see physicians and has not been to her primary care doctor in several years, but decided to come in today because her fatigue and weakness have become too severe. She reports that for the past few months she has had a poor appetite and is unable to eat most things without vomiting. Her diet consists mostly of f ..read more

CASE A 55 year-old-male presents to the emergency department complaining of dizziness. He has a past medical history of alcoholic cirrhosis (now sober for the past 4 years) and hypertension and is an active 1 pack/day smoker. His symptoms started the night after his second Covid vaccine two weeks ago, when he began to feel unsteady while walking. He also reports morning nausea and headaches which are relieved when he drinks coffee and takes aspirin. He believes that his symptoms were a result of his vaccine or his recent dental procedures, but his dentist said this was unlikely. His famil ..read more