Aaron Bright

Trust Me, This Is the Worst “Acne” of Your Life!

ANNALS CASE A 55-year-old woman presented to the emergency department (ED) with a 2-week history of a pruritic rash and progressive weakness. The eruption, first affecting the abdomen, appeared 9 days after initiation of vancomycin and cefepime (Figure 1). The patient had a temperature of 38.4 C (101.1 F) and a pulse rate of 160 beats/min. Physical examination revealed diffuse, edematous, erythematous plaques with overlying pustules and isolated bullae (Figure 2). The oral mucosa was not involved. Laboratory investigation identified an elevated lactate level of 6.4 mmol/L and leukocytosis of 28.9 10^9/L. To paraphrase Indiana Jones.rashes, why did it have to be rashes? When you take a look at these images, the rash is pretty impressive, and the patient sounds sick. A decision to admit this patient is probably the easy part. Butwhat’s your working diagnosis and what should you do next? Is this purpura fulminans in evolution or some autoimmune reaction? Do you give empiric antibiotics? Do you give empiric corticosteroids? Read on.

Chest Pain Bounce-Back: Posterior Sternoclavicular Dislocation

Editor’s note: Annals has partnered with Hippo Education and EM:RAP, enabling our readers without subscriptions to Hippo EM Board Review or EM:RAP to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and Hippo Education, EM:RAP or its authors.

Pyoderma Gangrenosum: An Inside Job.

Editor’s note: Annals has partnered with EM:RAP, enabling our readers without subscriptions to the EM:RAP service to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and EM:RAP or its authors.

Why Does Your Dandruff Smell Like Urine

ANNALS CASE A 26-year-old man with hypertension and end-stage renal disease (ESRD) presents to the emergency department (ED) with worsening shortness of breath developing during the past 2 weeks. He is visibly dyspneic and has difficulty speaking. He is alert but is slow to respond to questions. He reports that he stopped attending dialysis approximately 3 weeks ago because of fear that the dialysis staff was “stealing” his blood. On physical examination, white flaky material is noted on the patient’s scalp (Figure). The blood urea nitrogen (BUN) level is 249 mg/dL.

Brave new world of emergency medicine education.

To say that the past 25 years has seen unprecedented change in medicine, education and information technologies is to be redundant, stale and absolutely right! In 1989, the modern Internet did not exist. There was no Amazon®, Wikipedia or online textbooks. Most people used corded phones to make calls for goodness’ sake! If an emergency physician needed to look up the best therapy for asthma exacerbations, he or she headed to the book rack in the back of the emergency room and flipped through the index of some giant tome to find information that was often several years outdated. The present paper is being written on Google® Docs, shared internationally among four authors separated by over 5000 miles and group-edited in real time. Google® did not exist in 1989. Most people had never heard of a laptop let alone the idea of having most of the world’s information accessible immediately on a slick beautiful device in their pocket. The change has been so fast, so radical and so complete, that it is almost impossible for us to fathom it, let alone try and describe it to people who have not lived it. It has changed EVERYTHING and EVERYONE, and emergency medicine is no exception! We will attempt to explain how far information technology in emergency medicine education has come, where we are now and perhaps where we might go soon.

The Lowdown on Ventriculoperitoneal Shunts

Editor’s note: Annals has partnered with Hippo Education and EM:RAP, enabling our readers without subscriptions to Hippo EM Board Review or EM:RAP to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and Hippo Education, EM:RAP or its authors.

Limping Child? Think LIMPSS

Editor’s note: Annals has partnered with Hippo Education and EM:RAP, enabling our readers without subscriptions to Hippo EM Board Review or EM:RAP to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and Hippo Education, EM:RAP or its authors.

Air in the Belly: A Discussion of Abdominal Compartment Syndrome

Editor’s note: Annals has partnered with Hippo Education and EM:RAP, enabling our readers without subscriptions to Hippo EM Board Review or EM:RAP to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and Hippo Education, EM:RAP or its authors.

Twiddle Me This! A Look at Twiddler’s Syndrome

Editor’s note: Annals has partnered with EM:RAP, enabling our readers without subscriptions to the EM:RAP service to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and EM:RAP or its authors.

Probing the Utility of the Rectal Examination

Editor’s note: Annals has partnered with EM:RAP, enabling our readers without subscriptions to the EM:RAP service to enjoy their commentary on Annals publications. This article did not undergo peer review and may not reflect the view and opinions of the editorial board of Annals of Emergency Medicine. There are no financial relationships or other consideration between Annals and EM:RAP or its authors.