Visual Diagnosis

Andrew Brill MD
PGY-3 EM Resident
Brooklyn Hospital
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Annals of Emergency Medicine 2016 68, 614-617DOI: (10.1016/j.annemergmed.2016.04.059)

Copyright © 2016 American College of Emergency Physicians Terms and Conditions
 Necrotizing Fasciitis
• Necrotizing fasciitis is a rare, rapidly
progressive, life-threatening inflammatory
necrotizing soft-tissue infection (NSTI) of the
fascia with secondary necrosis of the
subcutaneous tissues. It can be associated
with severe systemic toxicity and may rapidly
lead to death unless promptly treated.
Necrotizing fasciitis is just part of a spectrum
of soft-tissue infections.
 Orbital Cellulitis
• Any patient w/ facial, sinus, or dental infection
w/ lid edema, orbital pain, proptosis, and
limited EOM.
 Lisfranc (midfoot) Injury
• MC type of dislocation involving the foot
• Bones in midfoot are broken or ligaments that
support midfoot are torn
• Lisfranc joint: articulation of tarsus w/ the
metatarsal bases
• Lisfranc ligament: strong band attaching the
medial cuneiform to 2nd metatarsal base on
the plantar aspect
 Noncardiogenic Pulm. Edema
Not Cardiac
• N – near drowning
• O – oxygen therapy/ post intubation pulm edema
• T- trauma/transfusion (TRALI)
• C – cns  neuro pulm edema
• A – allergic alveolitis
• R – renal failure
• D – drugs (heroin, methadone)
• I – inhalation (toxins)
• A – altitude (HAPE, ARDS)
• C – contusion
 Hemotympanum
• Associated w/ basilar skull fracture
– Posterior Skull base fxr
• Occipital, temporal, or sphenoid bone fxr
– Anterior Skull base fxr
• Spehnoid or ethmoid bone fxr
 Continuous Diaphragm Sign
• Diaphragm is seen continuously across the
midline  suggestive of gas

• If lucency is below diaphragm sign of:

– Pneumoperitoneum
• If lucency is above diaphragm sign of:
– Pneumopericardium
– Pneumomediastinum
 Hutchinson’s Sign
• Skin lesions at tip or side of nose caused by
latent herpes zoster virus in trigeminal ganglia
and involves opthalmic branch
• Often involve suporaorbital, nasociliary, and
lacrimal branches
 Ludwigs Angina
• Gangrenous infection of submandibular and
sublingual spaces
• Potentially Life threatening  airway
obstruction
• Spreads along fascial planes
• Dental infections = 90% cause
 References
• http://www.60secondem.com/visual-diagnosi
s-17-answers-2
/
• http://www.60secondem.com/visual-
diagnosis-16-answers/