82-year-old man injured from falling to his back

82-year-old man injured from falling to his back

The patient is an 82-year-old man who presents after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient enters the clinic using a walker, which he reports using on a regular basis. Examination reveals an abrasion over his forehead and over the anterior right tibia. The neurological exam shows no acute changes. The patient is specifically tender over the shoulder, but there is no spiny …

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9-year-old girl has painful breathing after falling on chest

9-year-old girl has painful breathing after falling on chest

The patient is a 9-year-old girl who presents after experiencing a fall and a blow to her right chest. She complains of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam is clear. She has an abrasion over her right chest. The patient is generally healthy, is on no medications, and has no significant past medical history. View the …

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Clinical Challenge: June, 2009

The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3°F View the electrocardiogram taken (Figure 1) and consider what your next steps …

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Clinical Challenge: April, 2009

The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day. On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue. View the x-ray taken …

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